Matisse Interactive group art therapy for people with schizophrenia: The Matisse study. www.awp.nhs.uk enabling and empowering people to reach their potential and live fulfilling lives
Background Emerging evidence base(Crawford & Patterson, 2007) Negative symptoms and social functioning respond less well to medication NICE guidelines find evidence that arts therapies are effective in reducing negative symptoms (2009) However; -Concerns about methodological quality of trials to date (Ruddy R & Milnes D, 2005) -No evidence on outcomes such as social functioning, quality of life, or cost effectiveness.
Background • Interactive group art therapy • Psychotherapeutic approach that synthesises concepts from art and group therapies. • Aims to encourage open communication, self-expression and interaction through the use of art materials and the group context. • The combination of image making and reflection can enable a person to work through difficult feelings. • A safe and consistent environment. • A non directive therapeutic stance. • Dame D. Waller (1996; 2000)
A Randomised Controlled Trial • Multicentre Art-Therapy in Schizophrenia Systematic Evaluation (MATISSE) • Single blind Randomised Controlled Trial (RCT) • group art therapy plus standard care • activity group plus standard care, and • standard care alone.
Study History Funding £960K Study duration 3yr originally, extended 9 months Study centres 2 London, AWP and Belfast Sample size 419
Study Aims Hypotheses: Among people with schizophrenia, interactive group art therapy is associated with improved: • global functioning and 2. cost effectiveness compared to attention control treatment or standard care alone. Inclusion Criteria: Schizophrenia (working diagnosis + Opcrit)
Study Design Outcome measures include: • Global Assessment of Functioning (GAF) scale. • Positive and Negative Symptom Scale (PANSS); • Quality of Life questionnaire; • Social Functioning questionnaire; • the General Wellbeing Scale; • Adult Service Use Schedule; • Morisky Scale and a satisfaction with care questionnaire. • Outcomes assessed at: Baseline, 12 months and 24 months after randomisation.
Study Design • Art therapy • Weekly groups (median 12 months) • Facilitator and co-facilitator • Max 8 per group • Activity Groups • Provide participants with an opportunity to meet socially with peers and undertake a range of activities in a relatively informal, yet structured environment • Participation in social and recreational activities with the support of ‘group leaders’
Success – Matisse Participants • Success dependent upon Matisse participants • Agree for notes to be screened • Provide Informed Consent • Discussing complex research issues • Agreeing to randomisation process • Completing baseline assessment • Attend groups • To meet with the researcher for FU assessments at 12 and 24 months
Success – AWP clinical teams • Success dependent upon AWP clinical teams • Engage with and adopt Matisse study • Successful adoption of Matisse trial across Trust • Identify participants and make first contact • Confidentiality and consent • Help clarify the Working Diagnosis • Study eligibility defined on a case by case basis supported by staff • Rate studyoutcomes • Primary outcome measure (GAF) • Staff questionnaire • Support follow up with researcher at 12 and 24 months after randomisation • Provide up to date contact information • Arrange appointments where contact difficult • Assess lone working risk, even attend assessments
Success – MHRN • Success dependent upon R&D hosted Mental Health Research Network (MHRN) • Clinical Studies Officer time to support recruitment of study participants. • Conducting FU assessments where researcher has been fully unblinded.
Benefits • Opportunity for AWP service users to be offered an intervention that they may not have been offered outside of the study. • Provide an opportunity for participants to contribute to the evidence base by taking part in research. • Providing additional contact time for the service user with the Trust at baseline, 12 and 24 months via the researcher. • Provides the Trust with an opportunity to assess the effectiveness of an intervention within a gold standard model. • Provision of financial remuneration in the form of service support costs for staff involvement. • Provide an opportunity for Trust staff to get involved with the design and conduct of a national research project.