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Specht U, Lahr D, May TW, Speicher P, Hausfeld H, Coban I, Müffelmann B, Bien CG, Hagemann A. Rehabilitation in patients with newly diagnosed epilepsy: A controlled, 1-year follow-up study on a specialized inpatient rehabilitation program. Epilepsia 2024; 65:1975-1988. [PMID: 38624142 DOI: 10.1111/epi.17985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES To evaluate the efficacy of a specialized inpatient rehabilitation program in patients with newly diagnosed epilepsy (NDE), who had been referred within 1 year after diagnosis. METHODS We performed an open, prospective, controlled study comparing a 1-year follow-up assessment of patients with NDE after completing a rehabilitation program at an epilepsy center (rehabilitation group) with a control group of patients with similar epilepsy duration, but without rehabilitation in the first year after diagnosis. Primary outcome measures comprised emotional adaptation to epilepsy, depression and anxiety; and secondary outcome measures were overall quality of life (QoL), overall health, perceived restrictions because of epilepsy, level of information about epilepsy, and employment status. RESULTS Comparison of the admission data of 74 rehabilitation group patients (mean age and SD 47.7 ± 13.0 years) with the pre-rehabilitation assessment of 56 control patients (45.5 ± 12.1 years) revealed no significant differences concerning sociodemographic and health data. Comparison of the follow-up assessment of the rehabilitation group and the pre-rehabilitation assessment of the control group showed significantly better values for the rehabilitation group on emotional adaptation to epilepsy (p = .003), overall QoL (p = .006) and overall health (p = .011), perceived restrictions because of epilepsy, and subjective level of information about epilepsy (both p's < .001). There were no statistically significant differences concerning depression and anxiety or employment status (all p's > .50). One year after rehabilitation, patients in the rehabilitation group were more often seizure-free and less often on sickness absence than control group patients (both p's < .001). SIGNIFICANCE Since reduced QoL shortly after diagnosis of NDE is associated with seizure recurrence, an early identification of patients with a greater need for support seems important. This epilepsy-related rehabilitation program showed lasting effects on several aspects of adaptation to epilepsy and QoL.
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Affiliation(s)
- Ulrich Specht
- Department of Epileptology, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Denise Lahr
- Department of Epileptology, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | | | - Pascal Speicher
- Department of Epileptology, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Heiko Hausfeld
- Department of Epileptology, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Ingrid Coban
- Department of Epileptology, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Birgitt Müffelmann
- Department of Epileptology, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Christian G Bien
- Department of Epileptology, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Bielefeld, Germany
- Society for Epilepsy Research, Bielefeld, Germany
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Algahtani R, Khateeb F, Khateb F, Alhazmi AS, Alshareef BA, Fatani BA. Public Awareness of Epilepsy and Social Attitude Toward Persons With Epilepsy Among the General Population in Makkah, Saudi Arabia. Cureus 2024; 16:e57398. [PMID: 38694680 PMCID: PMC11061814 DOI: 10.7759/cureus.57398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Epilepsy is a common neurological disorder characterized by an ongoing propensity to experience recurrent seizures. Public awareness varies significantly across different countries. The lack of awareness may lead to misconceptions, which in turn may affect the quality of care for these patients. AIM This study aims to assess public awareness and social attitudes toward patients with epilepsy among the general population in Makkah, Saudi Arabia. METHODS A questionnaire-based cross-sectional study was conducted, targeting the general population of Makkah, Saudi Arabia. Data were collected anonymously from participants who met our inclusion criteria via electronic data collection Google Forms distributed through social media platforms. Questionnaires included participants' demographic data and details about their awareness regarding epilepsy, attitude, and anticipated behaviors. The eligible persons were asked to fill out the study questionnaire completely. RESULTS A total of 1,126 eligible participants completed the study questionnaire. The participants' ages ranged from 18 to over 60, with a mean age of 32.1 ± 13.9 years. Of these participants, 849 (75.4%) were female. Interestingly, 97% of the participants reported that they had heard about epilepsy. A total of 96.7% do not think epilepsy is contiguous. Exactly 350 (31.1%) had an overall good knowledge and awareness regarding epilepsy. The most reported sources included relatives/friends (46.8%), internet (38.5%), and personal experience (27.9%). A total of 337 (29.9%) reported that they know how to deal with a seizure. CONCLUSION Our study revealed that the sampled population of Makkah is aware of epilepsy on a superficial level, but approximately one out each three participants in Makkah were knowledgeable regarding epilepsy and related causes overall. The overall attitude is positive. A well-targeted educational campaign, designed by physicians as trustful sources, is recommended.
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Affiliation(s)
- Rami Algahtani
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | | | - Fawaz Khateb
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
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Letén HM, Karterud HN, Mengshoel AM. Individuals' invisible work continues after epilepsy surgery: A qualitative interview study. Epilepsy Res 2024; 199:107281. [PMID: 38101177 DOI: 10.1016/j.eplepsyres.2023.107281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE How do persons with epilepsy (PWE) experience their everyday lives after epilepsy surgery? METHODS Qualitative thematic interviews were conducted with eight PWEs (30 to 60 years old). They were recruited when coming for post-operative control 1 to 5 years after epilepsy surgery. The interviews were transcribed. They were analysed by thematic analysis and inspired by Goffman who examines everyday life activities as a theatre play. RESULTS Before surgery, a substantial invisible and hidden work of adjustments was performed to prevent seizures, to secure help from others if seizures occurred, and to protect oneself from others' gaze during a seizure. This invisible work continued after surgery even for those who became seizure-free; but now for the purpose of protecting oneself from relapse of epilepsy. From the participants perspective there was no or minor change in daily activities among those not becoming seizure-free after surgery. In contrast, those who became seizure-free enjoyed the freedom to participate in social activities without planning or restrictions. CONCLUSIONS A striking finding was that daily life after surgery comprises considerably invisible work to protect a social self, and this preventive and protective invisible work continued, although those who became seizure-free were living an ordinary socially healthy life.
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Affiliation(s)
- Helene Myklebust Letén
- National Centre for Epilepsy (SSE), Neurological clinic, Oslo University Hospital, Norway.
| | - Hilde Nordahl Karterud
- National Centre for Epilepsy (SSE), Neurological clinic, Oslo University Hospital, Norway
| | - Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo, Norway
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Houta S, Bader A, Effert J, Esser B, Henze J, Spaic A, Zocher F, Lauerer M, Surges R. Digital health applications in the self-management of epilepsy-A survey on patients' perspective. Epilepsia Open 2023; 8:1288-1299. [PMID: 37438936 PMCID: PMC10690647 DOI: 10.1002/epi4.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE Digital health applications can be prescribed since 2019 in Germany, which is likely to facilitate a broad use of epilepsy self-management applications, possibly directly connected to clinical systems via telematics infrastructures. This article reports on patients' interest in digital support for epilepsy self-management, influencing factors and patients' knowledge about digitization of health care in Germany. METHODS This work is based on self-reported data from 115 people with epilepsy participating in an anonymous online survey with a total of 54 questions covering several topics, including sociodemographics and epilepsy manifestation, use of technology in general and for treatment support, training programs, affinity for technology, knowledge on the digital infrastructure in Germany, and self-efficacy in dealing with chronic illness. The self-constructed questionnaire uses existing instruments like TA-EG, SES6G, and Hoffmeyer-Zlotnik sociodemographic questionnaire. To analyze the knowledge about digitalization in health care, a combination of self-assessment and knowledge quiz was used. The analysis was performed using descriptive methods and inferential statistics (t-test, reliability analysis, and correlations). RESULTS Participants were most interested in seizure alerting and documentation with the possibility to share documentation with physicians. The analysis of technology affinity showed medium enthusiasm, with positively perceived consequences being rated higher than the negatively perceived consequences of technology use. Knowledge on national health infrastructures was mediocre and training on this was judged to be essential and desired. Furthermore, a significant correlation was found between interest in use and affinity for technology (enthusiasm for technology [r = 0.29; P = 0.00]) and positively perceived consequences of technology (r = 0.33; P = 0.00). SIGNIFICANCE Our results underline the high relevance of digital solutions for patients and the importance of individual training opportunities in digital health literacy, thereby enabling patients to decide competently for or against offered digital solutions.
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Affiliation(s)
- Salima Houta
- Fraunhofer Institute for Software and Systems Engineering ISSTDortmundGermany
- Department of Computer ScienceTU Dortmund University DortmundDortmundGermany
| | - Alisa Bader
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health SciencesUniversity of BayreuthBayreuthGermany
| | - Jana‐Sophie Effert
- Klinisches Innovationszentrum für Medizintechnik Oldenburg KIZMOOldenburgGermany
| | - Birgitta Esser
- Department of EpileptologyUniversity Hospital BonnBonnGermany
| | - Jasmin Henze
- Fraunhofer Institute for Software and Systems Engineering ISSTDortmundGermany
| | - Alexandra Spaic
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health SciencesUniversity of BayreuthBayreuthGermany
| | - Feline Zocher
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health SciencesUniversity of BayreuthBayreuthGermany
| | - Michael Lauerer
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health SciencesUniversity of BayreuthBayreuthGermany
| | - Rainer Surges
- Department of EpileptologyUniversity Hospital BonnBonnGermany
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Turan FD, Yangöz ŞT. Effect of educational interventions on level of epilepsy knowledge in children with epilepsy and parents: Systematic review and meta-analysis. J Clin Nurs 2023; 32:1381-1397. [PMID: 35534992 DOI: 10.1111/jocn.16346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/08/2022] [Accepted: 04/25/2022] [Indexed: 01/12/2023]
Abstract
AIM AND OBJECTIVES The aim of the study was to synthesise the effect of educational interventions on the level of epilepsy knowledge in children with epilepsy and parents. BACKGROUND Educational interventions are commonly used to provide knowledge about epilepsy management. One of the most important responsibilities of nurses is to inform children with epilepsy and parents in a skilful way. DESIGN Systematic review and meta-analysis based on PRISMA 2020. METHODS We searched CINAHL, Cochrane Library, Science Direct, Web of Science, Ovid, PubMed, Scopus, Springer Link, ProQuest, TR Index ending March 2021. The review followed the PRISMA guidelines. This meta-analysis was analysed in Comprehensive Meta-Analysis version 3 software. The risk of bias of included studies was assessed with the Cochrane handbook. The results were the level of epilepsy knowledge of children and parents. RESULTS Ten studies meeting the inclusion criteria were included in this meta-analysis, including four randomised studies and six non-randomised studies. Educational interventions had large effect on improving the level of epilepsy knowledge in children with epilepsy (p < .001, Hedge's g = 1.19) and parents (p < .001, Hedge's g = 1.41). As a result of the subgroup analyses, significant differences were found only in the type of educational intervention. It was found that traditional education is more effective than technology-based education in improving the level of epilepsy knowledge in parents (p = .005, Hedge's g = 1.77). CONCLUSION Educational interventions have high and beneficial effect on the level of epilepsy knowledge in the children with epilepsy and parents; can be used as effective interventions in the epilepsy management. However, due to low number of randomised controlled studies, further high-quality randomised controlled studies are needed about this topic. RELEVANCE TO CLINICAL PRACTICE The findings will contribute to the use of educational interventions in the epilepsy management for health professionals, especially nurses. Thus these interventions will contribute to improving epilepsy management of children with epilepsy and parents.
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Affiliation(s)
- Fatma D Turan
- Department of Pediatric Nursing, Faculty of Health Sciences, Aksaray University, Aksaray, Turkey
| | - Şefika T Yangöz
- Department of Internal Medicine Nursing, Faculty of Health Sciences, Pamukkale University, Denizli, Turkey
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Reeder S, Foster E, Vishwanath S, Kwan P. Experience of waiting for seizure freedom and perception of machine learning technologies to support treatment decision: A qualitative study in adults with recent onset epilepsy. Epilepsy Res 2023; 190:107096. [PMID: 36738538 DOI: 10.1016/j.eplepsyres.2023.107096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE With no reliable surrogate biomarkers for treatment response, people with epilepsy currently await the passage of time to determine whether prescribed treatments are effective. Few studies have examined the issues faced by people with epilepsy during this waiting period. We aim to explore the experiences of people with recently diagnosed epilepsy as they wait to achieve seizure freedom. METHODS We purposively sampled adults of working age who had been diagnosed and treated for epilepsy for less than four years. Semi-structured interviews were undertaken between July and September 2021. A thematic analysis using a framework approach was performed. RESULTS We recruited 15 patients. Results revealed four main themes: 1) Impact on mental health, as people with newly diagnosed epilepsy described waiting for seizure freedom as a time of vulnerability, uncertainty, and confusion. 2) Participants described their life as "on hold", prior to achieving effective seizure control 3) Difficulty navigating health systems to find and understand information about epilepsy, tests, and medications, and to find the 'right' health professional to address their needs. 4) Technology systems that support clinician decision making with selecting effective medications early after diagnosis were cautiously welcomed by participants. CONCLUSION Interventions are needed to reduce the negative impacts experienced by people who are newly diagnosed with epilepsy while waiting for effective seizure control. Technology systems that support clinician decision making were acceptable, as people with epilepsy sought accessible and effective solutions to restore a sense of control in their lives.
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Affiliation(s)
- Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne 3004, Australia; Department of Neurosciences, Monash University, Central Clinical School, 99 Commercial Road, Melbourne 3004, Australia.
| | - Emma Foster
- Department of Neurosciences, Monash University, Central Clinical School, 99 Commercial Road, Melbourne 3004, Australia; Department of Neurology, The Alfred, 55 Commercial Road, Melbourne 3004, Australia.
| | - Swarna Vishwanath
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne 3004, Australia; Department of Neurosciences, Monash University, Central Clinical School, 99 Commercial Road, Melbourne 3004, Australia.
| | - Patrick Kwan
- Department of Neurosciences, Monash University, Central Clinical School, 99 Commercial Road, Melbourne 3004, Australia; Department of Neurology, The Alfred, 55 Commercial Road, Melbourne 3004, Australia.
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Shafer PO, Gilchrist B, Miller W, Owens S, Ficker D, Haynes-Smith L, Kiriakopoulos E. Improving self-efficacy in seizure first aid: Developing a seizure first aid certification program in the United States. Epilepsy Behav 2022; 129:108624. [PMID: 35247833 DOI: 10.1016/j.yebeh.2022.108624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Seizures and epilepsy are very common neurologic disorders, yet knowledge of how to help a person having a seizure is sorely lacking, increasing the potential for injury and early death for people with seizures. We developed a standardized seizure first aid (SFA) training certification for the general public and evaluated its impact on knowledge and self-efficacy about SFA and program satisfaction. METHODS The Epilepsy Foundation's SFA certification was developed by a multidisciplinary group of experts, with extensive review, feasibility testing, and analysis of pilot tests from 10 sessions with 177 participants. Pre/post assessments were conducted immediately prior to and after participation in the 60-90-min program. Data from 94 people with complete pre/post assessments were used for analysis of demographics, program outcomes, and satisfaction. Descriptive statistics, paired sample T-tests, and Cronbach α coefficients were conducted. RESULTS Participants were over age 18, primarily female, and white/Caucasian. Significant improvements were seen in both SFA knowledge and self-efficacy on pre/post assessments across all pilot sites. Fourteen of 23 scale items had significant pre/post improvements. Training satisfaction was rated high by almost all participants. CONCLUSIONS The Epilepsy Foundation's Seizure First Aid certification focuses on ability to recognize seizure symptoms, respond with correct first aid steps, and know when emergency help is needed. Pilot assessments support increased knowledge and self-confidence, critical to promoting positive behavior change. This program offers an easy and scalable way for the general public to learn SFA and enhance seizure recognition and safety of people with seizures.
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Affiliation(s)
- Patricia O Shafer
- Epilepsy Foundation, United States; Osborne Health Consulting, United States.
| | | | - Wendy Miller
- Indiana University School of Nursing, United States
| | - Steven Owens
- Epilepsy Foundation, United States; Crescent Solutions, United States
| | - David Ficker
- University of Cincinnati Gardner Neuroscience Institute, United States
| | | | - Elaine Kiriakopoulos
- Epilepsy Foundation, United States; Dartmouth College Geisel School of Medicine, United States
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Moos TAO, Rydahl-Hansen S. 'Everything is as before, but nothing is as it was'-A phenomenological-hermeneutic study of meaningfulness in adult patients with refractory epilepsy after interdisciplinary epilepsy rehabilitation. Epilepsy Behav 2021; 122:108168. [PMID: 34271324 DOI: 10.1016/j.yebeh.2021.108168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Interdisciplinary Rehabilitation aimed at adults with refractory epilepsy (RE) establishes scientific evidence of higher health-related QoL, including improved self-worth and increased self-awareness as outcomes. Yet, there is very little research-based knowledge of how life transforms itself after the rehabilitation program from patients' perspectives. AIM The aim of this study was to identify and describe how - from the patient perspectives - life transforms itself after rehabilitation among adults with RE, focusing on the meaningfulness of interdisciplinary rehabilitation. METHOD Nine patients, who all completed an Interdisciplinary Rehabilitation Program in an Adult Epilepsy Clinic, were interviewed between six months and two years after rehabilitation. Nine interviews were recorded, transcribed verbatim, and analyzed as described by the phenomenological method 'Reflective Lifeworld Research' (RLR). FINDINGS The essence of the phenomenon was revealed as life as a struggle for a dignified existence with RE as a navigating life companion. Through the clusters of meaning, four constituents emerged from the phenomenon: 1) to accept the limitations of body and mind; 2) to be on a journey toward your inner self; 3) to be quietly understood; 4) to fight for renewed hope and recognition during transition. CONCLUSION The patients consider it significant to know their own bodies with the constraints that this involves. This knowledge helps them make decisions that not only have a positive effect on their epilepsy, but also raise their self-esteem and give them renewed hope and courage to face life. However, the struggle for a dignified life is continuously hard, and it comes to a head in patients' transition from 'patient to citizen', where asymmetries arise. These asymmetries leave considerable marks on the patients' worlds and challenge their renewed hope for a dignified existence.
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Affiliation(s)
- Trine Arnam Olsen Moos
- Department of Adult Epileptology and PNES, The Danish National Epilepsy Center, Filadelfia, Kolonivej 2 A, 1. Sal, 4293 Dianalund, Denmark.
| | - Susan Rydahl-Hansen
- Research Unit of Nursing and Healthcare, Institute of Public Health Health, Aarhus University, Department of Public Health - Department of Science in Nursing, Campus Emdrup, Tuborgvej 164, bygning B8, 1. sal, 2400 Copenhagen NV, Denmark.
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Almohammed OA, Almutiri NM, Almozaai SS, Alquraishi NH, Alotaibie MM, Al Yami MS. Patients' knowledge about epilepsy in a tertiary medical center: A cross-sectional study from Riyadh, Saudi Arabia. Epilepsy Behav 2021; 116:107395. [PMID: 33640295 DOI: 10.1016/j.yebeh.2020.107395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/05/2020] [Accepted: 08/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Epilepsy is a noncommunicable disease that affects approximately 65 million people worldwide. Its management depends greatly on the self-management capacity of the individual. Patients with epilepsy (PWE) who have a good level of knowledge about their disease tend to have better coping mechanisms, as well as better compliance in taking their antiepileptic drugs (AEDs), which improves overall control of symptoms. This study aimed to evaluate the current patients' knowledge about epilepsy and identify factors associated with knowledge of different aspects of epilepsy and its management in a tertiary medical center in Riyadh, Saudi Arabia. METHODS A cross-sectional study was carried out at a tertiary medical center in Riyadh, Saudi Arabia. Participants were included if they had a documented diagnosis of epilepsy and excluded if they were non-Saudi or had nonepileptic seizures. The Arabic version of the Epilepsy Patient Knowledge Questionnaire (EPKQ) was used to assess patient's knowledge of epilepsy definition and etiology, safety concerns, medication compliance, social activities, and legal issues of employment and driving. Fisher's exact and Chi-Square tests were used to investigate differences in knowledge of epilepsy among different segments of participants. Data management and statistical analyses were carried on using the IBM SPSS Statistics for Windows, version 25. RESULTS A total of 126 PWE were enrolled in the study. About two-thirds of them were females, and about 68% of them were at least high-school graduates. About one-half of PWE had good knowledge of their condition (>75%), and females had better knowledge than males (p = 0.004). The majority (75.4%) of PWE were knowledgeable about the etiology of epilepsy, about 70% knew that putting a foreign object in a seizing patients' mouth was inappropriate, and only 38% of them did not have adequate knowledge of situations that increase the risk of seizure. About 40% of PWE thought pregnant women should discontinue their AEDs, 53.2% of participants knew what to do when they experience side effects from AEDs, but most of them recognized that they should not automatically stop taking their medications when they stop having seizures. Patients older than 50 years or younger than 21 years of age were less likely to recognize that it was safe for PWE to engage in different social activities (p = 0.042). About 30% of respondents believed that PWE cannot engage in most types of jobs, and more than 50% of participants did not know under which situation PWE can drive. CONCLUSION This study revealed that about half of PWE had inadequate knowledge about their disorder. Patients with epilepsy had better knowledge about the causes of their condition compared with safety concerns and the treatment of epilepsy, whereas the majority of participants knew the types of jobs and activities that they could engage in. Hence, educational interventions are needed to promote patients' knowledge, especially in terms of safety and the legalities of employment and driving.
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Affiliation(s)
- Omar A Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia.
| | - Nouf M Almutiri
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shahad S Almozaai
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Norah H Alquraishi
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - May M Alotaibie
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Majed S Al Yami
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Côté J, Beaudet L, Auger P, Rouleau G, Chicoine G, Léger V, Keezer M, Reid MA, Nguyen DK. Evaluation of a web-based virtual nursing intervention to support self-management among adults with epilepsy: A mixed-methods study. Epilepsy Behav 2021; 114:107581. [PMID: 33246896 DOI: 10.1016/j.yebeh.2020.107581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A web-based intervention was developed to support epilepsy self-management. A mixed methods study was undertaken to evaluate the intervention's extent of utilization, acceptability and preliminary effects, and to assess user perception of it. METHODS First, a pilot parallel-group randomized controlled trial was conducted with a convenience sample of 75 adult with epilepsy who had Internet access allocated on a 1:1 ratio into an experimental group that received the intervention (experimental group (EG), n = 37) and a control group invited to consult epilepsy-related websites (control group (CG), n = 38). Self-management, knowledge, and quality of life (QoL) outcomes were measured at baseline and one and three months later. Descriptive statistics of extent of utilization and acceptability were computed. Linear mixed models were conducted to assess change in outcomes over time and between groups. Subsequently, an exploratory qualitative study was carried out with 15 EG participants. Qualitative data were subjected to thematic analysis. RESULTS Participants had a mean age of 40 years (range: 18-73), 45% were female, and mean time since diagnosis was 18 years (range: less than a year to 60 years). In the EG, 70% of the participants completed the intervention. Regarding acceptability, participants (n = 25) were satisfied overall (88%) and found content clear (92%) and the information reliable (100%). EG participants experienced greater improvement in QoL compared with CG participants, least-squares means (95% CI): 0.41 (0.06, 0.76). Three major themes emerged from the interviews (n = 15): intervention provides certain personal benefits; clinical content is of general interest but should be tailored; and intervention should target "new" patients early in the care trajectory. DISCUSSION The web-based intervention shows promise in terms of usefulness in enhancing QoL, and user experience showed that it is acceptable and helpful. It could constitute a complementary service in support of existing services for people with epilepsy and their families.
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Affiliation(s)
- José Côté
- Research Chair in Innovative Nursing Practices, 850 rue St-Denis, Montreal, Quebec H2X 0A9, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal, 850 rue St-Denis, Montreal, Quebec H2X 0A9, Canada; Faculty of Nursing of the Université de Montréal, 2375 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1A8, Canada.
| | - Line Beaudet
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 850 rue St-Denis, Montreal, Quebec H2X 0A9, Canada; Faculty of Nursing of the Université de Montréal, 2375 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1A8, Canada; Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, Quebec H2X 0A9, Canada.
| | - Patricia Auger
- Research Chair in Innovative Nursing Practices, 850 rue St-Denis, Montreal, Quebec H2X 0A9, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal, 850 rue St-Denis, Montreal, Quebec H2X 0A9, Canada.
| | - Geneviève Rouleau
- Research Chair in Innovative Nursing Practices, 850 rue St-Denis, Montreal, Quebec H2X 0A9, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal, 850 rue St-Denis, Montreal, Quebec H2X 0A9, Canada.
| | - Gabrielle Chicoine
- Research Chair in Innovative Nursing Practices, 850 rue St-Denis, Montreal, Quebec H2X 0A9, Canada; Faculty of Nursing of the Université de Montréal, 2375 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1A8, Canada.
| | - Vanessa Léger
- Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, Quebec H2X 0A9, Canada.
| | - Mark Keezer
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 850 rue St-Denis, Montreal, Quebec H2X 0A9, Canada; Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, Quebec H2X 0A9, Canada; Faculty of Medicine of the Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada.
| | - Marc-André Reid
- Research Chair in Innovative Nursing Practices, 850 rue St-Denis, Montreal, Quebec H2X 0A9, Canada; Faculty of Nursing of the Université de Montréal, 2375 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1A8, Canada.
| | - Dang Khoa Nguyen
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 850 rue St-Denis, Montreal, Quebec H2X 0A9, Canada; Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, Quebec H2X 0A9, Canada; Faculty of Medicine of the Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada.
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11
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Tan JW, Khoo TB, Burharudin NF, Mohamed Shah N. Medication self-management among parents of children with epilepsy at a tertiary care center in Malaysia. Epilepsy Behav 2020; 111:107317. [PMID: 32693382 DOI: 10.1016/j.yebeh.2020.107317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Self-management is crucial in the management of chronic diseases. However, information is limited on medication self-management among parents of children with epilepsy. This study aimed to assess medication self-management among parents of children with epilepsy and its association with sociodemographic data, clinical characteristics, antiepileptic drug (AED) regimen complexity, and parent self-reported AED adherence. METHOD A cross-sectional survey was conducted at a tertiary care center in Malaysia from February 2019 to June 2019. Parents of children with epilepsy who were on AED for at least 3 months and aged ≤18 years old were recruited. Medication self-management was assessed using a validated Pediatric Epilepsy Medication Self-Management Questionnaire (PEMSQ). A higher total score reflects better medication self-management. RESULTS A total of 166 patients were recruited. The mean ± standard deviation (SD) age of patients was 8.20 ± 5.21 years, and 51.8% and 36.7% of patients have generalized seizure and focal seizure, respectively. The mean ± SD PEMSQ score was 116.2 ± 11.28 from a total score of 135. Among the four domains of PEMSQ, the barriers to treatment contributed to the lowest mean scores. Univariate analysis showed that the following were significantly associated with poorer medication self-management: differences in ethnicity, religion; higher number of medications; presence of comorbidities; inability to swallow tablets; and a more complex AED regimen. Other variables were not significant. Multivariate analysis showed that only ethnicity and presence of comorbidity remained independently significant (R2 = 0.14; F [4, 161] = 6.28; p < 0.001). Poorer medication self-management was observed in the Malaysian Chinese population than in the Malaysian Malay population (b = -8.52; p < 0.001) and in children with comorbidities than in those without comorbidities (b = -5.04, p = 0.01). CONCLUSION The overall medication self-management was satisfactory. Barriers to treatment should be addressed to empower parents to achieve better medication self-management. Furthermore, medication self-management should be reinforced among Malaysian Chinese patients and children with comorbidities.
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Affiliation(s)
- Jing Wen Tan
- Paediatric Pharmacy Unit, Kuala Lumpur Women and Children Hospital, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Teik Beng Khoo
- Paediatric Neurology Unit, Kuala Lumpur Women and Children Hospital, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Nurul Farhana Burharudin
- Paediatric Pharmacy Unit, Kuala Lumpur Women and Children Hospital, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia.
| | - Noraida Mohamed Shah
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia.
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12
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Self-management practices associated with quality of life for adults with epilepsy. J Neurol 2019; 266:2821-2828. [DOI: 10.1007/s00415-019-09503-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/01/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
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13
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Peterson CL, Walker C, Coleman H, Shears G. Reported service needs at diagnosis of epilepsy and implications for quality of life. Epilepsy Behav 2019; 100:106527. [PMID: 31522077 DOI: 10.1016/j.yebeh.2019.106527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/30/2022]
Abstract
AIM This paper reports on contributing factors to Quality of Life (QoL) in an Australian community sample of people with epilepsy (PWE). METHOD Three hundred and ninety-three respondents or 29.6% of people on the Australian Epilepsy Research Register participated in Wave 4 of a longitudinal survey. A quantitative analysis was undertaken and a qualitative investigation examined open-ended responses by 44 PWE on the support services that they received following diagnosis of epilepsy. RESULTS Total Quality of Life in Epilepsy-31 Items (QOLIE-31) score for the community-based sample was 55.99 (SD 19.85) [Range 6.34-96.20]. Age, paid employment, seizure frequency, number of antiepileptic drugs (AEDs), and perceived prosperity had significant impacts on QoL. In addition, use of support services showed that availability of a first seizure clinic, accurate information on support services and peer support were associated with the highest QoL. A qualitative investigation revealed that on first diagnosis, a lack of information was the main theme. Furthermore, PWE reported a lack of understanding of available supports by a range of health professionals, schools, and in the general community. DISCUSSION Psychosocial factors were important in explaining QoL, and the positive effects of first seizure clinics, accurate information on support services, and of peer support have been confirmed in the literature. The lack of knowledge of support services on being diagnosed with epilepsy is a problem evident in the community and pathways are required to support people dealing with their epilepsy. CONCLUSION More emphasis is needed in providing availability of supports to enhance the future wellbeing and QoL of people when epilepsy is diagnosed.
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Affiliation(s)
- Chris L Peterson
- School of Humanities and Social Sciences, La Trobe University, Bundoora, Australia; Epilepsy Foundation, Surrey Hills, Victoria, Australia.
| | - Christine Walker
- Chronic Illness Alliance, Moonee Ponds, Australia; Epilepsy Foundation, Surrey Hills, Victoria, Australia.
| | - Honor Coleman
- School of Psychological Sciences, The University of Melbourne, Parkville, Australia; Department of Neuroscience, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Epilepsy Foundation, Surrey Hills, Victoria, Australia.
| | - Graeme Shears
- Epilepsy Foundation, Surrey Hills, Victoria, Australia.
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14
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Elliott N, Pembroke S, Quirke M, Pender N, Higgins A. Disclosure strategies in adults with epilepsy when telling, "I have epilepsy": The How2tell study. Epilepsia 2019; 60:2048-2059. [PMID: 31544237 DOI: 10.1111/epi.16338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To generate evidence-based knowledge about the strategies that adult people with epilepsy (PWEs) use in the process of telling others about their epilepsy. METHODS In-depth, one-to-one interviews explored PWEs' first-hand experiences of self-disclosure (or not), and grounded theory methods of inductive-deductive analysis were used to identify strategies used in disclosing. Interviews were audio-recorded, transcribed, coded, and independently recoded by two researchers using a coding framework specifically developed in this study. To account for maximum variation, PWEs (aged 18+ years) with different life experiences and situations relating to (1) gender, (2) age, (3) employment status, (4) personal relationships, (5) family relationship, (6) support group involvement, and (7) seizure frequency were included. Given the many variables and psychosocial issues associated with epilepsy, demographic details and validated measures including Quality of Life in Epilepsy-10-P, Coping Inventory of Stressful Situations-Adult, and Patient Health Questionnaire-9 were used to describe the characteristics of participants and to contextualize the results. RESULTS Forty-nine adults with epilepsy participated. Data analysis revealed six interrelated categories (with subcategories) of the strategies that PWEs reported using in the process of disclosure: (1) concerns about disclosing; (2) weighing up who and when to tell; (3) opportunities for telling; (4) moment of disclosure-how to construct the message; (5) tailoring the message to audience needs-altering the message when telling family members, partner, friends, children, or employer and workplace colleagues; and (6) managing reactions by making it ordinary. SIGNIFICANCE People with epilepsy use a range of different strategies during the process of disclosing their epilepsy. These strategies were used to inform the development of the How2tell multimedia self-management resource for PWEs on self-disclosure in everyday social and life situations. How2tell is designed to benefit PWEs by empowering them with practical information about the process of telling another person, "I have epilepsy."
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Affiliation(s)
- Naomi Elliott
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Sinead Pembroke
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mary Quirke
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Agnes Higgins
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Hum KM, Chan CJ, Gane J, Conway L, McAndrews MP, Smith ML. Do distance-delivery group interventions improve depression in people with epilepsy? Epilepsy Behav 2019; 98:153-160. [PMID: 31374471 DOI: 10.1016/j.yebeh.2019.06.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/18/2019] [Accepted: 06/27/2019] [Indexed: 01/20/2023]
Abstract
About one-third of people with epilepsy experience comorbid depression. The present study examined outcomes of a distance-delivery group intervention program designed to improve emotional well-being. Participants were 55 adults with epilepsy and self-reported depressive symptoms who were randomly assigned to take part in either a mindfulness-based cognitive behavioral therapy (CBT) program (UPLIFT, n = 20), an epilepsy information and self-management program (EpINFO, n = 24) that served as an active control group, or a wait-list control (WLC) group (n = 11). The Quick Inventory of Depressive Symptomatology (QIDS), Neurological Disorders Depression Inventory for Epilepsy (NDDIE), and the psychological health subscale of the World Health Organization Quality of Life (WHOQOL-BREF) scale were used to assess depression and psychological quality of life before and after treatment, and at short-term (six months) and long-term follow-up (one year) upon program completion. From pre- to posttreatment, a main effect of time was found, with participants in both the UPLIFT and EpINFO groups having reported to a similar degree a significant decrease in depressive symptoms and improved psychological health, improvements that were not seen in the WLC group. The time by group interaction effect was not significant. The effects seen at posttreatment in the UPLIFT and EpINFO groups remained at six months and one year after treatment. These data suggest that distance-delivery group intervention programs are effective at improving depression and psychological quality of life, with the EpINFO program offering benefits similar to the UPLIFT program.
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Affiliation(s)
| | | | | | - Lauryn Conway
- University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Pat McAndrews
- University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Mary Lou Smith
- University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
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Luedke MW, Blalock DV, Goldstein KM, Kosinski AS, Sinha SR, Drake C, Lewis JD, Husain AM, Lewinski AA, Shapiro A, Gierisch JM, Tran TT, Gordon AM, Van Noord MG, Bosworth HB, Williams JW. Self-management of Epilepsy: A Systematic Review. Ann Intern Med 2019; 171:117-126. [PMID: 31261386 DOI: 10.7326/m19-0458] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although self-management is recommended for persons with epilepsy, its optimal strategies and effects are uncertain. PURPOSE To evaluate the components and efficacy of self-management interventions in the treatment of epilepsy in community-dwelling persons. DATA SOURCES English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL in April 2018; the MEDLINE search was updated in March 2019. STUDY SELECTION Randomized and nonrandomized comparative studies of self-management interventions for adults with epilepsy. DATA EXTRACTION An investigator assessed study characteristics; intervention details, including 6 components of self-management; and outcomes, which were verified by a second reviewer. Risk of bias (ROB) was assessed independently by 2 investigators. DATA SYNTHESIS 13 randomized and 2 nonrandomized studies (2514 patients) evaluated self-management interventions. Interventions were delivered primarily in group settings, used a median of 4 components, and followed 2 general strategies: 1 based on education and the other on psychosocial therapy. Education-based approaches improved self-management behaviors (standardized mean difference, 0.52 [95% CI, 0.0 to 1.04]), and psychosocial therapy-based approaches improved quality of life (mean difference, 6.64 [CI, 2.51 to 10.77]). Overall, self-management interventions did not reduce seizure rates, but 1 educational intervention decreased a composite of seizures, emergency department visits, and hospitalizations. LIMITATION High ROB in most studies, incomplete intervention descriptions, and studies limited to English-language publications. CONCLUSION There is limited evidence that self-management strategies modestly improve some patient outcomes that are important to persons with epilepsy. Overall, self-management research in epilepsy is limited by the range of interventions tested, the small number of studies using self-monitoring technology, and uncertainty about components and strategies associated with benefit. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs. (PROSPERO: CRD42018098604).
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Affiliation(s)
- Matthew W Luedke
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (M.W.L., S.R.S., A.A.L., A.S., T.T.T., A.M.G.)
| | - Dan V Blalock
- Durham Veterans Affairs Medical Center and Duke University School of Medicine, Durham, North Carolina (D.V.B., K.M.G., J.M.G., J.W.W.)
| | - Karen M Goldstein
- Durham Veterans Affairs Medical Center and Duke University School of Medicine, Durham, North Carolina (D.V.B., K.M.G., J.M.G., J.W.W.)
| | | | - Saurabh R Sinha
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (M.W.L., S.R.S., A.A.L., A.S., T.T.T., A.M.G.)
| | - Connor Drake
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (C.D.)
| | - Jeffrey D Lewis
- Uniformed Services University School of Medicine, Bethesda, Maryland (J.D.L.)
| | - Aatif M Husain
- Duke University Medical Center, Durham Veterans Affairs Medical Center, and Duke University, Durham, North Carolina (A.M.H.)
| | - Allison A Lewinski
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (M.W.L., S.R.S., A.A.L., A.S., T.T.T., A.M.G.)
| | - Abigail Shapiro
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (M.W.L., S.R.S., A.A.L., A.S., T.T.T., A.M.G.)
| | - Jennifer M Gierisch
- Durham Veterans Affairs Medical Center and Duke University School of Medicine, Durham, North Carolina (D.V.B., K.M.G., J.M.G., J.W.W.)
| | - Tung T Tran
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (M.W.L., S.R.S., A.A.L., A.S., T.T.T., A.M.G.)
| | - Adelaide M Gordon
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (M.W.L., S.R.S., A.A.L., A.S., T.T.T., A.M.G.)
| | - Megan G Van Noord
- Durham Veterans Affairs Medical Center, Durham, North Carolina; University of California, Davis, Davis, California (M.G.V.)
| | - Hayden B Bosworth
- Durham Veterans Affairs Medical Center, Duke University School of Medicine, and Duke University, Durham, North Carolina (H.B.B.)
| | - John W Williams
- Durham Veterans Affairs Medical Center and Duke University School of Medicine, Durham, North Carolina (D.V.B., K.M.G., J.M.G., J.W.W.)
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17
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Ridsdale L, McKinlay A, Wojewodka G, Robinson EJ, Mosweu I, Feehan SJ, Noble AJ, Morgan M, Taylor SJ, McCrone P, Landau S, Richardson M, Baker G, Goldstein LH. Self-Management education for adults with poorly controlled epILEpsy [SMILE (UK)]: a randomised controlled trial. Health Technol Assess 2019; 22:1-142. [PMID: 29717699 DOI: 10.3310/hta22210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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.
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Affiliation(s)
- Leone Ridsdale
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alison McKinlay
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gabriella Wojewodka
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily J Robinson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iris Mosweu
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sarah J Feehan
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam J Noble
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Stephanie Jc Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Primary Care and Public Health, London, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Richardson
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gus Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Edward KL, Cook M, Stephenson J, Giandinoto JA. The impact of brief lifestyle self-management education for the control of seizures. ACTA ACUST UNITED AC 2019; 28:348-354. [PMID: 30925235 DOI: 10.12968/bjon.2019.28.6.348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIM: this study examined a brief lifestyle self-management intervention, based on self-determination theory, to manage seizure frequency, and its effects on health-related quality of life and resilience in people with epilepsy aged over 18 years. BACKGROUND: most people with epilepsy can identify factors that may trigger seizures and may try to avoid these; however, education from clinicians on this varies. DESIGN: a cohort study with control design. METHOD: sixty participants were purposively sampled and allocated to an intervention or a control group. RESULTS: moderate correlations were found, particularly between: resilience and satisfaction with life; medication adherence and psychological quality of life; and psychological quality of life and satisfaction with life. The mean seizure occurrences between the control and intervention groups were 12.71 (SD 24.55) and 6.76 (SD 13.40) respectively after the intervention. While the study was not powered to assess this, the intervention may be most effective regarding medication adherence and physical health quality of life. CONCLUSION: the relationship between self-efficacy and seizure management appeared to be strengthened by the programme. This study is the first known to measure resilience in relation to lifestyle self-management for seizure control in people with epilepsy. Relevance to practice: nurses are well placed to work with patients' strengths towards self-efficacy and potentially resilient coping.
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Affiliation(s)
- Karen-Leigh Edward
- Professor of Nursing and Practice Based Research, Faculty of Health, Arts and Design, Swinburne University of Technology, Visiting Professor, School of Human and Health Sciences, University of Huddersfield, UK, Visiting Professor of Practice Based Research, St Vincent's Private Hospital Melbourne, Australia
| | - Mark Cook
- Chair of Medicine, University of Melbourne, Professor and Director of Neurology, St Vincent's Hospital Melbourne, Australia
| | - John Stephenson
- Senior Lecturer in Biomedical Statistics, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Jo-Ann Giandinoto
- PhD Student, School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
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Oppenheimer J, Leviton A, Chiujdea M, Antonetty A, Ojo OW, Garcia S, Weas S, Fleegler EW, Chan E, Loddenkemper T. Caring electronically for young outpatients who have epilepsy. Epilepsy Behav 2018; 87:226-232. [PMID: 30197227 DOI: 10.1016/j.yebeh.2018.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to review electronic tools that might improve the delivery of epilepsy care, reduce medical care costs, and empower families to improve self-management capability. METHOD We reviewed the epilepsy-specific literature about self-management, electronic patient-reported or provider-reported outcomes, on-going remote surveillance, and alerting/warning systems. CONCLUSIONS The improved care delivery system that we envision includes self-management, electronic patient (or provider)-reported outcomes, on-going remote surveillance, and alerting/warning systems. This system and variants have the potential to reduce seizure burden through improved management, keep children out of the emergency department and hospital, and even reduce the number of outpatient visits.
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Affiliation(s)
- Julia Oppenheimer
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alan Leviton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Madeline Chiujdea
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Annalee Antonetty
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Oluwafemi William Ojo
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephanie Garcia
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Weas
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eric W Fleegler
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eugenia Chan
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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20
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Yeni K, Tulek Z, Simsek OF, Bebek N. Relationships between knowledge, attitudes, stigma, anxiety and depression, and quality of life in epilepsy: A structural equation modeling. Epilepsy Behav 2018; 85:212-217. [PMID: 30032810 DOI: 10.1016/j.yebeh.2018.06.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Epilepsy not only is a medical disorder characterized by seizures, but is also associated with stigma and a neurological disorder that affects quality of life. Insufficient knowledge and misconceptions about epilepsy that causes the development of negative attitudes towards patients with epilepsy increase the stigmatization and psychosocial problems and impact the quality of life. The aim of this study was to examine the relationship between epilepsy knowledge, attitude, stigma, anxiety and depression, and quality of life within the framework of structural equation modeling. METHOD This research was carried out between May 2015 and May 2016 at the Epilepsy Outpatient Clinic of Istanbul University Istanbul Faculty of Medicine. The Epilepsy Knowledge Scale, Epilepsy Attitude Scale, Stigma Scale, Hospital Anxiety and Depression Scale, and Quality of Life in Epilepsy Scale-10 (QOLIE-10) were used. To determine the relationship between the concepts, research hypotheses were created, and structural equation modeling was made. RESULTS Two hundred five patients were included in the study, 53.7% were women, and the mean age was 32.5. It was found that 72.2% had generalized seizures, and 46.3% had more than one seizure per month. According to our proposed model, knowledge had a moderate relationship with attitude (including stigma) (r = 0.50) that, in turn, had a strong relationship with mental health (r = -0.62) while a moderate relationship with quality of life (r = 0.45). Our findings revealed that proposed model accounted for 20% of the variance in quality of life and 39% of the variance in mental health (anxiety and depression). CONCLUSION Mental health and quality of life of patient with epilepsy are closely related to the knowledge, attitude, and perceived stigma of the patients. Therefore, educating/supporting patients can help increase the mental health and quality of life.
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Affiliation(s)
- Kubra Yeni
- Ondokuz Mayis University, Faculty of Health Sciences, Turkey
| | - Zeliha Tulek
- Istanbul University-Cerrahpasa, Florence Nightingale Faculty of Nursing, Turkey.
| | - Omer Faruk Simsek
- Istanbul Arel University, Faculty of Science and Letters, Department of Psychology, Turkey
| | - Nerses Bebek
- Istanbul University, Istanbul Medical Faculty, Department of Neurology, Turkey
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Afra P, Bruggers CS, Sweney M, Fagatele L, Alavi F, Greenwald M, Huntsman M, Nguyen K, Jones JK, Shantz D, Bulaj G. Mobile Software as a Medical Device (SaMD) for the Treatment of Epilepsy: Development of Digital Therapeutics Comprising Behavioral and Music-Based Interventions for Neurological Disorders. Front Hum Neurosci 2018; 12:171. [PMID: 29780310 PMCID: PMC5946004 DOI: 10.3389/fnhum.2018.00171] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/12/2018] [Indexed: 12/29/2022] Open
Abstract
Digital health technologies for people with epilepsy (PWE) include internet-based resources and mobile apps for seizure management. Since non-pharmacological interventions, such as listening to specific Mozart's compositions, cognitive therapy, psychosocial and educational interventions were shown to reduce epileptic seizures, these modalities can be integrated into mobile software and delivered by mobile medical apps as digital therapeutics. Herein, we describe: (1) a survey study among PWE about preferences to use mobile software for seizure control, (2) a rationale for developing digital therapies for epilepsy, (3) creation of proof-of-concept mobile software intended for use as an adjunct digital therapeutic to reduce seizures, and (4) broader applications of digital therapeutics for the treatment of epilepsy and other chronic disorders. A questionnaire was used to survey PWE with respect to preferred features in a mobile app for seizure control. Results from the survey suggested that over 90% of responders would be interested in using a mobile app to manage their seizures, while 75% were interested in listening to specific music that can reduce seizures. To define digital therapeutic for the treatment of epilepsy, we designed and created a proof-of-concept mobile software providing digital content intended to reduce seizures. The rationale for all components of such digital therapeutic is described. The resulting web-based app delivered a combination of epilepsy self-care, behavioral interventions, medication reminders and the antiseizure music, such as the Mozart's sonata K.448. To improve long-term patient engagement, integration of mobile medical app with music and multimedia streaming via smartphones, tablets and computers is also discussed. This work aims toward development and regulatory clearance of software as medical device (SaMD) for seizure control, yielding the adjunct digital therapeutic for epilepsy, and subsequently a drug-device combination product together with specific antiseizure medications. Mobile medical apps, music, therapeutic video games and their combinations with prescription medications present new opportunities to integrate pharmacological and non-pharmacological interventions for PWE, as well as those living with other chronic disorders, including depression and pain.
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Affiliation(s)
- Pegah Afra
- Department of Neurology, University of Utah, Salt Lake City, UT, United States.,Department of Neurology, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Carol S Bruggers
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Matthew Sweney
- Department of Neurology, University of Utah, Salt Lake City, UT, United States.,Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Lilly Fagatele
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Fareeha Alavi
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Michael Greenwald
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Merodean Huntsman
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Khanhly Nguyen
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Jeremiah K Jones
- Software Development Center, University of Utah, Salt Lake City, UT, United States
| | | | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
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Smith G, Modi AC, Johnson EK, Shegog R, Austin JK, Wagner JL. Measurement in pediatric epilepsy self-management: A critical review. Epilepsia 2018; 59:509-522. [PMID: 29322489 DOI: 10.1111/epi.13992] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 11/30/2022]
Abstract
Given the paucity of information available regarding self-management, the aims of this paper are to synthesize the literature on factors associated with and measures to assess self-management in pediatric epilepsy. INCLUSION CRITERIA youth birth to 18 years with a seizure disorder or an epilepsy diagnosis and/or their caregivers, published 1985-2014 in English, and conducted in countries with a very high human development index. The review was conducted in 6 phases: (1) identification of bibliographical search criteria and databases; (2) abstract assessment; (3) full article review; (4) organization of final citations into categories; (5) identification of predictors, potential mediators/moderators, and outcomes associated with self-management factors and categorization of factors as influences, processes, or behaviors across individual, family, community, and health care domains; and (6) critique of self-management instrument studies. Twenty-five studies that evaluated factors associated with self-management were identified. Individual and family-focused factors were the most commonly studied predictors of self-management, with psychosocial care needs and self-efficacy for seizure management identified as key factors associated with pediatric epilepsy self-management. Few studies have included mediator and moderator analyses. Measures of adherence were the most commonly used outcome. There has been a predominant focus on pediatric epilepsy influences and processes that are modifiable in nature, potentially at the expense of evidence for the role of community and health systems in pediatric epilepsy self-management. The 6 self-management instrument tools reported scientific rationale and good psychometric properties. Results highlight several key modifiable cognitive and behavioral targets for skills development: adherence, self-efficacy for seizure management, attitudes toward epilepsy, and family variables. Moving forward, a comprehensive pediatric epilepsy self-management model, well-validated measures of self-management behaviors, mediator/moderator designs to examine the complex relationships between predictors and pediatric epilepsy self-management outcomes, and studies examining the community and health care domains of self-management are necessary.
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Affiliation(s)
- Gigi Smith
- College of Nursing, Department of Pediatrics, Comprehensive Epilepsy Center, Medical University of South Carolina, Charleston, SC, USA
| | - Avani C Modi
- Center for Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Erica K Johnson
- School of Public Health, Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, UT Health School of Public Health, Houston, TX, USA
| | - Joan K Austin
- School of Nursing, Indiana University-Purdue University Indianapolis, Bloomington, IN, USA
| | - Janelle L Wagner
- College of Nursing, Department of Pediatrics, Comprehensive Epilepsy Center, Medical University of South Carolina, Charleston, SC, USA
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Shegog R, Begley CE. Clinic-Based Mobile Health Decision Support to Enhance Adult Epilepsy Self-Management: An Intervention Mapping Approach. Front Public Health 2017; 5:256. [PMID: 29043247 PMCID: PMC5632356 DOI: 10.3389/fpubh.2017.00256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 09/08/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Epilepsy is a neurological disorder involving recurrent seizures. It affects approximately 5 million people in the U.S. To optimize their quality of life people with epilepsy are encouraged to engage in self-management (S-M) behaviors. These include managing their treatment (e.g., adhering to anti-seizure medication and clinical visit schedules), managing their seizures (e.g., responding to seizure episodes), managing their safety (e.g., monitoring and avoiding environmental seizure triggers), and managing their co-morbid conditions (e.g., anxiety, depression). The clinic-based Management Information Decision Support Epilepsy Tool (MINDSET) is a decision-support system founded on theory and empirical evidence. It is designed to increase awareness by adult patients (≥18 years) and their health-care provider regarding the patient's epilepsy S-M behaviors, facilitate communication during the clinic visit to prioritize S-M goals and strategies commensurate with the patient's needs, and increase the patient's self-efficacy to achieve those goals. METHODS The purpose of this paper is to describe the application of intervention mapping (IM) to develop, implement, and formatively evaluate the clinic-based MINDSET prototype and in developing implementation and evaluation plans. Deliverables comprised a logic model of the problem (IM Step 1); matrices of program objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); a functional MINDSET program prototype (IM Step 4); plans for implementation (IM Step 5); and evaluation (IM Step 6). IM provided a logical and systematic approach to developing and evaluating clinic-based decision support toward epilepsy S-M.
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Affiliation(s)
- Ross Shegog
- School of Public Health, University of Texas Health Science Center, Houston, TX, United States
| | - Charles E. Begley
- School of Public Health, University of Texas Health Science Center, Houston, TX, United States
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Mugumbate J, Gray M. Individual resilience as a strategy to counter employment barriers for people with epilepsy in Zimbabwe. Epilepsy Behav 2017; 74:154-160. [PMID: 28768229 DOI: 10.1016/j.yebeh.2017.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/05/2017] [Accepted: 06/14/2017] [Indexed: 11/29/2022]
Abstract
Understanding individual resilience helps to improve employment opportunities of people with epilepsy. This is significant because, in Zimbabwe, as in many other countries in the Global South, people with epilepsy encounter several barriers in a context of less-than-ideal public services. Despite this disadvantage, some people with epilepsy have better employment outcomes for reasons including level of seizure control, social background, employment support services, and individual resilience. This article reports on data from participants (n=8), who were part of a larger study (n=30) on employment experiences of people with epilepsy in Harare. The study used in-depth interviews with the participants, who were all service users and members of the Epilepsy Support Foundation (ESF) in Harare. The eight resilient participants comprised four males and four females aged between 26-48years, who were selected because, unlike the remaining 22 participants, they had overcome chronic unemployment. Seven of the eight participants were employed, while one had recently become unemployed. Views of service providers (n=7) were sought on the experiences of people with epilepsy through a focus group discussion. The service providers included two health workers, three social service workers, and two disability advocacy workers. Data were analysed using NVivo, a computer-assisted qualitative data analysis package. The study found that participants experienced barriers, such as a lack of medical treatment, yet this was important for education and training, lack of finances for training, and negative attitudes at workplaces. Despite these barriers, participants had overcome chronic unemployment due to their individual resilience characterised by: (i) a 'fighting spirit', (ii) being their own advocates, and (iii) having a mastery over, and acceptance of, their epilepsy. The research concluded that, where people with epilepsy faced barriers, as in Zimbabwe, individual resilience acted as a strong coping mechanism that resulted in better employment outcomes. This suggested service providers should strengthen resilience-building initiatives and make them more accessible to people with epilepsy. However, this is only a coping mechanism that should not stop service providers and service users from advocating for government-provided employment services.
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Affiliation(s)
- Jacob Mugumbate
- School of Humanities and Social Science, University of Newcastle, New South Wales, Australia.
| | - Mel Gray
- School of Humanities and Social Science, University of Newcastle, New South Wales, Australia
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25
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Characteristics associated with quality of life among people with drug-resistant epilepsy. J Neurol 2017; 264:1174-1184. [PMID: 28550480 PMCID: PMC5486549 DOI: 10.1007/s00415-017-8512-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/19/2017] [Accepted: 05/06/2017] [Indexed: 12/02/2022]
Abstract
Quality of Life (QoL) is the preferred outcome in non-pharmacological trials, but there is little UK population evidence of QoL in epilepsy. In advance of evaluating an epilepsy self-management course we aimed to describe, among UK participants, what clinical and psycho-social characteristics are associated with QoL. We recruited 404 adults attending specialist clinics, with at least two seizures in the prior year and measured their self-reported seizure frequency, co-morbidity, psychological distress, social characteristics, including self-mastery and stigma, and epilepsy-specific QoL (QOLIE-31-P). Mean age was 42 years, 54% were female, and 75% white. Median time since diagnosis was 18 years, and 69% experienced ≥10 seizures in the prior year. Nearly half (46%) reported additional medical or psychiatric conditions, 54% reported current anxiety and 28% reported current depression symptoms at borderline or case level, with 63% reporting felt stigma. While a maximum QOLIE-31-P score is 100, participants’ mean score was 66, with a wide range (25–99). In order of large to small magnitude: depression, low self-mastery, anxiety, felt stigma, a history of medical and psychiatric comorbidity, low self-reported medication adherence, and greater seizure frequency were associated with low QOLIE-31-P scores. Despite specialist care, UK people with epilepsy and persistent seizures experience low QoL. If QoL is the main outcome in epilepsy trials, developing and evaluating ways to reduce psychological and social disadvantage are likely to be of primary importance. Educational courses may not change QoL, but be one component supporting self-management for people with long-term conditions, like epilepsy.
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26
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Pembroke S, Higgins A, Pender N, Elliott N. Becoming comfortable with "my" epilepsy: Strategies that patients use in the journey from diagnosis to acceptance and disclosure. Epilepsy Behav 2017; 70:217-223. [PMID: 28437750 DOI: 10.1016/j.yebeh.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Proponents of resilience theory have highlighted the importance of understanding the processes of resilience. The objective of the study was to explore how people with epilepsy reach a stage of being comfortable with their epilepsy. Identifying the processes used is important to developing effective self-management for people who are newly diagnosed with epilepsy. METHOD A grounded theory approach involving forty-nine consenting adult people with epilepsy (18 years and over), was used to explore their first-hand experiences of coming to terms with their epilepsy. Data were collected using one-to-one interview to elicit in-depth personal accounts of people with epilepsy's experiences of adjusting to their diagnosis of epilepsy. Using grounded theory's systematic inductive-deductive process data of analysis, the core findings that emerged from the open coding and inductive phase were analyzed independently by two researchers to ensure that findings were verified and validated across the interview dataset. FINDINGS Three core categories emerged as central to the journey that people experience after receiving their diagnosis of epilepsy towards becoming comfortable with their epilepsy. These were: i) meaning of "my" epilepsy diagnosis, to capture people with epilepsy's feelings, reactions and concerns after being diagnosed with epilepsy, ii) useful strategies, to identify what people with epilepsy did to become comfortable with their diagnosis, and iii) being comfortable with my epilepsy, to account for the frame of mind of people with epilepsy when they reach a point of accepting their diagnosis. DISCUSSION The findings provide important insights into the personal experiences of people with epilepsy after receiving their diagnosis and identifies a range of strategies they find useful in helping them reach a position of acceptance and being 'comfortable with my epilepsy'.
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Affiliation(s)
- Sinead Pembroke
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Naomi Elliott
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
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Yennadiou H, Wolverson E. The experience of epilepsy in later life: A qualitative exploration of illness representations. Epilepsy Behav 2017; 70:87-93. [PMID: 28411521 DOI: 10.1016/j.yebeh.2017.01.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/08/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study was to explore how older people living with epilepsy appraise their condition through their lived-experience. The common-sense model of illness representations (CSMIR) provides a framework to explain how individuals make sense of and manage health threats. Semi-structured in-depth interviews based on the CSMIR were conducted with ten people with epilepsy who were above the age of 65. The results were analyzed using Interpretative Phenomenological Analysis. Three overarching themes emerged from the analysis: 'the power of epilepsy', 'they say you can live a normal life but you can't' and 'attempts to adjust and cope'. Epilepsy was described as a threatening, persistent, and unpredictable condition associated with distressing experiences. Participants described a process of balancing negative psychosocial consequences including stigma, loss of control, and reliance on other people and medication with parallel co-existing coping strategies. These attempts to manage the condition were characterized by a desire for acceptance and increased awareness of epilepsy, strategies to restore loss of control, and strength derived from supportive relationships. We conclude that there is large scope for psychosocial interventions in healthcare provision for this patient group. The roles of specialist nursing, relationship-centered models, psychotherapy, educational, and self-management programs are highlighted.
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Affiliation(s)
- Haris Yennadiou
- The University of Hull, Faculty of Health and Social Care, Aire Building, Hull, Cottingham Road, Hull HU6 7RX, UK.
| | - Emma Wolverson
- The University of Hull, Faculty of Health and Social Care, Aire Building, Hull, Cottingham Road, Hull HU6 7RX, UK.
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Helmers SL, Kobau R, Sajatovic M, Jobst BC, Privitera M, Devinsky O, Labiner D, Escoffery C, Begley CE, Shegog R, Pandey D, Fraser RT, Johnson EK, Thompson NJ, Horvath KJ. Self-management in epilepsy: Why and how you should incorporate self-management in your practice. Epilepsy Behav 2017; 68:220-224. [PMID: 28202408 PMCID: PMC5381244 DOI: 10.1016/j.yebeh.2016.11.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Rosemarie Kobau
- Centers for Disease Control and Prevention, Epilepsy Program, Atlanta, GA.
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Mengoni SE, Gates B, Parkes G, Wellsted D, Barton G, Ring H, Khoo ME, Monji-Patel D, Friedli K, Zia A, Irvine L, Durand MA. Wordless intervention for people with epilepsy and learning disabilities (WIELD): a randomised controlled feasibility trial. BMJ Open 2016; 6:e012993. [PMID: 28186943 PMCID: PMC5128894 DOI: 10.1136/bmjopen-2016-012993] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/01/2016] [Accepted: 08/25/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of a full-scale randomised controlled trial of a picture booklet to improve quality of life for people with epilepsy and learning disabilities. TRIAL DESIGN A randomised controlled feasibility trial. Randomisation was not blinded and was conducted using a centralised secure database and a blocked 1:1 allocation ratio. SETTING Epilepsy clinics in 1 English National Health Service (NHS) Trust. PARTICIPANTS Patients with learning disabilities and epilepsy who had: a seizure within the past 12 months, meaningful communication and a carer with sufficient proficiency in English. INTERVENTION Participants in the intervention group used a picture booklet with a trained researcher, and a carer present. These participants kept the booklet, and were asked to use it at least twice more over 20 weeks. The control group received treatment as usual, and were provided with a booklet at the end of the study. OUTCOME MEASURES 7 feasibility criteria were used relating to recruitment, data collection, attrition, potential effect on epilepsy-related quality of life (Epilepsy and Learning Disabilities Quality of Life Scale, ELDQOL) at 4-week, 12-week and 20-week follow-ups, feasibility of methodology, acceptability of the intervention and potential to calculate cost-effectiveness. OUTCOME The recruitment rate of eligible patients was 34% and the target of 40 participants was reached. There was minimal missing data and attrition. An intention-to-treat analysis was performed; data from the outcome measures suggest a benefit from the intervention on the ELDQOL behaviour and mood subscales at 4 and 20 weeks follow-up. The booklet and study methods were positively received, and no adverse events were reported. There was a positive indication of the potential for a cost-effectiveness analysis. CONCLUSIONS All feasibility criteria were fully or partially met, therefore confirming feasibility of a definitive trial. TRIAL REGISTRATION NUMBER ISRCTN80067039.
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Affiliation(s)
- Silvana E Mengoni
- Department of Psychology, Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
| | - Bob Gates
- Institute for Practice, Interdisciplinary Research and Enterprise (INSPIRE), University of West London, London, UK
| | - Georgina Parkes
- Learning Disabilities Services, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - David Wellsted
- Department of Psychology, Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
| | - Garry Barton
- Norwich Medical School and Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Howard Ring
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Mary Ellen Khoo
- Research and Development, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Deela Monji-Patel
- Research and Development, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
- Division 4, Mental Health, NIHR Clinical Research Network: Eastern, UK
| | - Karin Friedli
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Asif Zia
- Learning Disabilities Services, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Lisa Irvine
- Norwich Medical School and Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Marie-Anne Durand
- Department of Psychology, Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
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Mengoni SE, Gates B, Parkes G, Wellsted D, Barton G, Ring H, Khoo ME, Monji-Patel D, Friedli K, Zia A, Durand MA. "Sometimes, it just stops me from doing anything": A qualitative exploration of epilepsy management in people with intellectual disabilities and their carers. Epilepsy Behav 2016; 64:133-139. [PMID: 27736660 PMCID: PMC5140003 DOI: 10.1016/j.yebeh.2016.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/02/2016] [Accepted: 09/18/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Epilepsy affects 1 in 5 people with an intellectual disability (ID), but little is known about their experiences of living with epilepsy. A qualitative study was conducted to investigate the impact and management of epilepsy in people with ID. MATERIALS AND METHODS People with epilepsy and ID and their carers were invited to take part in semi-structured interviews. Eleven participants with ID and their carers were interviewed together, one participant with ID and their carer were interviewed separately, two interviews took place with the participant with ID only, and one interview took place with the carer only. The interviews were transcribed verbatim, coded, and analyzed thematically (dual independent coding for 30% of the transcripts). RESULTS Three themes emerged (participant characteristics, living with epilepsy, epilepsy management and information needs) which indicated the following: 1) diversity regarding health profiles, communication abilities, severity of epilepsy, perceived control of epilepsy, and support needs; 2) a reduction in severity and frequency of seizures for a sizeable proportion of participants through antiepileptic drugs; 3) the lifelong impact of epilepsy and related seizures on participants' activities and quality of life; 4) the perceived burden of epilepsy and difficulty managing the condition for a large proportion of participants; 5) high levels of satisfaction with epilepsy-related services and care; and 6) an overall lack of written accessible information about epilepsy. CONCLUSIONS This study has highlighted a significant impact of epilepsy and related seizures on the daily lives and quality of life of people with ID. Although a sizeable proportion of participants and their carers considered their epilepsy to be well controlled, the majority reported difficulties managing epilepsy and minimizing its impact on their wellbeing. Excluding care staff and the support provided by epilepsy clinics, the participants had not accessed any adapted self-management or information resources about epilepsy.
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Affiliation(s)
- Silvana E Mengoni
- Centre for Health Services and Clinical Research, Department of Psychology, University of Hertfordshire, Hatfield, UK.
| | - Bob Gates
- Institute for Practice, Interdisciplinary Research and Enterprise (INSPIRE), University of West London, UK
| | - Georgina Parkes
- Learning Disabilities Services, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - David Wellsted
- Centre for Health Services and Clinical Research, Department of Psychology, University of Hertfordshire, Hatfield, UK
| | - Garry Barton
- Norwich Medical School and Norwich Clinical Trials Unit, University of East Anglia, UK
| | - Howard Ring
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Box 189, Cambridge Biomedical Campus, Cambridge CB2 2QQ, UK
| | - Mary Ellen Khoo
- Research and Development, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Deela Monji-Patel
- Research and Development, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK; NIHR Clinical Research Network: Eastern, Division 4, Mental Health, UK
| | - Karin Friedli
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Asif Zia
- Learning Disabilities Services, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Marie-Anne Durand
- Centre for Health Services and Clinical Research, Department of Psychology, University of Hertfordshire, Hatfield, UK; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
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Chen HF, Tsai YF, Hsi MS, Chen JC. Factors affecting quality of life in adults with epilepsy in Taiwan: A cross-sectional, correlational study. Epilepsy Behav 2016; 58:26-32. [PMID: 27002941 DOI: 10.1016/j.yebeh.2016.02.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 02/12/2016] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to assess eight factors considered important for quality of life in persons with epilepsy in order to determine which of these components affect quality of life in adults with epilepsy in Taiwan. METHODS A cross-sectional, correlational study using structured questionnaires assessed 260 patients with epilepsy purposively sampled from a medical center in Northern Taiwan. Health-related quality of life (HRQoL) was evaluated with the Quality of Life in Epilepsy-31 (QOLIE-31) questionnaire. Data also included personal and health-related characteristics, knowledge of epilepsy, efficacy in the self-management of epilepsy, and social support. RESULTS Scores for the QOLIE-31 were correlated with the following factors: (1) demographic characteristics of age, gender, and income; (2) sleep quality; (3) symptoms of anxiety and depression; (4) epilepsy-specific variables: seizure frequency; types, number, and frequency of antiepileptic drugs (AEDs); and adverse events of AEDs; and (5) social support. Stepwise regression analysis showed that seven factors were predictive for quality of life: anxiety, depression, adverse events of AEDs, social support, seizure frequency of at least once in three months, household income of NT$ 40,001-100,000, and male gender. These factors accounted for 58.2% of the variance of quality of life. SIGNIFICANCE Our study assessed multiple factors in an examination of relationships and predictive factors for quality of life in adults with epilepsy in Taiwan. Knowledge of these contributing factors can assist health-care providers when evaluating patients with epilepsy to help target interventions for improving quality of life.
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Affiliation(s)
- Hsiu-Fang Chen
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| | - Mo-Song Hsi
- Department of Neurology, Chang Gung Memorial Hospital at Taipei, Taiwan; Taiwan Epilepsy Association, Taiwan
| | - Jui-Chen Chen
- Department of Nursing, Chang Gung Memorial Hospital at Taipei, Taiwan; Taiwan Epilepsy Association, Taiwan
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Shafer PO, Buchhalter J. Patient Education: Identifying Risks and Self-Management Approaches for Adherence and Sudden Unexpected Death in Epilepsy. Neurol Clin 2016; 34:443-56, ix. [PMID: 27086989 DOI: 10.1016/j.ncl.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patient education in epilepsy is one part of quality epilepsy care and is an evolving and growing field. Health outcomes, patient satisfaction, safety, patient/provider communication, and quality of life may all be affected by what people are taught (or not taught), what they understand, and how they use this information to make decisions and manage their health. Data regarding learning needs and interventions to address medication adherence and sudden unexpected death in epilepsy education can be used to guide clinicians in health care or community settings.
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Affiliation(s)
- Patricia Osborne Shafer
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue KS 457, Boston, MA 02215, USA; Epilepsy Foundation, Landover, MD 20785-2353, USA.
| | - Jeffrey Buchhalter
- Comprehensive Children's Epilepsy Centre, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail Northwest, Calgary, Alberta T3B 6A8, Canada
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33
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Hosseini N, Sharif F, Ahmadi F, Zare M. Determining the disease management process for epileptic patients: A qualitative study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:54-62. [PMID: 26985223 PMCID: PMC4776561 DOI: 10.4103/1735-9066.174748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Epilepsy exposes patients to many physical, social, and emotional challenges. Thus, it seems to portray a complex picture and needs holistic care. Medical treatment and psychosocial part of epilepsy remain central to managing and improving the patient's qualify of life through team efforts. Some studies have shown the dimensions of self-management, but its management process of epilepsy patients, especially in Iran, is not clear. This study aimed to determine the disease management process in patients with epilepsy in Iran. MATERIALS AND METHODS This qualitative approach and grounded theory study was conducted from January 2009 to February 2012 in Isfahan city (Iran). Thirty-two participants were recruited by the goal-oriented, and snowball sample selection and theoretical sampling methods. After conducting a total of 43 in-depth interviews with the participants, the researchers reached data saturation. Data were analyzed using Strauss and Corbin method. RESULTS With a focus on disease management process, researchers found three main themes and seven sub-themes as a psychosocial process (PSP). The main themes were: perception of threat to self-identity, effort to preserve self-identity, and burn out. The psychosocial aspect of the disease generated one main variable "the perception of identity loss" and one central variable "searching for self-identity." CONCLUSIONS Participants attributed threat to self-identity and burn out to the way their disease was managed requiring efforts to preserve their identity. Recommendations consist of support programs and strategies to improve the public perception of epilepsy in Iran, help patients accept their condition and preserve self-identity, and most importantly, enhance medical management of epilepsy.
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Affiliation(s)
- Nazafarin Hosseini
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Farkhondeh Sharif
- Department of Psychiatric Nursing, Community Based Psychiatric Nursing Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammad Zare
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
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Blond BN, Detyniecki K, Hirsch LJ. Assessment of Treatment Side Effects and Quality of Life in People with Epilepsy. Neurol Clin 2016; 34:395-410, viii. [PMID: 27086986 DOI: 10.1016/j.ncl.2015.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epilepsy impairs quality of life in physical, psychological, cognitive, social, and occupational domains. In people who are not seizure free, depression and adverse medication effects have a predominant role in determining quality of life. The assessment of these factors and other comorbidities is essential for maximizing quality of life in epilepsy. There are multiple tools available to assess medication effects and quality of life in a structured format. Such tools can provide superior assessments and allow clinicians to have a greater impact on their patients' quality of life.
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Affiliation(s)
- Benjamin N Blond
- Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA
| | - Kamil Detyniecki
- Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA
| | - Lawrence J Hirsch
- Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA.
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