The HOBSCOTCH self-management program improves the quality of life of epileptics

The results of a recent study suggest that a self-management and cognitive training program at home, called the HOBSCOTCH program, is effective in improving the quality of life of people with epilepsy.1

Ultimately, those who completed the in-person HOBSTOCH intervention experienced a 12.4-point improvement in quality of life scores compared to controls (P <.001 with pairwise comparisons showing a point treatment effect for subjective cognition in the in-person group>P <.001 the analysis included of recruited participants.>

The virtual part of the intervention demonstrated feasibility but did not significantly improve outcomes compared to controls. Within-group analysis revealed improvements in quality of life for virtual and in-person groups. Although this evaluation was conducted before the COVID-19 pandemic, study researcher Barbara C. Jobst, MD, PhD, FAAN, FAES and colleagues wrote that “remote intervention may be particularly well suited to the current environment. adding that “future research will explore modifications designed to improve the effectiveness of [the virtual program] and the durability of HOBSCOTCH’s treatment effect.

Notably, there were no significant differences between the identified groups in objective cognition or health care utilization at any time point in the study, and the effect of treatment on quality of life diminished after 6 months.

The HOBSCOTCH program consists of 8 sessions to address cognitive disorders and quality of life that last between 45 and 60 minutes, with a goal set for each session.2 Developed by a multidisciplinary task force at Dartmouth-Hitchcock Medical Center, including Jobst and Tracie Caller, MD, MPH, FAAN, the program is commonly used by the HOBSCOTCH Institute for Cognitive Health and Wellbeing, which was founded in 2020 by Jobst and Elaine T. Kiriakopoulos, MD, MSc.2.3 Previously, the program has been shown to be effective for adults with epilepsy who experience memory problems, that is, those with controlled and uncontrolled seizures.

This analysis included participants from epilepsy centers in 4 states who were block-randomised into 3 groups: HOBSCOTCH in-person (H-IP), virtual HOBSCOTCH (HV), and waitlist control. Outcome measures were assessed at baseline, 3 months, and 6 months, and intervention groups received long-term follow-up at 9 and 12 months. Study patients had a mean age at baseline of 47.5 years (SD, 11.5; 68% female).

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Previously, 2016 work by Caller et al in a cohort of 66 people with epilepsy who were randomized to receive 8 weeks of HOBSCOTCH, with or without additional working memory training on a commercial gaming device, or a control, showed significant improvements in quality of life. epilepsy quality of life scale scores (Intervention groups: 5 [SE, 2.2]; controls: − 2.2 [SE, 2.7]; P = .05). The treatment effect in this study was 7.1 points. When the subscales of the scale were analyzed, each of the subscales showed a trend of improvement in the intervention group, while the controls declined on all measures, with significant improvement in the subscales. -scores of worry about seizures (P = .04) and energy (P = 0.04).4

As the medical field continues to push for more holistic approaches to patients with chronic diseases, the HOBSCOTCH program is part of several efforts to help address quality of life challenges, particularly in patients with epilepsy. In December 2021, at the 2021 Annual Meeting of the American Epilepsy Society (AES), findings were presented suggesting that a neuropalliative care (NPC) tactic for people with drug-resistant epilepsy could help this population. to face life with crises.5

Ultimately, these data included 20 adults with drug-resistant epilepsy and a mean age of 39 years (range, 27-61; SD, 9.4) who volunteered to respond to an interview of 2 hours on their identity, their perceptions, their experiences and their needs. in terms of living with drug-resistant epilepsy (mean, 5.9 anticonvulsant drugs; range, 2-14; SD, 2.8) for a mean duration of 16 years (range, 3-42; SD, 11.1 ). Patients read a description of the NPC and were asked if they thought it had the potential to play a role in their care. Two quality of life questionnaires were also completed, the Quality of Life in Epilepsy-10 (QOLIE-10) and the McGill Quality of Life (MQOL).

Responses from four patients revealed coping difficulties, indicating issues that could be addressed by NPC, namely a lack of planning for the future, a need for social and spiritual support, and gaps in communication with care providers. ‘epilepsy. Only 2 participants were able to provide a description of the NPCs, both of which focused on aging and death. Despite their different time scales of 4 weeks versus 2 days, the QOLIE-10 and MQOL analyzes for 19 patients (1 lost to follow-up) suggested a strong correlation between the 2 questionnaires (R2 = 0.68). A high rate of existential distress was reported on the MQOL by half of respondents asked about life progress and self-esteem. The cohort reported comorbidities including depression (n=14; 70%), anxiety (n=12; 60%), and memory problems (n=18; 90%).5

Additionally, another review, a 2022 multicenter cross-sectional study by Shah et al, provided evidence that a new 2-item health-related quality of life prompt, called Pediatric Epilepsy Learning Healthcare System Quality of Life (PELHS -QOL-2), is valid in a recent study, with investigators concluding that the prompt is suitable for use in a clinical setting.6

The final study sample included a total of 154 caregivers of children with epilepsy, all of whom were English-speaking and had a mean age of 9.7 years (range, 0.5-18.0). The PELHS-QOL-2 was correlated with the 4 comparison instruments, the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55), the Pediatric Epilepsy Side Effects Questionnaire, the Global Quality of Life in Childhood Epilepsy Questionnaire and the Global Assessment of Severity of epilepsy.

Shah et al found moderate to large correlations between PELHS-QOL-2 and QOLCE-55 (n=132; ρ=0.55; P <.0001 and gas .52>P <.0001 and a strong correlation between the pelhs-qol-medications pesq>P <.0001 pelhs-qol-seizures was significantly associated with all qolce-55 subscores and pelhs-qol-medication pesq excluding weight.>6

REFERENCES
1. Streltzov NA, Schmidt S, Schommer L, et al. Effectiveness of a self-management program to improve cognition and quality of life in epilepsy: a pragmatic, randomized, multicenter trial. Neurology. Published online April 06, 2022. doi:10.1212/WNL.0000000000200346.
2. Patient Support and Education: Home Self-Management and Cognitive Training Change Lives (HOBSCOTCH). Dartmouth Health website. Accessed April 18, 2022. https://www.dartmouth-hitchcock.org/epilepsy/hobscotch
3. About Us: Program Development. HOBSCOTCH Institute website. Accessed April 18, 2022. https://www.hobscotch.org/story
4. Appellant TA, Ferguson RJ, Roth RM. A cognitive-behavioral intervention (HOBSCOTCH) improves quality of life and attention in epilepsy. Epilepsy behavior. 2016;57:111-117. doi:10.1016/j.yebeh.2016.01.024
5. Hixon A, Vaughan C, Baca C, et al. Neuropalliative care for people with drug-resistant epilepsy – A needs assessment. Presented at AES2021; December 3-7, 2021; Chicago, Illinois and virtual. Summary 2.099
6. Shah PD, Yun M, Wu A. Pediatric Epilepsy Learning System Healthcare Quality of Life (PELHS-QOL-2): A new health-related quality of life prompt for children with epilepsy. Epilepsy. 2022;63(3):672-685. doi:10.1111/epi.17156

Ryan H. Bowman