Abstracts

Rationale: People with epilepsy (PWE) experience multiple stressors that diminish quality of life (QOL) including impaired cognition/memory, social stigma and isolation, changes in mood and energy, side effects from anti-epileptic drugs (AEDs), and transportation restraints. HOBSCOTCH (HOme Based Self-management and COgnitive Training CHanges Lives), a telephone-based epilepsy self-management program for memory, was shown to improve QOL in a pilot study. The current analysis examines preliminary data from the multi-site replication trial of HOBSCOTCH, presents initial findings on the virtual delivery of HOBSCOTCH, and reports on QOL and healthcare outcomes. Methods: All data were collected as part of an ongoing study of HOBSCOTCH at four New England epilepsy centers (n=47). HOBSCOTCH is a 3-month, 8-session intervention to address memory issues in daily life. It is well suited for distance-delivery; however, both Session #1 and #8 were previously performed in-person during a face to face appointment. The current multi-center replication trial adds a virtual version of HOBSCOTCH that replaces the in-person appointments with a web-based session with a secure audio and visual connection that allows the participant both see and hear the program administrator.Participants were randomly assigned to an intervention group (n=20) or a waitlist control group (n=27). Twelve participants received the standard, in-person method (H-IP), and 8 participants received the virtual delivery (H-V). The treatment group was assessed for QOL (QOLIE-31) at baseline and upon completion of the program, and the waitlist control group was assessed at baseline and after 3 months. Results: HOBSCOTCH participants had significant QOL improvements from baseline (p=0.005) when compared to the control group after 3 months (p=0.004). The H-IP group improved on all subsets of the QOLIE-31, while the control group had no meaningful change. H-IP subjects reported better mood and more energy, enhanced reasoning, concentration and memory; they derived greater satisfaction from their social life, and had less worry about the physical and mental effects of AEDs. These differences were less pronounced for the H-V group. In a pairwise comparison with controls, the H-V group did not show statistically significant improvements on any QOL subset, while the H-IP group had significant changes in both energy (p < .0001) and medication-related anxiety (p=0.03) compared to the H-V group. On healthcare utilization outcomes (routine and emergency visits or procedures), no reportable group differences were observed; however, long-term data collection is ongoing and will track health care use for one year following treatment. Conclusions: An interim analysis from the multi-site trial of HOBSCOTCH replicated QOL findings from the pilot study, and generalized those findings outside of a single epilepsy center. Initial results suggest that the in-person delivery may offer greater benefit than the virtual method, however conclusions should be restrained given the limited sample size.