Authors :
Presenting Author: Sarah Kaden, BA – Dartmouth-Hitchcock Medical Center
Barbara Jobst, MD, PhD – Dartmouth-Hitchcock Medical Center
Edward Camp, BA – HOBSCOTCH Institute
Maureen Quigley, APRN – Dartmouth-Hitchcock Medical Center
Lisa Sackett, Ph.D – Dartmouth-Hitchcock Medical Center
Suzanne Lenz, MA, CCRP – Dartmouth-Hitchcock Medical Center
Trina Dawson, BA, CHW – Dartmouth-Hitchcock Medical Center
Anna Graefe, PhD – Dartmouth-Hitchcock Medical Center
Elaine Kiriakopoulos, MD, MPH, MSc – Dartmouth-Hitchcock Medical Center
Rationale:
Rationale Individuals impacted by post traumatic epilepsy (PTE) present a complex and unique set of medical, and psychosocial issues for providers to manage. Even when seizures are well controlled, co-morbid cognitive dysfunction and psychosocial challenges often persist as a result of treatment for seizures or the underlying brain injury, leading to increased morbidity, mortality and decreased quality of life (QOL). Additionally, the typical treatment course in PTE which requires a patient to take anti-seizure medication on a long-term basis, can potentially lead to negative side effects that influence QOL and neuropsychiatric symptoms. This project examines efficacy of the adapted, HOBSCOTCH-PTE (HOme Based Self-Management and COgnitive Training CHanges Lives
in Post Traumatic Epilepsy) intervention on QOL, depression and suicidality.
Methods:
Methods This analysis uses data from adults (n=54) with PTE and cognitive dysfunction enrolled in the HOBSCOTCH-PTE RCT (3/22-5/24). Study subjects were screened for eligibility using the OSU TBI Screener. Demographic data and medical history (Table 1), as well as depression (assessed using the PHQ-9), and QoL (assessed using the QOLIE-31) were collected at baseline. PHQ-9 and QOLIE-31 responses were also collected post-HOBSCOTCH intervention (n=26) and 3 months after baseline in the waitlist control group (n=28).
Differences between baseline and 3-month scores were assessed with paired t-tests. All subjects were monitored for risk of suicidality (PHQ-9). Data were analyzed in SAS 9.3 and the R programming language.
Results:
Results Baseline PHQ-9 assessments revealed a high level of depression at time of enrollment; 76.9% of intervention and 82.1% of waitlisted participants screened positive on the PHQ-9 for mild (24.1%), moderate (25.9%), moderate to severe (18.5%), or severe (11.1%) depression. Additionally, 29.6% of PwPTE had PHQ-9 assessments revealing risk for suicidality and were assessed by a study physician. Analysis showed a significant improvement in PHQ-9 scores (p=.0009) in the HOBSCOTCH-PTE intervention group (Figure 1a). Participants in the waitlist group showed no significant change in PHQ-9 scores in the 3 months prior to intervention (p=.177). A paired samples t-test revealed a positively-trending improvement in suicidality risk after the intervention (p=.07). PwPTE in the intervention group had a significant improvement in their QOLIE-31 scores (p=.001), and the waitlist group had no significant change (p=.399; Figure 1b).
Conclusions:
Conclusion There is critical need for supports tailored for PwPTE to help them better navigate the range of challenges associated with comorbid TBI, epilepsy, and cognitive impairment. Our data suggests promising outcomes for the adapted HOBSCOTCH-PTE intervention in improving QOL and reducing depression and suicidality risk. It is essential that interventions capable of enhancing QOL for PwPTE are easily accessible. The telehealth access provided by HOBSCOTCH-PTE positions it as a viable solution for addressing challenges broadly.
Funding:
Funding Source: Department of Defense W81XWH2110279