Adapting CIRCuiTS™ cognitive remediation therapy with the help of people with MS

by Rebecca Thomas, King’s College London

CIRCuiTS™ (Computerised Interactive Remediation of Cognition & Thinking Skills) has been shown to help people with a range of mental health problems to manage their cognitive difficulties. Difficulties with thinking are also experienced by those with physical health conditions like Multiple Sclerosis (MS), with about 50% of people with MS reporting slowed thinking, memory problems, and difficulties with attention, planning and multitasking. These difficulties significantly affect their quality of life.

Cognitive rehabilitation has shown promise for improving thinking difficulties in MS, with some interventions showing long-term benefit. However, the research has primarily focused on improving cognitive test scores rather than the outcomes that matter most to people with MS, like managing everyday tasks and responsibilities.

Our research group at King’s College London, led by Dr Sara Simblett, believes that CIRCuiTS™ has the potential to improve the quality of life and functioning of people with MS because it places everyday life and wellbeing at the heart of the rehabilitation intervention. It helps people ‘think about thinking’ so that they know how and when to use the skills they learn in CIRCuiTS™ in real-world situations, helping them to achieve their personal goals.

We are investigating the feasibility of delivering CIRCuiTS™ therapy to people with MS by adapting it to be practicable and relevant to their needs. Collaboration with people with MS has been essential to these changes.

Engaging with people with lived experience

With the help of our lived experience lead, a well-known MS blogger, we assembled a focus group of people with MS. We had productive discussions about how to adapt CIRCuiTS™ delivery and how to run the feasibility trial. The group agreed on many points but also had disagreements, highlighting the diverse needs and perspectives of people with MS.

Adapting CIRCuiTS™ for MS

The group recommended changes to CIRCuiTS™ content (such as making tasks accessible to people with fine motor control difficulties), delivery (offering remote as well as in-clinic sessions), and therapist training (educating therapists on the diversity of cognitive and physical challenges experienced by people with MS). We have taken these recommendations into consideration in the MS-adapted version of the CIRCuiTS™ programme – CIRCuiTS™ MS.

Assessing CIRCuiTS™ MS in a trial

Our focus group also provided valuable advice on conducting the feasibility trial. To reach the full range of people who might benefit from CIRCuiTS™ MS, they advised recruiting through clinical settings like neurology clinics rather than solely through MS charities. They also highlighted the gatekeeping role of neurologists and MS nurses, suggesting that recruitment would be more effective if they also understood how cognitive remediation could benefit their patients. We also noticed some confusion among focus group members about CIRCuiTS™ and its delivery. Recognising this has helped us craft clear and engaging recruitment materials.

Moving forward

Our next step will be to carry out the feasibility trial. Its findings will inform the development of a protocol for a larger trial aimed at testing the effectiveness of CIRCuiTS™ MS. We hope that CIRCuiTS™ MS will become a key tool for improving the lives of people living with the cognitive challenges of MS. Watch this space for further developments!

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