Abstracts

Rationale: People living with epilepsy (PWE) frequently experience cognitive difficulties. The Home-Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH) is a self-management program designed to improve cognition and quality of life among PWE and has cognitive coaches engaging individual participants in problem-solving therapy and memory improvement strategies. Effectiveness of HOBSCOTCH has been shown in single center and multicenter pragmatic studies across the Northeastern U.S. and, at our large academic center in the Southeastern U.S. We present findings from a replication trial of HOBSCOTCH with participants recruited through a large academic center clinical trial and community trial setting in a racially diverse area of the Southeast.


Methods: We conducted a randomized waitlist control replication trial of HOBSCOTCH. Participants were recruited from Emory University, Grady Memorial Hospital, epilepsy community groups and community medical centers across Georgia. They were randomized to the HOBSCOTCH program or waitlist control group. Demographic and seizure information were collected at baseline. Quality of Life in Epilepsy v1.0 (QOLIE-31), Quality of Life in Neurologic Disorders v2.-Cognitive Function (Neuro-QOL), Medication Adherence Rating Scale (MARS), Adult Epilepsy Self-Management Measurement Index-65 (AESMMI-65) and Patient Health Questionnaire-9 (PHQ-9) were collected at baseline and at 3-months (immediately post intervention for the intervention group). We ran separate linear regression models for each HOBSCOTCH assessment outcome. The main predictor was intervention group (1=HOBSCOTCH, 0=Waitlist). Race was also included as a predictor and participants were grouped into racially white and racially minoritized (white=1, racially minoritized=0) groups. For each model, we also controlled for baseline scores for each scale.


Results: A total of 84 participants (41 HOBSCOTCH, 43 waitlist control) were enrolled in the study with 64 patients (30 HOBSCOTCH, 34 waitlist control) completing 3-month assessments.

Most individuals identified as female (67%) and non-Hispanic (86%). 37% of individuals belonged to a racially minoritized group and 63% of individuals were white. The intervention effect was statistically significant (p< 0.05) for the QOLIE-31 (Beta=5.97, SE=2.65) and Neuro-QOL (beta=6.15, SE=2.98) while controlling for racial group membership and baseline scores. Intervention group was not statistically significant for MARS, AESMMI-65 and PHQ-9 outcomes. Membership to a racially minoritized group was not a statistically significant predictor for any outcome.


Conclusions: These data support improvements in neurologic health and quality of life at 3 months following HOBSCOTCH intervention for patients in a racially diverse setting in the Southeast. Additionally, these findings suggest that HOBSCOTCH may impact individuals similarly across racial groups at 3-months. Future work will examine longitudinal durability of changes and any potential additional outcome changes. These findings will guide the future dissemination of the HOBSCOTCH program.


Funding: Centers for Disease Control and Prevention U48 DP006377, SIP 19-002 Managing Epilepsy Well Coordinating Center