Spinal Muscular Atrophy PSP Protocol

Purpose of the PSP and background

The purpose of this protocol is to clearly set out the aims, objectives and commitments of the SMA (spinal muscular atrophy) Europe Priority Setting Partnership (PSP) in line with James Lind Alliance (JLA) principles. The Protocol is a JLA requirement and will be published on the PSP’s page of the JLA website. The Steering Group will review the Protocol regularly and any updated version will be sent to the JLA.

The JLA is a non-profit making initiative, established in 2004. It brings people living with SMA, carers and healthcare professionals together in PSPs. These PSPs identify and prioritise the evidence uncertainties, or ‘unanswered questions’, that they agree are the most important for research in their topic area. Traditionally PSPs have focused on uncertainties about the effects of treatments, but some PSPs have chosen to broaden their scope beyond that. The aim of a PSP is to help ensure that those who fund health research are aware of what really matters to patients, carers and healthcare professionals. The National Institute for Health Research (NIHR) coordinates the infrastructure of the JLA to oversee the processes for PSPs, based at the NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC), University of Southampton.

This PSP was born out of a need for people living with SMA to be at the heart of research on their condition and our research programme. By understanding the research priorities of our community, we will be able to inform our research programme, push other funders, scientists and service providers to recognise the views and needs of those living with SMA and get their questions answered.

Aims, objectives and scope of the PSP

The aim of the SMA Europe PSP is to identify the unanswered questions about spinal muscular atrophy from patient, carer and clinical perspectives and then prioritise those that patients, carers and healthcare professionals agree are the most important for research to address.

The objectives of the PSP are to:

• work with people who live with SMA, carers and healthcare professionals to identify uncertainties about spinal muscular atrophy. The scope is wide and will include treatments (e.g., effect on different populations, gender/ age; long-term effects), management and care, as well as wellbeing and participation, here described as topics that address the holistic needs of an individual.
• to agree by consensus a prioritised list of those uncertainties, for research
• to publicise the results of the PSP and process
• to take the results to research commissioning bodies to be considered for funding.

The scope of the SMA Europe PSP is defined as:

Treatment, management and care, wellbeing and participation. The PSP will exclude from its scope questions about:

• Diagnosis of SMA
• Newborn screening

The Steering Group is responsible for discussing what implications the scope of the PSP will have for the evidence-checking stage of the process. Resources and expertise will be put in place to do this evidence checking.

The Steering Group

The Steering Group includes membership of patients and carers and healthcare professionals, as individuals or representatives from a relevant group.

The SMA Europe PSP will be led and managed by a Steering Group involving the following:

People living with SMA and carer representative/s:

People living with SMA

• Véronique Van Assche (Belgium) – adult
• Jana Popova (Bulgaria) – adult
• Mia Meyers (UK) – teenager
• Jane Velkovski (North Macedonia) – teenager

Carers

• Olga Germanenko (Russia) – carer for a teenager
• Inge Schwersenz (Germany) – carer for an adult
• Huub van Rijswijck (the Netherlands) – carer of a teenager
• Kacper Rucinski (Poland) – carer of a teenager
• Denica Velkovska (North Macedonia) – carer of a teenager

Healthcare professionals

• Yury Seliverstov, Neurologist, Research Center of Neurology: Moscow, Russia
• Anna Mayhew, Physiotherapist, John Walton Muscular Dystrophy Research Centre based, Centre for Life, Newcastle.
• Robert Muni Lofra, Physiotherapist, John Walton Muscular Dystrophy Research Centre based,Centre for Life, Newcastle.
• Jatin Pattni, Clinical Psychologist, UCL, London, UK
• Marianne Nordstrøm, Clinical Nutritionist, Oslo University Hospital, Oslo, Norway
• Katy Howarth, Speech & language, Bristol Royal Hospital for Children, University Hospitals Bristol &
  Weston NHS Foundation Trust, Bristol, UK

Organisation representative

• Nicole Gusset & Yasemin Erbas, SMA Europe
• Alexandre Méjat, ENMC Representative

Project coordinator & lead: Vanessa Christie-Brown, Research Programme Manager, SMA Europe

James Lind Alliance Adviser and Chair of the Steering Group: Suzannah Kinsella, JLA

The Steering Group will agree the resources, including time and expertise that they will be able to contribute to each stage of the process, with input and advice from the JLA.

Partners

Organisations and individuals will be invited to be involved with the PSP as partners. Partners are organisations or groups who will commit to supporting the PSP, promoting the process and encouraging their represented groups or members to participate. Organisations which can reach and advocate for these groups will be invited to become involved in the PSP. Partners represent the following groups:

• people who live with SMA
• carers of people who live with SMA
• health and social care professionals - with experience of SMA

Exclusion criteria

Some organisations may be judged by the JLA or the Steering Group to have conflicts of interest. These may be perceived to potentially cause unacceptable bias as a member of the Steering Group. As this is likely to affect the ultimate findings of the PSP, those organisations will not be invited to participate. It is possible, however, that interested parties may participate in a purely observational capacity when the Steering Group considers it may be helpful.

The methods the PSP will use

This section describes a schedule of proposed steps through which the PSP aims to meet its objectives. The process is iterative and dependent on the active participation and contribution of different groups. The methods used in any step will be agreed through consultation between the Steering Group members, guided by the PSP’s aims and objectives. More details of the method are in the Guidebook section of the JLA website where examples of the work of other JLA PSPs can be seen.

Step 1: Identification and invitation of potential partners

Potential partner organisations will be identified through a process of peer knowledge and consultation, through the Steering Group members’ networks. Potential partners will be contacted and informed of the establishment and aims of the SMA Europe PSP.

Patient organisation:

• SMA Europe

Management & Care:

• UMC Utrecht SMA Expertise Centre
• the John Walton Muscular Dystrophy Research Centre

Treatments

• The MDUK Neuromuscular Centre
• The Institut de Myologie

Wellbeing

• TBC

Cochrane:

• Neuromuscular Review Group

Step 2: Awareness raising

The SMA Europe PSP will raise awareness of its proposed activity among the patient, carer and healthcare professional communities, in order to secure support and participation. This will be done through a communications plan, e.g., website, social media, newsletters. It may be carried out as part of steps 1 and/or 3. The Steering Group will advise on when to do this. Awareness raising has several key objectives:

• to present the proposed plan for the PSP
• to generate support for the process
• to encourage participation in the process
• to initiate discussion, answer questions and address concerns.

Step 3: Identifying evidence uncertainties

The SMA Europe PSP will carry out a consultation to gather uncertainties from patients, carers and healthcare professional. A period of 18 months will be given to complete this exercise (which may be revised by the Steering Group if required).

The SMA Europe PSP recognises that the following groups may require additional consideration:

Young teenagers.

The Steering Group will use the following methods to reach the target groups:

• Surveys
• Physical workshops when possible or online workshops
• MS Teams

Existing sources of evidence uncertainties may also be searched:

• Question-answering services for patients, carers and healthcare professionals
• Research recommendations in systematic reviews and clinical guidelines
• Protocols for systematic reviews being prepared
• Registers of ongoing research

Step 4: Refining questions and uncertainties

The consultation process will produce ‘raw’ questions and comments indicating patients’, carers’ and healthcare professional’ areas of uncertainty. These raw questions will be categorised and refined by Vanessa Christie- Brown and Kristina Staley into summary questions which are clear, addressable by research, and understandable to all. Similar or duplicate questions will be combined where appropriate. Out-of-scope and ‘answered’ submissions will be compiled separately. The Steering Group will have oversight of this process to ensure that the raw data is being interpreted appropriately and that the summary questions are being worded in a way that is understandable to all audiences. Suzannah Kinsella will observe to ensure accountability and transparency.

This will result in a long list of in-scope summary questions. These are not research questions and to try and word them as such may make them too technical for a non-research audience. They will be framed as researchable questions that capture the themes and topics that people have suggested.

The summary questions will then be checked against evidence to determine whether they have already been answered by research. This will be done by Vanessa Christie-Brown and Kristina Staley. The PSP will complete the JLA Question Verification Form, which clearly describes the process used to verify the uncertainty of the questions, before starting prioritisation. The Question Verification Form includes details of the types and sources of evidence used to check uncertainty. The Question Verification Form should be published on the JLA website as soon as it has been agreed to enable researchers and other stakeholders to understand how the PSP has decided that its questions are unanswered, and any limitations of this.

Questions that are not adequately addressed by previous research will be collated and recorded on a standard JLA template by Vanessa Christie-Brown. This will show the checking undertaken to make sure that the uncertainties have not already been answered. The data should be submitted to the JLA for publication on its website on completion of the priority setting exercise, taking into account any changes made at the final workshop, in order to ensure that PSP results are publicly available.

The Steering Group will also consider how it will deal with submitted questions that have been answered, and questions that are out of scope.

Step 5: Prioritisation – interim and final stages

The aim of the final stage of the priority setting process is to prioritise through consensus the identified uncertainties about SMA. This will involve input from patients, carers and healthcare professionals. The JLA encourages PSPs to involve as wide a range of people as possible, including those who did and did not contribute to the first consultation. There are usually two stages of prioritisation.

1. Interim prioritisation is the stage where the long list of questions is reduced to a shorter list that can be taken to the final priority setting workshop. This is aimed at a wide audience and is done using similar methods to the first consultation. With the JLA’s guidance, the Steering Group will agree the method and consider how best to reach and engage patients, carers and healthcare professionals in the process. The most highly ranked questions (around 25) will be taken to a final priority setting workshop. Where the interim prioritisation does not produce a clear ranking or cut off point, the Steering Group will decide which questions are taken forwards to the final prioritisation.
   
   
2. The final priority setting stage is generally a one-day workshop facilitated by the JLA. With guidance from the JLA and input from the Steering Group, up to 30 patients, carers and healthcare professionals will be recruited to participate in a day of discussion and ranking, to determine the top 10 questions for research. All participants will declare their interests. The Steering Group will advise on any adaptations needed to ensure that the process is inclusive and accessible.

Dissemination of results

The Steering Group will identify audiences with which it wants to engage when disseminating the results of the priority setting process, such as researchers, funders and the patient and clinical communities. They will needto determine how best to communicate the results and who will take responsibility for this. Previous PSPs’ outputs have included academic papers, lay reports, infographics, conference presentations and videos for social media.

It should be noted that the priorities are not worded as research questions. The Steering Group should discuss how they will work with researchers and funders to establish how to address the priorities and to work out what the research questions are that will address the issues that people have prioritised. The dissemination of the results of the PSP will be led by Vanessa Christie-Brown.

The JLA encourages PSPs to report back about any activities that have come about because of the PSP, including funded research. Please send any details to jla@soton.ac.uk.

Agreement of the Steering Group

The SMA PSP Steering Group agreed the content and direction of this Protocol on 29th April 2022.