Ridsdale, Leone, Wojewodka, Gabriella, Robinson, Emily J, Noble, Adam J 
ORCID: 0000-0002-8070-4352, Morgan, Myfanwy, Taylor, Stephanie JC, McCrone, Paul, Richardson, Mark P, Baker, Gus, Landau, Sabine et al (show 1 more authors)
(2018)
The effectiveness of a group self-management education course for adults with poorly controlled epilepsy, SMILE (UK): A randomized controlled trial.
EPILEPSIA, 59 (5).
pp. 1048-1061.
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Abstract
<h4>Objective</h4>Epilepsy is one of the most common neurological conditions affecting about 1% of adults. Up to 40% of people with epilepsy (PWE) report recurring seizures while on medication. And optimal functioning requires good self-management. Our objective was to evaluate a group self-management education courses for people with epilepsy and drug-resistant seizures by means of a multicenter, pragmatic, parallel group, randomized controlled trial.<h4>Methods</h4>We recruited adults with epilepsy, having ≥2 seizures in the prior 12 months, from specialist clinics. Consenting participants were randomized 1:1 to a group course or treatment as usual. The primary outcome measure was quality of life 12 months after randomization using Quality of Life 31-P (QOLIE-31-P). Secondary outcome measures were seizure frequency and recency, psychological distress, impact and stigma of epilepsy, self-mastery, medication adherence, and adverse effects. Analysis of outcomes followed the intention-to-treat principle using mixed-effects regression models.<h4>Results</h4>We enrolled 404 participants (intervention: n = 205, control: n = 199) with 331 (82%) completing 12-month follow-up (intervention: n = 163, control: n = 168). Mean age was 41.7 years, ranging from 16 to 85, 54% were female and 75% were white. From the intervention arm, 73.7% attended all or some of the course. At 12-month follow-up, there were no statistically significant differences between trial arms in QOLIE-31-P (intervention mean: 67.4, standard deviation [SD]: 13.5; control mean: 69.5, SD 14.8) or in secondary outcome measures.<h4>Significance</h4>This is the first pragmatic trial of group education for people with poorly controlled epilepsy. Recruitment, course attendance, and follow-up rates were higher than expected. The results show that the primary outcome and quality of life did not differ between the trial arms after 12 months. We found a high prevalence of felt-stigma and psychological distress in this group of people with drug-resistant seizures. To address this, social and psychological interventions require evaluation, and may be necessary before or alongside self-management-education courses.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | education, epilepsy, quality of life, randomized controlled trial, self-management |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 15 Mar 2018 17:03 |
| Last Modified: | 19 Jan 2023 06:38 |
| DOI: | 10.1111/epi.14073 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3019079 |
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