A 6-month prospective randomized controlled trial of remotely delivered group-format epilepsy self-management vs. waitlist control for high-risk people with epilepsy

Details

• Alternative Title:
  Epilepsia
• Personal Author:
  Sajatovic, Martha ; Colon-Zimmermann, Kari ; Kahriman, Mustafa ; Fuentes-Casiano, Edna ; Liu, Hongyan ; Tatsuoka, Curtis ; Cassidy, Kristin A. ; Lhatoo, Samden ; Einstadter, Douglas ; Chen, Peijun
• Description:
  Objective:
  
  In spite of advances in care, many people with epilepsy have negative health events (NHEs) such as accidents, emergency department (ER) visits and poor quality of life. “Self-management for people with epilepsy and a history of negative health events” (SMART) is a novel group-format epilepsy self-management intervention. A community participatory approach informed the refinement of SMART which was then tested in a 6-month randomized controlled trial of SMART (N=60) vs. wait-list control (WL, N=60).
  
  Methods:
  
  Participants were adults ≥ age 18 with epilepsy and an NHE within the last six months (seizure, accident, self-harm attempt, ER visit, or hospitalization). Assessments were conducted at screening, baseline, 10 weeks and 24 weeks (six-months). Primary outcome was 6-month change in total NHE count. Additional outcomes included depression on the 9-item Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS), quality of life on the 10-item Quality of Life in Epilepsy (QOLIE-10), functioning on the 36-item short-form health survey (SF-36), and seizure severity on the Liverpool Seizure Severity Scale.
  
  Results:
  
  Mean age was 41.3 years (SD = 11.82), 69.9% were African-American, 74.2% were unemployed and 87.4% with an annual income < U.S. $25,000. 57.5% had a seizure within 30 days of enrollment. Most NHEs were seizures. Six month study attrition was 14.2% overall and similar between arms. Individuals randomized to SMART had greater reduction in total median NHEs from baseline to 6-months compared to WL (p=.04). SMART was also associated with improved PHQ-9 (p=.032), MADRS (p= .002), QOLIE-10 (p<.001) and SF-36 (p=.015 physical health, p=.003 mental health) vs. WL. There was no difference in seizure severity.
  
  Significance:
  
  SMART is associated with reduced health complications and improved mood, quality of life and health functioning in high-risk people with epilepsy. Additional efforts are needed to investigate potential for scale-up.
  
  
• Subjects:
  Adult Article Depression Epilepsy Female Hospitalization Humans Male Middle Aged Prospective Studies Quality Of Life Seizures Self-management Telemedicine Treatment Outcome

  More +
• Source:
  Epilepsia. 59(9):1684-1695
• Pubmed ID:
  30098003
• Pubmed Central ID:
  PMC6128290
• Document Type:
  Journal Article
• Funding:
  U48 DP005030/DP/NCCDPHP CDC HHS/United States ; U48DP005030/ACL HHS/United States
• Volume:
  59
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:89d912a0f5757e6cc6807853b8c95a5f8b3114d6bab6376cda92ea93b0c14ed9
• Download URL:
  https://stacks.cdc.gov/view/cdc/58767/cdc_58767_DS1.pdf
• File Type:
  [PDF - 628.39 KB ]