i
One-year follow-up of a remotely delivered epilepsy self-management program in high-risk people with epilepsy
-
7 2019
-
-
Source: Epilepsy Behav. 96:237-243
[PDF-207.96 KB]
Details:
-
Alternative Title:Epilepsy Behav
-
Personal Author:
-
Description:Objective:
Self-management for people with epilepsy and a history of negative health events” (SMART) is a novel group-format epilepsy self-management intervention demonstrated to reduce negative health events (NHEs) such as accidents, emergency department visits, and seizures in adults with epilepsy in a 6-month prospective randomized controlled trial (RCT). SMART also reduced depressive symptoms and improved health functioning and quality of life. This report describes the longer-term (12-month) post-efficacy RCT outcomes in adults with epilepsy who received SMART.
Methods:
After completing a 6-month, prospective RCT that demonstrated efficacy of SMART vs. 6-month waitlist control (WL), adults ≥ age 18 with epilepsy were followed for an additional 12 months. Individuals originally randomized to WL received the 8-week SMART intervention immediately following the conclusion of the RCT. For this long-term extension analysis, assessments were conducted at 24 weeks (the 6-month primary outcome time-point of the efficacy RCT), at 32 weeks for individuals originally randomized to WL, and at 48 weeks and 72 weeks for all individuals. Outcomes assessed included past 6-month NHE counts, depressive symptoms assessed with the 9-item Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS), and quality of life assessed with the 10-item Quality of Life in Epilepsy (QOLIE-10).
Results:
At the beginning of this long-term observational period (24-week follow-up time point for the original RCT) there were 50 individuals in the group originally randomized to SMART and 52 originally randomized to WL. Mean age was 41.4 years, 70% women (N=71), 64% (N=65) African-American, 8% Hispanic (N=8). Study attrition from week 24 to week 72 was 8% in the arm originally randomized to SMART and 17% in the arm originally randomized to WL. During the 12-month observation period (24 weeks to 72 weeks) there were a total of 44 serious adverse events and 4 deaths, none related to study participation. There was no significant change in total past 6-month NHE counts in the group originally randomized to SMART, although the group had significantly reduced 6-month seizure counts. The group originally randomized to WL, who received SMART during this observational period, had a reduction in total NHE counts. The group originally randomized to SMART had relatively stable levels on other outcome variables except for a trend for improved MADRS (p=.08). In the group originally randomized to WL, there were significant improvements in PHQ-9 (p=.01), MADRS (p=<.01), and QOLIE-10 (p=.004).
Conclusions:
This post-RCT extension study suggests that adults with epilepsy who participate in the SMART intervention sustain clinical effects at 1-year follow-up and may have incremental improvements in seizure frequency and mood. Future research needs to identify opportunities for scale-up and outreach to other high-risk groups with epilepsy.
-
Subjects:
-
Keywords:
-
Source:
-
Pubmed ID:31126825
-
Pubmed Central ID:PMC7370541
-
Document Type:
-
Funding:
-
Volume:96
-
Collection(s):
-
Main Document Checksum:
-
Download URL:
-
File Type:
