Background
Current treatments for long-term depression
Group music therapy: evidence to date
Theoretical basis of the intervention
Rationale for the current study
Feasibility of the intervention
Feasibility of the research design
Estimation and appropriateness of outcomes
Design considerations
Methods
Design
Aims and objectives
Setting and participants
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Confirmed diagnosis of depression (ICD10 F31-39) including post-schizophrenic depression (ICD10 F20.4) and prolonged depressive reaction (ICD10 F43.21)
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Receiving pharmacological and/or psychological treatment for 12 months or longer
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Aged 18 years or above
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Capacity to give informed consent
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Diagnosis of organic mental disorder (ICD10 F00-09)
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Bipolar affective disorder - current manic episode (ICD10 F30, F31.0, F31.2, F31.6, F31.70-F31.74)
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No capacity to give informed consent
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Risk of suicide necessitating hospitalisation
Participant identification and recruitment process
Intervention
Wait-list control
Criteria for discontinuation
Randomisation
Blinding
Outcome measures and endpoints
Outcome | Method | Success criteria | Timing | |||
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Stop | Continue, modify protocol | Continue without modification but monitor closely | Continue without modifications | |||
Acceptability of methodology | Recruitment and retention rates as below | End of recruitment (week 8) | ||||
Compliance | Mean attendance <10 sessions | Mean attendance <14 sessions | Mean attendance 14 sessions | Mean attendance 14+ sessions | End of intervention (week 22) | |
End interviews | Unfavourable views, serious concerns | Unfavourable views, suggestions for modification | Favourable views, suggestions for modification | Favourable views, no concerns | 1 month post-intervention (week 26) | |
Feasibility of recruitment processes | Screening rates | Identify <50 potentially eligible subjects | Identify <100 potentially eligible subjects | Identify 100–128 potentially eligible subjects | Identify >128 potentially eligible subjects | End of recruitment |
Recruitment rates | Recruit <50% of sample size | N <25 in 8wks, <5% per week |
N = 25–30 in 8wks, <13% per week |
N = 30 in 8wks, 13% per week or greater | End of recruitment | |
Participation rates | Participation rate <5% | Participation rate 5–15% | Participation rate 15–25% | Participation rate 25% or greater | 6 months post-intervention | |
Retention rates | Attrition >75% | Attrition 50–75% | Attrition 30 − 50% | Attrition <30% | 6 months post-intervention | |
End interviews | N/A | Major suggestions to improve recruitment processes | Minor suggestions to improve recruitment processes | No suggestions to improve expressed | 1 month post-intervention (week 26) | |
Identify number of eligible participants, participant rates and retention rates | Number identified by HCPs | <50 identified | 50–100 identified | 100–128 identified | >128 potentially eligible identified | End of recruitment |
Number expressing interest | <30 express interest | 30–40 express interest | 40–60 express interest | >60 express interest | End of recruitment | |
Number providing consent | <15 provide consent | 15–25 provide consent | 25–30 provide consent | 30 provide consent | End of recruitment post-intervention, 3 and 6 months post-intervention | |
Number lost to follow up | Attrition >75% | Attrition 50–75% | Attrition 30–50% | Attrition <30% | ||
Researcher time and costs per participant | Researcher diary | N/A | Researcher time exceeds allocated time requiring additional study support | Researcher time and cost only just covers time required | Researcher time and cost fully covers time required | 6 months post-intervention |
Appropriate outcome measures | Variability of outcome Estimate of control mean and SD of change | No difference or clinically important difference favouring control detected based on confidence limits | Difference cannot be detected based on confidence limits but data suggest improvement favouring intervention | Difference can be detected based on confidence limits | Clinically important difference can be detected based on confidence limits | End of intervention |
Intervention components | Therapist adherence | Adherence <50% | Adherence <50% | Adherence 50–75% | Adherence >75% | End of intervention |
End interviews | Serious concerns expressed regarding intervention | Major suggestions to adapt intervention | Minor suggestions to adapt intervention | No concerns or suggestions to adapt intervention | ||
Intervention adherence | Therapist self-rated adherence Video-rated adherence | Adherence <25% | Adherence 25–50% | Adherence 50–75% | Adherence >75% | End of intervention |
Estimate of cost of intervention and services received | Therapist time CSRI | Cost significantly greater than usual care, no potential to modify intervention, no indication of benefits | Cost is greater than usual care - intervention may be modified, but outcomes suggest some benefits | Cost is greater than usual care but outcomes strongly suggest benefits | Cost is equivalent to or slightly greater than usual care, outcomes strongly suggest benefits | 6 months post-intervention |
Data collection
Nested process evaluation
Sample size
Statistical analysis
Feasibility
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• Acceptability of methodology to professionals and patients through interviews via recruitment rates, compliance, end interviews
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• Feasibility of recruitment processes
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• Deviation around specific post-intervention, and 3-month and 6 month post-intervention follow-up assessment dates for actual data collection
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• Number of eligible participants, participation rates and retention rates
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• Researcher time and costs per participant
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• Appropriateness of outcome measures