Abstracts

Self management approaches to reduce disability and increase emotional well being have been helpful in the treatment of chronic medical conditions. We developed a 6 week group-based self management-intervention (SMI) for IWE. We hypothesized that subjects who participated in the intervention would show an improved quality of life (QOL) compared to those in the treatment as usual group., Individuals aged [ge]18 years treated for epilepsy at the Univ. of Pittsburgh Epilepsy Center or its VA Hospital were eligible to participate. 61 adults (43 men, 18 women; age range 21-79) consented and were randomized to treatment in the SMI (31) or treatment as usual (24). Measures included the Quality of Life in Epilepsy-89 (QOLIE-89), Washington Psychosocial Seizure Inventory (WPSI), Locus of Control (LOC), and Epilepsy Self-Efficacy Scale-2000 (ESES). We followed an intent-to-treat study design; 6 withdrew prior to baseline testing and 13 did not follow up after baseline assessment. Treatment analysis included 19 controls and 19 IWE who participated in the SMI and completed baseline and follow up testing. SPSS 13.0 was used for analysis. Mean differences and their 95% confidence intervals were examined between groups using ANCOVA controlling for baseline scores. Partial Eta² effect size estimates were examined., There was no significant difference between patient demographics at the two sites or the two groups, although IWE with later seizure onset and men were over represented at the VA. Statistically significant differences were not found in overall QOL or other primary outcome measures, and effect sizes were small ([le]0.05). The treatment group showed a statistically significant improvement (p=0.039) in QOLIE-Role Limitations Emotional score at follow up compared to the change in the control group. Strong and significant correlations were observed between QOL and self-efficacy (r =0.523), QOL and psychosocial/medical function as measured by the WPSI (r = -0.768) and between QOL and locus of control (r = 0.458)., There was no significant change in overall QOL following SMI and effect sizes were small. A statistically significant positive change was demonstrated in one parameter of QOL (Role Limitations Emotional), although this might not be clinically meaningful. The strengths of this study were: a) the development of a SMI program targeting IWE b) use of a control group and randomization c) successful recruitment of a larger sample size compared to prior studies and d) the strong associations among outcome measures. Limitations included recruitment challenges, attrition, and insufficient power to detect meaningful change. Future projects will examine alternative methods of administering SMIs to IWE., (Supported by Centers for Disease Control and Prevention (CDC).)