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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)

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Matisse l.jpg

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 l.jpg
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.


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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)




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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.


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    Study History

    Funding

    £960K

    Study duration

    3yr originally, extended 9 months

    Study centres

    2 London, AWP and Belfast

    Sample size 419


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    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)


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    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.


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    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’





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    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


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    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


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    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.


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    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.


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