Intervention Review

Care delivery and self-management strategies for adults with epilepsy

  1. Peter M Bradley1,*,
  2. Bruce Lindsay2

Editorial Group: Cochrane Epilepsy Group

Published Online: 23 JAN 2008

Assessed as up-to-date: 13 NOV 2007

DOI: 10.1002/14651858.CD006244.pub2


How to Cite

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.

Author Information

  1. 1

    Thingoe House, Suffolk West PCT, Bury St Edmunds, UK

  2. 2

    University of East Anglia, School of Nursing and Midwifery, Faculty of Health, Norwich, Norfolk, UK

*Peter M Bradley, Suffolk West PCT, Thingoe House, Cotton Lane, Bury St Edmunds, IP33 1YJ, UK. peter.bradley@suffolkwest-pct.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 JAN 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

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 methods

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Care delivery and self-management strategies for adults with epilepsy

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.