Abstracts

Rationale: Nonadherence to antiseizure medication (ASM) remains a major barrier to adequate epilepsy treatment. Self-reported medication adherence can provide an efficient means of measuring nonadherence. We conducted a systematic review to evaluate the quality of self-reported tools used to measure nonadherence to ASM.

Methods: The study protocol was registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42020147052). The findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. EMBASE (Ovid), MEDLINE (Ovid), CINAHL and SCOPUS were searched from 1947 to July 24, 2019 using relevant terms (e.g. epilepsy, seizure, questionnaire, tool, survey, measure, scale, self-report, compliance). All steps were completed in duplicate. We included studies which used a patient or caregiver reported questionnaire to assess medication adherence. We excluded conference proceedings/abstracts, studies not written in English, case reports, studies with less than 10 participants, reviews, and studies that did not use self-report to measure adherence. We extracted data such as sample size, age of target population, and tool used to measure adherence. We determined whether each measure was validated in people with epilepsy or other populations. We determined which validated tools were most commonly used. Quality assessment of the validated tools is in progress.

Results: After screening 1903 abstracts, 480 studies were selected for full text review, of which 156 met inclusion criteria. Hand searching revealed an additional 21 studies, for a total of 177 studies. The mean and median sample sizes of the studies were 302.3 and 142.0 respectively. Adults (≥18 years old) were the target population in 100 studies, children (< 18 years) in 30 studies, and both age groups in 47 studies. In 135 studies, the respondent was the person with epilepsy, in 8 studies the respondent was a caregiver or family member, and in 34 studies both the person with epilepsy and caregiver were respondents. In total, 96 (54%) studies used a validated tool. The most common validated tools used were the four and eight item Morisky Medication Adherence Scales (MMAS-4 and MMAS-8), the Epilepsy Self-Management Scale, the Medication Adherence Report Scale, and the Pediatric Epilepsy Medication Self-Management Questionnaire (PEMSQ). The PEMSQ and MMAS-8 were the only measures validated in persons with epilepsy.

Conclusions: In this systematic review, we found that more than half of the studies did not use a validated tool to measure adherence. Additionally, only two self-report measures were previously validated in people with epilepsy. Since accurate assessment of adherence is important to optimize epilepsy care, it is crucial that future research on self-reported adherence to ASM employs validated tools, ideally validated in people with epilepsy, to ensure that reliable information is being gathered and acted upon.

Funding: Please list any funding that was received in support of this abstract.: Icahn School of Medicine Bludhorn Professorship of International Medicine (NJ); Patient-Centered Outcomes Research Institute.