Self-Management education for adults with poorly controlled epILEpsy [SMILE (UK)]: a randomised controlled trial.
Leone Ridsdale,Alison McKinlay,Gabriella Wojewodka,Emily J. Robinson,Iris Mosweu,Sarah J Feehan,Adam J. Noble,Myfanwy Morgan,Stephanie Taylor,Paul McCrone,Sabine Landau,Mark P. Richardson,Gus A. Baker,Laura H. Goldstein +13 more
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TLDR
The cost-effectiveness study showed that SMILE (UK) was possibly cost-effective but was also associated with lower QoL, whereas for people with epilepsy and persistent seizures, a 2-day self-management education course is cost-saving, but does not improve quality of life after 12-months or reduce anxiety or depression symptoms.Abstract:
Background Epilepsy is a common neurological condition resulting in recurrent seizures. Research evidence in long-term conditions suggests that patients benefit from self-management education and that this may improve quality of life (QoL). Epilepsy self-management education has yet to be tested in a UK setting. Objectives To determine the effectiveness and cost-effectiveness of Self-Management education for people with poorly controlled epILEpsy [SMILE (UK)]. Design A parallel pragmatic randomised controlled trial. Setting Participants were recruited from eight hospitals in London and south-east England. Participants Adults aged ≥ 16 years with epilepsy and two or more epileptic seizures in the past year, who were currently being prescribed antiepileptic drugs. Intervention A 2-day group self-management course alongside treatment as usual (TAU). The control group received TAU. Main outcome measures The primary outcome is QoL in people with epilepsy at 12-month follow-up using the Quality Of Life In Epilepsy 31-P (QOLIE-31-P) scale. Other outcomes were seizure control, impact of epilepsy, medication adverse effects, psychological distress, perceived stigma, self-mastery and medication adherence. Cost-effectiveness analyses and a process evaluation were undertaken. Randomisation A 1 : 1 ratio between trial arms using fixed block sizes of two. Blinding Participants were not blinded to their group allocation because of the nature of the study. Researchers involved in data collection and analysis remained blinded throughout. Results The trial completed successfully. A total of 404 participants were enrolled in the study [SMILE (UK), n = 205; TAU, n = 199] with 331 completing the final follow-up at 12 months [SMILE (UK), n = 163; TAU, n = 168]. In the intervention group, 61.5% completed all sessions of the course. No adverse events were found to be related to the intervention. At baseline, participants had a mean age of 41.7 years [standard deviation (SD) 14.1 years], and had epilepsy for a median of 18 years. The mean QOLIE-31-P score for the whole group at baseline was 66.0 out of 100.0 (SD 14.2). Clinically relevant levels of anxiety symptoms were reported in 53.6% of the group and depression symptoms in 28.0%. The results following an intention-to-treat analysis showed no change in any measures at the 12-month follow-up [QOLIE-31-P: SMILE (UK) mean: 67.4, SD 13.5; TAU mean: 69.5, SD 14.8]. The cost-effectiveness study showed that SMILE (UK) was possibly cost-effective but was also associated with lower QoL. The process evaluation with 20 participants revealed that a group course increased confidence by sharing with others and improved self-management behaviours. Conclusions For people with epilepsy and persistent seizures, a 2-day self-management education course is cost-saving, but does not improve QoL after 12-months or reduce anxiety or depression symptoms. A psychological intervention may help with anxiety and depression. Interviewed participants reported attending a group course increased their confidence and helped them improve their self-management. Future work More research is needed on self-management courses, with psychological components and integration with routine monitoring. Trial registration Current Controlled Trials ISRCTN57937389. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 21. See the NIHR Journals Library website for further project information.read more
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Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy
TL;DR: Randomised and quasi-randomised controlled trials of adherence-enhancing interventions aimed at people with a clinical diagnosis of epilepsy, of any age and treated with antiepileptic drugs in a primary care, outpatient or other community setting demonstrate some positive results.
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Psychological treatments for people with epilepsy
Rosa Michaelis,Venus Tang,Janelle L. Wagner,Avani C Modi,William Curt LaFrance,Laura H. Goldstein,Tobias Lundgren,Markus Reuber +7 more
TL;DR: Significant mean changes were found in the QOLIE-31 total score and six subscales (emotional well-being, energy and fatigue, overall QoL, seizure worry, medication effects, and cognitive functioning) which provided evidence of moderate quality that psychological treatments for adults with epilepsy may enhance overallQoL in people with epilepsy.
Journal ArticleDOI
A systematic review of economic evaluations of treatments for patients with epilepsy
Ben F. M. Wijnen,Ghislaine A. P. G. van Mastrigt,Silvia M. A. A. Evers,Silvia M. A. A. Evers,Olga Gershuni,Danielle A.J.E. Lambrechts,Marian Majoie,Debby Postulart,Bert A.P. Aldenkamp,Reina J.A. de Kinderen +9 more
TL;DR: Overall, the methodologic quality of the full economic evaluations included was acceptable; however, some studies performed significantly worse than others and the heterogeneity between the studies stresses the need to derive consensus on what constitutes “standard optimal care.”
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Determinants of depression among people with epilepsy in Central Ethiopia
Asrat Chaka,Tadesse Awoke,Zegeye Yohannis,Getinet Ayano,Minale Tareke,Andargie Abate,Mulugeta Nega +6 more
TL;DR: There is a high prevalence of depression among epilepsy patients, and early detection and prompt management of depressive symptoms are critically important in reducing depression burden among people living with epilepsy.
References
More filters
Journal ArticleDOI
The measurement of observer agreement for categorical data
J. R. Landis,Gary G. Koch +1 more
TL;DR: A general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies is presented and tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interob server agreement are developed as generalized kappa-type statistics.
Journal ArticleDOI
Self-efficacy: toward a unifying theory of behavioral change.
TL;DR: An integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment is presented and findings are reported from microanalyses of enactive, vicarious, and emotive mode of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes.
Journal ArticleDOI
The Hospital Anxiety and Depression Scale.
A. S. Zigmond,R. P. Snaith +1 more
TL;DR: It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Journal ArticleDOI
Diffusion of innovations
TL;DR: Upon returning to the U.S., author Singhal’s Google search revealed the following: in January 2001, the impeachment trial against President Estrada was halted by senators who supported him and the government fell without a shot being fired.