Effectiveness of a Self-Management Program to Improve Cognition and Quality of Life in Epilepsy: A Pragmatic, Randomized, Multicenter Trial. (24th May 2022)

• Record Type: Journal Article
• Authors: Streltzov, Nicholas A.; Schmidt, Samantha S.; Schommer, Lindsay M.; Zhao, Wenyan; Tosteson, Tor D.; Mazanec, Morgan T.; Kiriakopoulos, Elaine T.; Chu, Felicia; Henninger, Heidi L.; Nagle, Keith; Roth, Robert M.; Jobst, Barbara
• Is Part Of: Neurology. Volume 98:Number 21(2022)
• Page Start: e2174
• Page End: e2184
• Publication Date: 2022-05-24
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000200346
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Background and Objectives: We conducted a multisite, pragmatic replication trial at 4 New England epilepsy centers to determine the effectiveness of Home-Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH) in a real-world setting and to assess feasibility of a virtual intervention. Methods: HOBSCOTCH is an 8-session intervention addressing cognitive impairment and quality of life (QoL) for people with epilepsy (PWE). Participants were recruited from epilepsy centers in 4 states and block-randomized into the following groups: in-person HOBSCOTCH (H-IP), virtual HOBSCOTCH (H-V), and waitlist control. Outcome measures were assessed for all groups at baseline, 3 months, and 6 months; intervention groups received long-term follow-up at 9 and 12 months. Results: A total of 108 participants were recruited, of whom 85 were included in this analysis (age at baseline 47.5 ± 11.5 years; 68% female). Participants completing the in-person intervention (H-IP) had a 12.4-point improvement in QoL score compared with controls ( p < 0.001). Pairwise comparisons found a 6.2-point treatment effect for subjective cognition in the H-IP group ( p < 0.001). There were no meaningful group differences in objective cognition or health care utilization at any time points and the treatment effect for QoL diminished by 6 months. The virtual intervention demonstrated feasibility but did not significantly improve outcomes compared with controls. Within-group analysis found improvements in QoL for both H-V and H-IP. Discussion: This study replicated the effectiveness of the HOBSCOTCH program in improving QoL for PWE. The study was conducted prior to the COVID-19 pandemic, but the distance-delivered intervention may be particularly well-suited for the current environment. Future research will explore modifications designed to improve the efficacy of H-V and the sustainability of HOBSCOTCH's treatment effect. Trial Registration Information: ClinicalTrials.gov (NCT02394509). Classification of Evidence: This study provides Class III evidence that in-person HOBSCOTCH delivery improved subjective measures of cognition in persons with epilepsy.