Ridsdale, Leone, McKinlay, Alison, Wojewodka, Gabriella, Robinson, Emily J., Mosweu, Iris, Feehan, Sarah J., Noble, Adam J., Morgan, Myfanwy, Taylor, Stephanie J.C., McCrone, Paul, Landau, Sabine, Richardson, Mark, Baker, Gus and Goldstein, Laura H. (2018) Self-management education for adults with poorly controlled epilEpsy [SMILE (UK)]: a randomised controlled trial. Health Technology Assessment, 22 (21). ISSN 1366-5278
Full text not available from this repository.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.
| Item Type: | Article |
|---|---|
| Official URL: | https://www.journalslibrary.nihr.ac.uk/hta/#/ |
| Additional Information: | © 2018 Queen’s Printer and Controller of HMSO |
| Divisions: | LSE |
| Subjects: | R Medicine > RC Internal medicine R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
| Date Deposited: | 17 Aug 2020 14:15 |
| Last Modified: | 14 Sep 2024 08:21 |
| URI: | http://eprints.lse.ac.uk/id/eprint/106172 |
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