A multicenter randomized controlled feasibility trial of a digital self‐management intervention for adults with epilepsy

Author:

Michaelis Rosa1ORCID,Knake Susanne2,Rosenow Felix3,Grönheit Wenke1,Hamer Hajo4ORCID,Schmitz Bettina5,Accarie Alison6,Dedeken Peter6,Immisch Ilka2,Habermehl Lena2,Zöllner Johann Philipp3ORCID,Mann Catrin3ORCID,Wehner Tim1ORCID,Wellmer Jörg1,Cuny Jeanne4,Gollwitzer Stephanie4ORCID,Losch Florian5,Krämer Kirsten5,Voss Kevin Steffen7,Heinen Gerd8,Strzelczyk Adam3ORCID

Affiliation:

1. Ruhr‐Epileptology, Department of Neurology University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum Bochum Germany

2. Department of Neurology, Epilepsy Center Hessen University Hospital and Philipps‐University Marburg Marburg Germany

3. Department of Neurology, Epilepsy Center Frankfurt Rhine‐Main, Center of Neurology and Neurosurgery University Hospital and Goethe‐University Frankfurt Frankfurt Germany

4. Epilepsy Center, Department of Neurology University of Erlangen‐Nürnberg Erlangen Germany

5. Stroke Unit, and Center for Epilepsy, Department of Neurology Vivantes Humboldt‐Klinikum Berlin Berlin Germany

6. Neuroventis BV Overijse Belgium

7. Voss Clinical Consulting GbR Spaichingen Germany

8. Ringpraxis Berlin Berlin Germany

Abstract

AbstractObjectiveSelf‐management interventions may enhance health‐related quality of life (HRQoL) in epilepsy. However, several barriers often impair their implementation in the real world. Digital interventions may help to overcome some of these barriers. Considering this, the Helpilepsy Plus Prototype was developed as a prototype smartphone‐delivered self‐care treatment program for adults with epilepsy.MethodsThe 12‐week Helpilepsy Plus Prototype was evaluated through a randomized controlled feasibility trial with a waiting‐list control (WLC) group. Outcome measurement at baseline and at 12 weeks assessed adherence to the prototype intervention and changes in epilepsy‐related outcomes. The primary endpoint was patient autonomy measured with EASE, and secondary endpoints included HRQoL measured with QOLIE‐31, health literacy measured with HLQ, anxiety, and depression symptoms measured with HADS. Semi‐structured interviews were conducted with a heterogeneous sample of participants to assess user‐friendliness and usefulness. The prototype program was delivered through the Neuroventis Platform (Neuroventis, BV, Overijse, Belgium), a certified medical device (under EU/MDD Class I, and EU/MDR grace period).ResultsNinety‐two patients were included (46 in the intervention group, 46 in WLC). Most participants (63%, 58/92 women, median age 30 years) had pharmacoresistant epilepsy (61%, 56/92). Only 22% of participants (10/46) in the intervention group completed at least half of all intervention sessions. No significant differences between the intervention group and WLC were observed. Although there was a larger proportion of patients in the intervention group with meaningful improvements in HRQoL compared to WLC (19/46 versus 11/46), the difference was not significant (p = 0.119). Qualitative feedback showed that participants would appreciate more personalization, such as adaptation of the content to their current epilepsy knowledge level, a more interactive interface, shorter text sections, and interaction through reminders and notifications.SignificanceDigital interventions should allow sufficient scope for personalization and interaction to increase patient engagement and enable benefits from self‐care apps. Feedback loops allow the participatory development of tailored interventions.Plain Language SummaryIn this study, we investigated the effectiveness of an app‐based self‐help intervention. Study participants were either randomly assigned to a group that had access to the app or a group that received access to the app after the end of the study. Although a larger proportion of participants in the intervention group showed a relevant improvement in quality of life, the difference between the two groups was not statistically significant. Less than one‐fifth of participants in the intervention group attended at least half of all intervention sessions; patient feedback showed that patients required more personalization and interactive options.

Publisher

Wiley

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