Self-management in epilepsy: Why and how you should incorporate self-management in your practice

Helmers, Sandra L.; Kobau, Rosemarie; Sajatovic, Martha; Jobst, Barbara C.; Privitera, Michael; Devinsky, Orrin; Labiner, David M.; Escoffery, Cam; Begley, Charles E.; Shegog, Ross; Pandey, Dilip K.; Fraser, Robert; Johnson, Erica K.; Thompson, Nancy J.; Horvath, Keith J.

doi:10.1016/j.yebeh.2016.11.015

Cited by 46 publications

(17 citation statements)

References 44 publications

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“…Although this RCT did not specifically include either a diagnosis of depression or any specific depressive symptom severity threshold in study inclusion criteria, we expected that individuals with poorly controlled epilepsy might have substantial depressive symptom severity upon enrollment, and this turned out to be the case. The relevance of depressive symptom severity to the quality of life and other outcomes in people with epilepsy is substantial, and for this reason, the Managing Epilepsy Well Network has prioritized a focus on mental health comorbidity . A study of people with poorly controlled epilepsy found that in the order of large to small magnitude, depression, low self‐mastery, anxiety, stigma, medical and psychiatric comorbidity, poor medication adherence, and more frequent seizures were associated with worse quality of life .…”

Section: Discussionmentioning

confidence: 99%

“…The relevance of depressive symptom severity to the quality of life and other outcomes in people with epilepsy is substantial, and for this reason, the Managing Epilepsy Well Network has prioritized a focus on mental health comorbidity. 6,29 A study of people with poorly controlled epilepsy found that in the order of large to small magnitude, depression, low selfmastery, anxiety, stigma, medical and psychiatric comorbidity, poor medication adherence, and more frequent seizures were associated with worse quality of life. 30 A previous report by these investigators found that NHEs confined to ER visits and hospitalizations were more common in people with epilepsy and comorbid mental illness versus in people with epilepsy who did not have mental health comorbidity.…”

Section: Discussionmentioning

confidence: 99%

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A 6‐month prospective randomized controlled trial of remotely delivered group format epilepsy self‐management versus waitlist control for high‐risk people with epilepsy

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A 6‐month prospective randomized controlled trial of remotely delivered group format epilepsy self‐management versus waitlist control for high‐risk people with epilepsy

et al. 2018

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“…Our results also highlight the close relationship between depressive symptom severity and quality of life (higher/worse depression severity = lower quality of life) . The relevance of depressive symptoms to quality of life and other outcomes in people with epilepsy is substantial, and the MEW Network has prioritized a focus on mental health comorbidity with a particular emphasis on depression . A non–MEW Network study that analyzed individuals with poorly controlled epilepsy found that, in order of large to small magnitude, depression, low self‐mastery, anxiety, stigma, medical and psychiatric comorbidity, poor medication adherence, and more frequent seizures were associated with worse quality of life …”

Section: Discussionmentioning

confidence: 71%

“…28 The relevance of depressive symptoms to quality of life and other outcomes in people with epilepsy is substantial, and the MEW Network has prioritized a focus on mental health comorbidity with a particular emphasis on depression. 9,29 A non-MEW Network study that analyzed individuals with poorly controlled epilepsy found that, in order of large to small magnitude, depression, low self-mastery, anxiety, stigma, medical and psychiatric comorbidity, poor medication adherence, and more frequent seizures were associated with worse quality of life. 30 This analysis has a number of limitations, including the inherent difficulty in interpreting aggregate outcomes from studies that were conducted in different settings with different eligibility criteria.…”

Section: F I G U R E 1 Total Mean Score On Nine-item Patient Healthmentioning

confidence: 99%

Self‐management for adults with epilepsy: Aggregate Managing Epilepsy Well Network findings on depressive symptoms

et al. 2019

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Objective To assess depressive symptom outcomes in a pooled sample of epilepsy self‐management randomized controlled trials (RCTs) from the Managing Epilepsy Well (MEW) Network integrated research database (MEW DB). Methods Five prospective RCTs involving 453 adults with epilepsy compared self‐management intervention (n = 232) versus treatment as usual or wait‐list control outcomes (n = 221). Depression was assessed with the nine‐item Patient Health Questionnaire. Other variables included age, gender, race, ethnicity, education, income, marital status, seizure frequency, and quality of life. Follow‐up assessments were collapsed into a visit 2 and a visit 3; these were conducted postbaseline. Results Mean age was 43.5 years (SD = 12.6), nearly two‐thirds were women, and nearly one‐third were African American. Baseline sample characteristics were mostly similar in the self‐management intervention group versus controls. At follow‐up, the self‐management group had a significantly greater reduction in depression compared to controls at visit 2 (P < .0001) and visit 3 (P = .0002). Quality of life also significantly improved in the self‐management group at visit 2 (P = .001) and visit 3 (P = .005). Significance Aggregate MEW DB analysis of five RCTs found depressive symptom severity and quality of life significantly improved in individuals randomized to self‐management intervention versus controls. Evidence‐based epilepsy self‐management programs should be made more broadly available in neurology practices.

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“…Research has shown the importance of allocating resources, balancing context-specific adaptation and program fidelity, and involving key stakeholders during initial and sustained implementation and adoption [24][25][26][27]. Although scientific organizations recommend self-management support [28][29][30], there is little guidance about how to implement these programs, and we identified no prior systematic reviews that focused on this issue. We conducted a systematic review of quantitative, qualitative, and mixed-methods studies to examine the barriers and facilitators to implementing and adopting epilepsy self-management programs in large health care systems.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to implementation of epilepsy self-management programs: a systematic review using qualitative evidence synthesis methods

et al. 2020

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Background: Epilepsy affects nearly 50 million people worldwide. Self-management is critical for individuals with epilepsy in order to maintain optimal physical, cognitive, and emotional health. Implementing and adopting a selfmanagement program requires considering many factors at the person, program, and systems levels. We conducted a systematic review of qualitative and mixed-methods studies to identify facilitators and barriers that impact implementation and adoption of self-management programs for adults with epilepsy. Methods: We used established systematic review methodologies for qualitative and mixed-methods studies. We included studies addressing facilitators (i.e., factors that aided) or barriers (i.e., factors that impeded) to implementation and adoption of self-management interventions for adults with epilepsy. We conducted a narrative thematic synthesis to identify facilitators and barriers. Results: The literature search identified 2700 citations; 13 studies met eligibility criteria. Our synthesis identified five themes that categorize facilitators and barriers to successful implementation epilepsy self-management: (1) relevance, intervention content that facilitates acquisition of self-management skills; (2) personalization, intervention components that account for the individual's social, physical, and environmental characteristics; (3) intervention components, components and dosing of the intervention; (4) technology considerations, considerations that account for individual's use, familiarity with, and ownership of technology; and (5) clinician interventionist, role and preparation of the individual who leads intervention. We identified facilitators in 11 of the 13 studies and barriers in 11 of the 13 studies and classified these by social-ecological level (i.e., patient/caregiver, program, site/system).

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Self-management in epilepsy: Why and how you should incorporate self-management in your practice

Cited by 46 publications

References 44 publications

A 6‐month prospective randomized controlled trial of remotely delivered group format epilepsy self‐management versus waitlist control for high‐risk people with epilepsy

A 6‐month prospective randomized controlled trial of remotely delivered group format epilepsy self‐management versus waitlist control for high‐risk people with epilepsy

Self‐management for adults with epilepsy: Aggregate Managing Epilepsy Well Network findings on depressive symptoms

Barriers and facilitators to implementation of epilepsy self-management programs: a systematic review using qualitative evidence synthesis methods

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