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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. [PMID: 38624142 DOI: 10.1111/epi.17985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Hutchinson K, Ryder T, Coleman H, Nullwala R, Herkes G, Bleasel A, Nikpour A, Wong C, Todd L, Ireland C, Shears G, Bartley M, Groot W, Kerr M, Vagholkar S, Braithwaite J, Rapport F. Determining the role and responsibilities of the community epilepsy nurse in the management of epilepsy. J Clin Nurs 2022. [PMID: 36494199 DOI: 10.1111/jocn.16582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/28/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study is to enhance the understanding of the core elements and influencing factors on the community-based epilepsy nurse's role and responsibilities. BACKGROUND Internationally, epilepsy nurse specialists play a key role in providing person-centred care and management of epilepsy but there is a gap in understanding of their role in the community. DESIGN A national three-stage, mixed-method study was conducted. METHODS One-on-one, in-depth semi-structured qualitative interviews were conducted online with 12 community-based epilepsy nurses (Stage 1); retrospective analysis of data collected from the National Epilepsy Line, a nurse-led community helpline (Stage 2); and focus group conducted with four epilepsy nurses, to delve further into emerging findings (Stage 3). A thematic analysis was conducted in Stages 1 and 3, and a descriptive statistical analysis of Stage 2 data. Consolidated Criteria for Reporting Qualitative studies checklist was followed for reporting. RESULTS Three key themes emerged: (1) The epilepsy nurse career trajectory highlighted a lack of standardised qualifications, competencies, and career opportunities. (2) The key components of the epilepsy nurse role explored role diversity, responsibilities, and models of practice in the management of living with epilepsy, and experiences navigating complex fragmented systems and practices. (3) Shifting work practices detailed the adapting work practices, impacted by changing service demands, including COVID-19 pandemic experiences, role boundaries, funding, and resource availability. CONCLUSION Community epilepsy nurses play a pivotal role in providing holistic, person-centred epilepsy management They contribute to identifying and addressing service gaps through innovating and implementing change in service design and delivery. RELEVANCE TO CLINICAL PRACTICE Epilepsy nurses' person-centred approach to epilepsy management is influenced by the limited investment in epilepsy-specific integrated care initiatives, and their perceived value is impacted by the lack of national standardisation of their role and scope of practice. NO PATIENT OR PUBLIC CONTRIBUTION Only epilepsy nurses' perspectives were sought.
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Affiliation(s)
- Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Honor Coleman
- Melbourne School of Psychological Science, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Geoffrey Herkes
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Andrew Bleasel
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Armin Nikpour
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Chong Wong
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Lisa Todd
- Epilepsy Action Australia, North Ryde, New South Wales, Australia
| | - Carol Ireland
- Epilepsy Action Australia, North Ryde, New South Wales, Australia
| | | | - Melissa Bartley
- Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Wendy Groot
- Epilepsy Australia, Melbourne, Victoria, Australia.,Epilepsy Tasmania, Launceston, Tasmania, Australia
| | - Michael Kerr
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Sanjyot Vagholkar
- MQ Health General Practice, Macquarie University, North Ryde, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
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Hagemann A, Lahr D, May TW, Speicher P, Hausfeld H, Coban I, Müffelmann B, Bien CG, Specht U. Efficacy of a specialized inpatient rehabilitation program in patients with early versus chronic epilepsy. Epilepsy Behav 2022; 142:108999. [PMID: 36446667 DOI: 10.1016/j.yebeh.2022.108999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a specialized inpatient rehabilitation program in patients with early in comparison with chronic epilepsy. METHODS We performed a prospective, open pre/post study using a parallel group design. Patients with early epilepsy (EE, treatment with anti-seizure medication [ASM] ≤ 1 year) or with chronic epilepsy (CE, ASM treatment > 5 years) completed questionnaires at the time of their admission to the rehabilitation program and at discharge. Outcome measures comprised scales from the PESOS questionnaire (PErformance, SOciodemographic aspects, Subjective estimation; e.g., emotional adaptation to epilepsy) as well as screening instruments for depression (Neurological Disorders Depression Inventory for Epilepsy, NDDI-E) and anxiety (Generalized Anxiety Disorder Scale, GAD-7). Linear mixed models (LMMs) were used to determine the effects of the program in the total group and to compare the effects between patients with EE and CE. RESULTS The analyses included 79 patients with EE and 157 patients with CE. Baseline comparisons revealed differences in disease-related and sociodemographic variables (e.g., patients with EE were older, those with CE had a higher seizure frequency and a higher rate of unemployment; all p < .01). LMMs showed significant improvements in emotional adaptation to epilepsy, depression, anxiety, overall quality of life and overall health as well as in perceived overall restrictions because of epilepsy and the subjective level of information about epilepsy (all p < .001). Despite the different duration of epilepsy, baseline levels as well as improvements did not differ between patients with EE and CE (all p > .05) except for the perceived level of information, which was significantly lower in patients with EE at admission and improved to a higher extent in this group (both p < .001). CONCLUSION Both patients with EE and patients with CE who are referred to a specialized comprehensive rehabilitation program benefit from the participation in this program with respect to emotional adaptation to epilepsy, aspects of quality of life, and level of information about epilepsy.
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Affiliation(s)
- Anne Hagemann
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany.
| | - Denise Lahr
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Theodor W May
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany.
| | - Pascal Speicher
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Heiko Hausfeld
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Ingrid Coban
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Birgitt Müffelmann
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Christian G Bien
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany; Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Ulrich Specht
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
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Rozenek H, Zaręba K, Banasiewicz J, Wójtowicz S, Krasuski T, Owczarek K. The Quality of Life in Patients with Epilepsy in the Context of Sleep Problems and Sexual Satisfaction. Brain Sci 2021; 11:brainsci11060778. [PMID: 34208311 PMCID: PMC8231274 DOI: 10.3390/brainsci11060778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022] Open
Abstract
Epilepsy influences the quality of patient functioning in almost all aspects of life. This study aimed to assess the quality of difficulties with sleep initiation and those concerning sexual function, and to assess whether sleep disorders are associated with selected aspects of sexual function and quality of life. The study involved completing a quality-of-life questionnaire for persons with epilepsy: a QOLIE-31 questionnaire, and the present authors' questionnaire, including 20 questions. A total of 170 questionnaires were completed by 89 men and 81 women. Sleep problems of various frequency were reported by 98 participants (57.6%). Only 41% of patients were definitely satisfied with their sex life. The respondents who declared dissatisfaction with their sex life more often reported difficulties with sleep initiation (χ2 = 10.20; p ≤ 0.001). Moreover, those who claimed that epilepsy might contribute to sex life problems more commonly declared dissatisfaction with their sex life (χ2 = 20.01; p ≤ 0.001) and more frequently, reported difficulties with sleep initiation (χ2 = 6.30; p ≤ 0.012). The issues should constitute the constant element of medical history taking, as improvement in these areas of functioning may promote better quality of life in patients with epilepsy.
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Affiliation(s)
- Hanna Rozenek
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, 02-091 Warsaw, Poland; (H.R.); (J.B.); (S.W.); (T.K.); (K.O.)
| | - Kornelia Zaręba
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 01-004 Warsaw, Poland
- Correspondence: ; Tel.: +48-662-051-602
| | - Jolanta Banasiewicz
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, 02-091 Warsaw, Poland; (H.R.); (J.B.); (S.W.); (T.K.); (K.O.)
| | - Stanisław Wójtowicz
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, 02-091 Warsaw, Poland; (H.R.); (J.B.); (S.W.); (T.K.); (K.O.)
| | - Tomasz Krasuski
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, 02-091 Warsaw, Poland; (H.R.); (J.B.); (S.W.); (T.K.); (K.O.)
| | - Krzysztof Owczarek
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, 02-091 Warsaw, Poland; (H.R.); (J.B.); (S.W.); (T.K.); (K.O.)
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Josephson CB, Engbers JDT, Wang M, Perera K, Roach P, Sajobi TT, Wiebe S. Psychosocial profiles and their predictors in epilepsy using patient-reported outcomes and machine learning. Epilepsia 2020; 61:1201-1210. [PMID: 34080185 DOI: 10.1111/epi.16526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To apply unsupervised machine learning to patient-reported outcomes to identify clusters of epilepsy patients exhibiting unique psychosocial characteristics. METHODS Consecutive outpatients seen at the Calgary Comprehensive Epilepsy Program outpatient clinics with complete patient-reported outcome measures on quality of life, health state valuation, depression, and epilepsy severity and disability were studied. Data were acquired at each patient's first clinic visit. We used k-means++ to segregate the population into three unique clusters. We then used multinomial regression to determine factors that were statistically associated with patient assignment to each cluster. RESULTS We identified 462 consecutive patients with complete patient-reported outcome measure (PROM) data. Post hoc analysis of each cluster revealed one reporting elevated measures of psychosocial health on all five PROMs ("high psychosocial health" cluster), one with intermediate measures ("intermediate" cluster), and one with poor overall measures of psychosocial health ("poor psychosocial health" cluster). Failing to achieve at least 1 year of seizure freedom (relative risk [RR] = 4.34, 95% confidence interval [CI] = 2.13-9.09) predicted placement in the "intermediate" cluster relative to the "high" cluster. In addition, failing to achieve seizure freedom, social determinants of health, including the need for partially or completely subsidized income support (RR = 6.10, 95% CI = 2.79-13.31, P < .001) and inability to drive (RR = 4.03, 95% CI = 1.6-10.00, P = .003), and a history of a psychiatric disorder (RR = 3.16, 95% CI = 1.46-6.85, P = .003) were associated with the "poor" cluster relative to the "high" cluster. SIGNIFICANCE Seizure-related factors appear to drive placement in the "intermediate" cluster, with social determinants driving placement in the "poor" cluster, suggesting a threshold effect. Precision intervention based on cluster assignment, with an initial emphasis on improving social support and careful titration of medications for those reporting the worst psychosocial health, could help optimize health for patients with epilepsy.
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Affiliation(s)
- Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada
| | | | - Meng Wang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Pamela Roach
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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