Abstracts

Rationale: Rationale: People with epilepsy (PWE) face heightened risks for cognitive and psychiatric comorbidities, which often have a more significant impact on their quality of life (QOL) than seizures themselves. One out of two PWE experience cognitive impairment which adversely affects their health, productivity, and overall QOL. Despite being among the most debilitating comorbidities, there are few interventions aimed at assisting PWE in managing cognitive impairment. Home-Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH) is an epilepsy self-management program developed and tested at Dartmouth in two prior randomized controlled trials in Northern New England that uses evidence-based strategies to address cognitive impairment and cultivate self-efficacy. The current study presents data from Dartmouth’s HOBSCOTCH 3 RCT delivered entirely by telehealth to a more diverse population recruited nationally and supplemented by a Smartphone HOBSCOTCH App.


Methods: Methods: A total of 106 adults with epilepsy were enrolled in the HOBSCOTCH3 RCT and completed the 9-week intervention. Participants completed surveys related to quality-of-life (QOLIE-31), depression (PHQ-9), cognitive function (Neuro-QOL), and epilepsy self-management behaviors (AESSMI) at the beginning of the study (i.e., baseline) and at 3-month intervals up to a year. Those in the intervention group started the invention at baseline and had completed the program by 3 months after baseline. Those in the waitlist group did not start the intervention until 6 months after baseline and completed the study program by 9 months after baseline.


Results: Results: We analyzed participants (n=106) survey scores from baseline to 3 months after baseline across two groups: intervention (n=59) and control/waitlist (n=47; Table 1). Of total participants, 67.9% were women, 84.0% were white, 5.7% were black or African American, 2.8% were Asian, 67.0% completed 4 years of college or more, and had a mean age of 43.2 (range 20 to 73 years old). We examined the participants in both intervention and waitlist groups who submitted surveys at baseline and 3 months after baseline and found that quality of life (QOLIE-31, p< 0.001), cognitive function (Neuro-QOL, p< 0.001), and epilepsy self-management behaviors (AESSMI, p=0.005) significantly improved and depression severity (PHQ-9, p=0.008) significantly decreased for the intervention group (Figure 1A-D). The waitlist group did not experience a significant change in any of the same outcome measures.


Conclusions: Conclusion: This nationally recruiting pragmatic replication of HOBSCOTCH delivered by telehealth provides early data sharing participant benefits in QOL, cognition, depression and self-management behaviors. The results support feasibility of efficacious virtual intervention delivery. HOBSCOTCH’s distance delivery makes it a candidate for broad dissemination and brings great potential to more equitably increase access for PWE.


Funding: Funding: Centers for Disease Control and Prevention U48 DP006377-01-00.