Multiple Sclerosis Clinical Trial
Official title:
Abdominal Massage for Neurogenic Bowel Dysfunction in People With Multiple Sclerosis (AMBER Abdominal Massage for Bowel Dysfunction Effectiveness Research).
The aim of the AMBER trial is to determine the effectiveness and cost effectiveness of abdominal massage as part of the adjunct to bowel care in people with Multiple Sclerosis who have problems with their bowel i.e. faecal incontinence and/or constipation.
Neurogenic bowel dysfunction (NBD: constipation and/or faecal incontinence) is common in
people with multiple sclerosis (MS) and is rated as the most severe impact of their
disease/injury, above wheelchair dependence. Despite this, current treatment options are
limited, poorly evaluated and complex.
This research aims to find out whether abdominal massage can help improve the symptoms of
NBD in these patients. A small study has already shown that it is possible for patients or
carers to perform abdominal massage and in some cases this helped the patient with their
symptoms. A larger study is now required to confirm the results one way or another.
Patients with Multiple Sclerosis who attend one of the participating study centres who are
bothered by constipation and or faecal incontinence will be asked to take part if they fit
the other requirements for the trial. Those who agree to take part will be allocated at
random to one of two groups, one will receive advice on the management of bowel dysfunction
(called optimised bowel care), and the other will receive the same advice and will be taught
how to do the abdominal massage (called abdominal massage and optimised bowel care). Both
groups will visit a specialist nurse for 1 additional hour after their normal clinical
appointment, or at an agreed time, to receive optimised bowel care advice. The patients in
the intervention group +/or their carers will receive training on abdominal massage and a
DVD/copy of demonstration of the massage for home use. All patients will also be called
weekly for 6 weeks to discuss their bowel care.
The investigators will measure the results of treatment after 6 and 24 weeks. The
investigators are primarily interested in whether patients in the intervention group
(receiving optimized bowel care & abdominal massage) have had more of an improvement in
their NBD score at 24 weeks after they start the study that the control group (receiving
optimized bowel care only). The investigators also want to find out how bad the constipation
and bowel symptoms are, how much this affects their life and if they have any problems with
their bladder. The investigators will also measure the costs of the treatments and any costs
to the patient and their family, and balance these against any benefits of the intervention
treatment.
During the trial the investigators will assess how well the optimized bowel care and
abdominal massage training was delivered by speaking with nurses and listening to recordings
of some of the telephone calls. The investigators will talk to the patients to find how they
perceive the treatment they received and how they got on during the treatment period and
once the treatment finished. The investigators will explore how the treatment delivery and
patient's perceptions impact on the patients NBD symptoms.
The investigators have worked out from previous research that if 200 patients take part and
most complete the trial, there will be enough data to successfully compare the treatments to
find out if one is better than the other. Individual participation will be entirely
voluntary and the investigators do not believe there are any risks associated with taking
part.
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