EXPAND-ing evidence-based epilepsy self-management into clinical settings

OBJECTIVES: This is a scale-up report on the SMART (Self-management for people with epilepsy and a history of negative health events) epilepsy self-management (ESM) program. METHODS: Engagement in SMART was assessed via session attendance (maximum of 8). Outcomes included the 10-item Quality of Life in Epilepsy (QOLIE-10), Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Neurological DisordersDepression Inventory for Epilepsy (NDDI-E) and past 30-day seizure frequency. RESULTS: 153 PWE were referred to ESM, mean age 37.6 (SD 12.8). Average attendance for PWE who attended ≥ 1 session (N = 115) was 5.8 (SD 2.6). There were no significant pre/post changes for QOLIE-10, NDDI-E, GAD-7, PHQ-9 or past 30-day seizure counts. Exploratory analysis of clinically relevant subgroups found PWE with PHQ-9 ≥ 10 at baseline (N = 27), had significant improvement pre/post SMART with means of 15.0 (SD 4.5) and 11.7 (SD 5.1), respectively (p = 0.001), those with GAD-7 ≥ 10 at baseline (N = 31) had significant improvement pre/post SMART with means of 14.4 (SD 3.2) and 11.2 (SD 3.8), respectively (p = 0.001) and those in the lowest quartile of QOLIE-10 scores (N = 16) had significant improvement pre/post SMART with means of 3.8 (SD 0.5) and 3.4 (SD 0.8), respectively. DISCUSSION: This analysis from a real-world, non-research study sample suggests scaling up ESM in an epilepsy-care clinical setting appears feasible, acceptable to PWE, and can improve outcomes for PWE with depression, anxiety and suboptimal quality of life. Future work needs to address barriers to generalizability.