Since November 2018 six physiotherapists
have attended King’s College London to complete the MOSAIC therapist training
days. The MOSAIC therapist training package is a two-part course with regular
refresher training and ongoing support from the trial team.
As a part of the therapists’ introduction to the trial and MOSAIC intervention, the therapists were introduced to and practised a collaborative communication style called Motivational Interviewing (MI). This training was provided by Pip Mason who is an experienced MI teacher and practitioner from Pip Mason Consultancy Ltd.
Pip has been using and teaching
MI since the 1980s, originally in the field of substance misuse and more
recently in the wider health care arena. Pip trained as a general nurse and
also in cognitive approaches to counselling and became interested in the issues
of motivation and change as public health and chronic disease treatments moved
in the direction of encouraging patients to take action themselves in changing
the ways they live their lives.
When not teaching Pip is a
practitioner in a recovery hub for addictions, helping people with gambling
problems this gives her ample opportunity to keep her practice skills in MI
honed. After delivering the MOSAIC training, Pip comments that ‘working on MOSAIC has been enormously
challenging and fun. We delivered a training package which was true to the
spirit of MI and taught the team to use an approach which is potentially
deliverable by physiotherapists in a typical healthcare setting.’ Pip is
eagerly waiting for the results of the trial and also feedback from the
therapists about their experiences of the bespoke MOSAIC training package and
delivering MOSAIC to patients with intermittent claudication. She hopes that
the MOSAIC trial and training will add to the body of knowledge on how well MI
can be incorporated into physiotherapy practice.
Dr Lindsay Bearne, Chief Investigator of the MOSAIC Trial, delivered last month a presentation about the MOSAIC Trial at King’s College London’s Rehabilitation Research Showcase. The showcase attracted delegates from a range of healthcare disciplines and the audience included students, healthcare practitioners and academics.
The MOSAIC intervention was systematically developed over four years by Dr Melissa Galea Holmes, Professor John Weinman and Dr Lindsay Bearne. The main aim of the trial is to assess whether the MOSAIC intervention improves walking ability at three-months compared to usual care for patients with intermittent claudication caused by Peripheral Arterial Disease. In Lindsay’s talk, she shared details on how MOSAIC was developed based on Medical Research Council guidelines and highlighted the key features of the MOSAIC intervention. Delegates were interested to hear more about the main outcome measure being used for the trial, and whether participants’ body mass index was being recorded.
The talk gave delegates a sense of how our preliminary research informed the development of the MOSAIC intervention and trial. The talk coincided with the publication of our feasibility study ‘A randomised controlled feasibility trial of a home-based walking behaviour-change intervention for people with intermittent claudication’ in the Journal of Vascular Nursing.
Lindsay comments that “It was an honour to be invited to present the development of the MOAIC intervention and design of MOSAIC trial to this interested audience”.
The day showcased leading rehabilitation research by Researchers at King’s College London evoking stimulating discussions and thoughts about ongoing research, implementation and collaboration.
The full MOSAIC Trial feasibility study is available at: https://kclpure.kcl.ac.uk/portal/en/persons/lindsay-bearne(ea7d99c0-4683-4be5-b706-ac7eaa1242cc)/publications.html
Link to departmental twitter account: https://twitter.com/Physio_KCL
Patients with Intermittent Claudication, who are eligible and willing to be involved in the MOSAIC Trial will be invited to attend an appointment with Dr Julie Bieles, the MOSAIC Research Associate and Trial Coordinator.
At this appointment patients have the chance to find out more about participating in the MOSAIC trial and have their questions answered before agreeing to take part (informed consent).
At the baseline visit, participants have the blood pressures in their arms and legs measured, complete questionnaires on paper or directly into the MOSAIC online database, and complete and two six-minute walking tests. The walking test estimates how far people can walk in six minutes with a minute by minute count-down is given, so that participants know how long they have left to walk. Participants may stop walking if they need to and the overall distance walked in each test is recorded.
Many MOSAIC participants are pleasantly surprised by how well they do in the walking test. Many participants also report a great sense of achievement once they have completed the three questionnaires, the longest of which is completed between the walking tests, allowing time for participants to rest.
We aim to make MOSAIC participants feel at ease during their visit and we encourage participants to prepare well for the visit by reading the Participant Information Sheet and noting down any questions that they may have in advance.
Please contact us if you would like to receive a copy of associated literature, such as: Montgomery, P.S. and A.W. Gardner, The Clinical Utility of a Six-minute Walk Test in Peripheral Arterial Occlusive Disease Patients. Journal of the American Geriatrics Society, 1998. 46(6): p. 706-711.
Dr Julie Bieles, MOSAIC Research Associate, joined the MOSAIC Trial team in March 2018, covering on an interim basis until May 2018 when she was successfully appointed to the Research Associate position.
Julie has a PhD in Physiology, awarded in 2018 from the Centre for Human & Applied Physiological Sciences at King’s College London and draws on this and her past project management experience to manage various aspects of the MOSAIC Trial. This includes day to day management of the trial including; communication with the research sites, participant recruitment and participant outcome assessment. Julie’s PhD work gave her lots of experience of recruiting participants, and Julie is always very grateful to people who give their time to take part in research.
Julie comments on her MOSAIC trial role: “As a clinician I wanted a patient-facing role that allowed me to use my research expertise, such as managing research trials and completing participant assessments. MOSAIC gave me this opportunity, as well as the chance to learn about vascular medicine, and behaviour change”
Julie describes the role as busy, but rewarding. The role involves Julie working across several locations, she has found the site staff welcoming, making it a pleasure to visit each site.
Participant recruitment and retention remains a large focus of the trial and Julie looks forward to meeting new participants and those participants returning for their three month follow-up appointments. In the longer term, Julie looks forward to presenting the findings from the trial to public and academic audiences.
The MOSAIC Trial team includes two Patient Representatives. This means that the patient’s perspective is at the centre of all stages of the research. This includes all the decisions made about the trial at our regular trial management meetings. One representative, Mr Graham Fisher, has worked closely with the MOSAIC team since the early research design stage, after working with Melissa Galea Holmes during the MOSAIC feasibility study.
Mr Fisher has Intermittent Claudication (IC) and first noticed pain in his calf when gardening six years ago. After referrals to orthopaedics and other outpatient departments, the blockage in his thigh was identified and walking was proposed as the main way for Mr Fisher to manage his IC.
Mr Fisher enjoys being outdoors and, having learned about the benefits of walking during the MOSAIC feasibility study, he began to walk more. Nowadays, he enjoys walking for up to one-hour around his local park. He is dedicated to supporting MOSAIC and comments: “The ‘M’ in MOSAIC really is ‘Motivating’, I would convince people to take part”. He readily fits being a patient representative on the MOSAIC trial team into his life “I was long retired and had time on my hands. The trial meetings were reachable, and I was interested in all the theory behind it and wondered how being in MOSAIC could help me”.
Mr Fisher has recently been involved with sharing his experiences of IC with therapists training to deliver MOSAIC as well as sharing his experiences more widely – such as contributing to the MOSAIC blog.
We thank Mr Fisher and our other representative for their contribution!
The MOSAIC trial physiotherapists are an integral part of the team, delivering MOSAIC to participants at home, over the telephone or at the physiotherapy departments of the participating hospitals. Currently there are 10 physiotherapists trained to deliver MOSAIC. They all completed an initial two-day group training programme and received a manual detailing the rationale, aims and research processes of the MOSAIC trial, as well as materials to support the delivery of MOSAIC to participants.
Throughout the trial the physiotherapists will receive ongoing support from the trial research team via one-to-one supervision telephone calls and further group sessions at three and six-months. The one-to-one supervision calls offer physiotherapists the chance to receive personalised feedback on their delivery of MOSAIC and the group sessions are designed to be interactive and allows the physiotherapists the opportunity to consider and build on their successes or discuss any challenges they have experienced delivering MOSAIC.
This ongoing training will enable the MOSIAC physiotherapists to retain and develop their skills over the trial, which has an anticipated end date of summer 2020. We will be exploring the physiotherapists experience of participating in the MOSAIC physiotherapy training and the implementation of delivering MOSAIC in summer 2018.
Thank you to all the MOSAIC physiotherapists!
MOSAIC trainers: Chief Investigator, Trial Co-ordinator, Patient partner, Trial Psychologist and Research Assistant.
Melissa Galea Holmes, MOSAIC Trial Research Associate, presented at the SRR’s 40th Anniversary conference earlier this month. The presentation was titled ‘A brief physiotherapist-led behaviour change intervention to facilitate walking in older people with peripheral arterial disease: protocol for a randomised controlled trial’. Melissa also presented the outcomes of the preceding (feasibility) study that informed the development of the full MOSAIC Trial.
This was an important opportunity for the MOSAIC team to share their work with a wider multi-disciplinary audience.
Melissa comments: “Presenting on behalf of the MOSAIC Trial team at the 40th Anniversary of the SRR was a great privilege and a rich learning experience. Our presentations on the rehabilitation of people with IC were very well received. The feedback and interest of the audience in our research demonstrates the importance of our work to rehabilitation researchers and clinicians.”
Conference delegates were particularly interested in the MOSAIC Trial primary outcome, of whether MOSAIC will improve walking ability after three months in people with IC, compared to NHS Usual Care and the refinement of the MOSAIC intervention following the feasibility study. Melissa also discussed with attendees strategies which could be used to recruit hard to reach groups of people with high prevalence rates of peripheral arterial disease.
Overall, introducing MOSAIC Trial at this conference was a great success. The MOSAIC Trial is in the first months of enrolling participant’s at all four participating hospital sites, so this is an ideal time for this engagement.
Please contact us if you would like more information about the presentation or for a copy of the slides or poster. The abstract will be published shortly in the journal Clinical Rehabilitation.
Welcome to our new blog to report news about MOSAIC (Motivating Structured walking Activity in Intermittent Claudication), a randomised controlled trial of a new treatment aimed at increasing walking in people with Intermittent Claudication (IC).
IC is a painful leg condition caused by Peripheral Arterial Disease (PAD). People with IC have narrowed or blocked arteries of their leg(s), reducing blood flow to the muscles, which causes cramping leg pain. Walking exercise improves walking ability and provides other health benefits in people with IC, such as improved quality of life. Unfortunately walking recommendations to offer at least 2 hours supervised exercise per week to people with IC are not being implemented as there are limited walking programmes offered by the NHS. Patients may benefit from support and guidance to increase their walking.
The MOSAIC Trial has been developed in consultation with patients and clinicians to evaluate a physiotherapy-led walking treatment. This provides patients with tools, such as a pedometer and walking diary, to help them increase their walking. The impact of MOSAIC treatment on walking ability will be compared with usual NHS care
The trial is now open and recruiting participants referred by the Vascular teams at Guy’s & St Thomas’ Hospitals, King’s College Hospital, Ashford & St Peter’s Hospitals and St George’s Hospital University Hospital NHS Foundation Trusts. We aim to recruit 192 patients in total and the main eligibility criteria are: 1) above 50 years of age, 2) confirmed IC caused by PAD, 3) not currently recommended for revascularisation or 4) no contraindications to walking exercise. Patients will not be able to take part if they have 1) unstable IC, 2) walking more than 90 minutes per week, 3) contraindications to walking exercise or 4) recent or upcoming participation in supervised exercise therapy.
We look forward to providing you with more updates about MOSAIC as the trial progresses. Please do contact us for more information or visit our trial website https://www.kcl.ac.uk/lsm/research/divisions/hscr/research/groups/Rehabilitation/MOSAIC-Trial.aspx
Contact: Brittannia Abdul-Aziz, MOSAIC Research Assistant firstname.lastname@example.org