Effectiveness of a Self-Management Program to Improve Cognition and Quality of Life in Epilepsy

Abstract

Objective:To determine the effectiveness of HOBSCOTCH (Home-based self-management and cognitive training changes lives) in a real-world setting, and to assess feasibility of a virtual intervention, we conducted a multi-site, pragmatic replication trial at four New England epilepsy centers.Methods:HOBSCOTCH is an 8-session intervention addressing cognitive impairment and quality of life (QOL) for people with epilepsy (PWE). Participants were recruited from epilepsy centers in four states and block-randomized into the following groups: in-person HOBSCOTCH (H-IP), virtual HOBSCOTCH (H-V), and waitlist control. Outcome measures were assessed for all groups at baseline, 3-months, and 6-months; intervention groups received long-term follow-up at 9- and 12-months.Results:A total of 108 participants were recruited, of which 85 were included in this analysis (age at baseline 47.5 ± 11.5 years; 68% female). Participants completing the in-person intervention (H-IP) had a 12.4-point improvement in QOL score compared to controls (p < 0.001). Pairwise comparisons found a 6.2-point treatment effect for subjective cognition in the H-IP group (p < 0.001). There were no meaningful group differences in objective cognition or healthcare utilization at any timepoints, and the treatment effect for QOL diminished by 6-months. The virtual intervention demonstrated feasibility, but did not significantly improve outcomes compared to controls. Within-group analysis found improvements in QOL for both H-V and H-IP.Conclusions:This study replicated the effectiveness of the HOBSCOTCH program in improving QOL for PWE. The study was conducted prior to the COVID-19 pandemic, but the distance-delivered intervention may be particularly well-suited for the current environment. Future research will explore modifications designed to improve the efficacy of H-V and the sustainability of HOBSCOTCH’s treatment effect.Classification of Evidence:This study provides Class III evidence that in-person HOBSCOTCH delivery improved subjective measures of cognition in persons with epilepsy.The study was registered and listed on ClinicalTrials.gov (NCT02394509)

Rehabilitation of cognition and psychosocial well-being – a better life with epilepsy (ReCaP-ABLE): a protocol for a randomized waitlist-controlled trial

“…Patients will also complete a metacognition questionnaire – a relatively novel tool in PWE set to assess coping and thinking mechanisms that underlie self-regulation in psychopathology and may help to explain better response to CoRE ( 17 , 18 ). Finally, patient-oriented outcome measures (i.e., quality of life) will be essential to define the overall impact of the CoRE program ( 30 , 31 ).…”

HOBSCOTCH Your Way to Improved Cognition for Patients With Epilepsy

“…HOBSCOTCH uses patient education, self-monitoring, problem-solving therapy (PST), and memory strategies to target cognitive impairment in PWE. 3 The hope was to improve QoL by improving the ability to cope with cognitive challenges. There were 8 sessions delivered by trained coaches who focused on rapport building, validating participants’ memory challenges, and helping them to identify cognition-related problems and develop solutions.…”

Beyond Seizures

“…Patients often ask us what they can do to take charge of their epilepsy, participate in their own care, and improve quality of life. In this issue of Neurology® , Streltzov et al 1 examined the value of a self-management and cognitive training program in people with epilepsy (PWE) and compared the intervention using in-person and virtual platforms. They found improvements in quality of life and subjective measures of cognition in people participating in the in-person sessions but less of an effect in those using a fully virtual format.…”

“…8 The Centers for Disease Control and Prevention (CDC) funded a research network focused on the study and development of self-management programs for PWE aimed at improvement in quality of life. 8 Streltzov et al 1 leverage the support from this network to compare the efficacy of selfmanagement training in PWE reporting cognitive complaints using in-person and virtual platforms. They also assess the feasibility and durability of a novel virtual form of the intervention.…”

“…Streltzov et al 1 leverage the support from this network to compare the efficacy of self-management training in PWE reporting cognitive complaints using in-person and virtual platforms. They also assess the feasibility and durability of a novel virtual form of the intervention.…”