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Abstract
Background and Objectives We conducted a multisite, pragmatic replication trial at 4 New England epilepsy centers to determine the effectiveness of Home-Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH) in a real-world setting and to assess feasibility of a virtual intervention.
Methods HOBSCOTCH is an 8-session intervention addressing cognitive impairment and quality of life (QoL) for people with epilepsy (PWE). Participants were recruited from epilepsy centers in 4 states and block-randomized into the following groups: in-person HOBSCOTCH (H-IP), virtual HOBSCOTCH (H-V), and waitlist control. Outcome measures were assessed for all groups at baseline, 3 months, and 6 months; intervention groups received long-term follow-up at 9 and 12 months.
Results A total of 108 participants were recruited, of whom 85 were included in this analysis (age at baseline 47.5 ± 11.5 years; 68% female). Participants completing the in-person intervention (H-IP) had a 12.4-point improvement in QoL score compared with controls (p < 0.001). Pairwise comparisons found a 6.2-point treatment effect for subjective cognition in the H-IP group (p < 0.001). There were no meaningful group differences in objective cognition or health care utilization at any time points and the treatment effect for QoL diminished by 6 months. The virtual intervention demonstrated feasibility but did not significantly improve outcomes compared with controls. Within-group analysis found improvements in QoL for both H-V and H-IP.
Discussion This study replicated the effectiveness of the HOBSCOTCH program in improving QoL for PWE. The study was conducted prior to the COVID-19 pandemic, but the distance-delivered intervention may be particularly well-suited for the current environment. Future research will explore modifications designed to improve the efficacy of H-V and the sustainability of HOBSCOTCH's treatment effect.
Trial Registration Information ClinicalTrials.gov (NCT02394509).
Classification of Evidence This study provides Class III evidence that in-person HOBSCOTCH delivery improved subjective measures of cognition in persons with epilepsy.
Glossary
- BTACT=
- Brief Test of Adult Cognition by Telephone;
- ESMS=
- Epilepsy Self-Management Scale;
- FWA=
- Federalwide Assurance;
- H-IP=
- in-person HOBSCOTCH;
- H-V=
- virtual HOBSCOTCH;
- HCU-E=
- Healthcare Utilization in Epilepsy;
- HOBSCOTCH=
- Home-Based Self-Management and Cognitive Training Changes Lives;
- IRB=
- institutional review board;
- MEW=
- Managing Epilepsy Well;
- Neuro-QoL=
- Quality of Life in Neurological Disorders;
- PHQ-9=
- Patient Health Questionnaire–9;
- PST=
- problem-solving therapy;
- PWE=
- people with epilepsy;
- QoL=
- quality of life;
- QOLIE-31=
- 31-item Quality of Life in Epilepsy
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 873
Class of Evidence: NPub.org/coe
CME Course: NPub.org/cmelist
- Received April 8, 2021.
- Accepted in final form February 21, 2022.
- © 2022 American Academy of Neurology
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