Care delivery and self-management strategies for adults with epilepsy

Bradley PM, Lindsay B

Published Online:

October 7, 2009

Evidence for the effectiveness of care interventions for adults with epilepsy is still unclear.

This review compared the effectiveness of a range of interventions, including specialist nurses and management strategies, in improving outcomes for adults with epilepsy. Seven distinct intervention types were identified, with varying amounts of evidence available. While there was some evidence of benefit from specialist epilepsy nurses and self-management education, other intervention types lack evidence of effectiveness. This lack is compounded by the poor quality methods of some studies and by the complex nature of the interventions, whose impact may vary according to the context in which delivery takes place. Based on this evidence, it is not possible to advocate any specific intervention type in the care of adults with epilepsy.

Abstract (click to read)

Background:

Epilepsy care has been criticised for its lack of impact. Various service models and strategies have been developed in response to perceived inadequacies in care provision.

Objectives:

To compare the effectiveness of any specialised or dedicated intervention for the care of adults with epilepsy to the effectiveness of usual care.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE (1966 to May 2006), EMBASE (1988 to May 2006), PsychINFO (1806 to May 2006) and CINAHL (1982 to May 2006).

Selection criteria:

Randomised controlled trials, controlled or matched trials, cohort studies or other prospective studies with a control group, or time series studies.

Data collection and analysis:

Each review author independently selected studies, extracted data and assessed the quality of included studies.

Main results:

There are 13 trials and 16 reports included in this review. Seven distinct groups of interventions were identified: seven papers reported on five trials of specialist epilepsy nurses. Of the 13 trials, at least three (four reports) have methodological weaknesses, and some of the results from other analyses within studies need to be interpreted with caution because of limiting factors in the studies. Consequently, there is currently limited evidence for the effectiveness of interventions to improve the health and life quality of people with epilepsy. It was not possible to combine study results in a meta-analysis because of the heterogeneity of outcomes, study populations, interventions, and time scales across the studies.

Authors' conclusions:

Two intervention types, the specialist epilepsy nurse and self-management education, have some evidence of benefit. However, we did not find clear evidence that other service models substantially improve outcomes for adults with epilepsy. It is also possible that benefits are situation specific and may not generalise to other settings. These studies included only a small number of service providers whose individual competence or expertise may have had a significant impact on outcomes. At present it is not possible to advocate any single model of service provision.

This record should be cited as:

Bradley PM, Lindsay B. Care delivery and self-management strategies for adults with epilepsy. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD006244. DOI: 10.1002/14651858.CD006244.pub2

Assessed as up to date:

November 14, 2007

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Primary Review Group:

Epilepsy Group

Health topics:

Neurology > Epilepsy > Psychosocial interventions

Neurology > Epilepsy > Service provision

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Care delivery and self-management strategies for adults with epilepsy

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