Longitudinal assessment following the self-management for people with epilepsy and a history of negative health events (SMART) intervention: An exploratory analysis.

OBJECTIVES

To examine longer-term outcomes following completion of the SMART self-management intervention among people with epilepsy (PWE), with a focus on whether seizure frequency and psychosocial outcomes remained stable beyond the initial 6-month randomized trial period.

METHODS

The sample comprised 63 PWE who were assigned to the SMART intervention group. The primary outcome was change in seizure count from 6 to 12- and 18-months post-intervention. Secondary outcomes included changes in depression, functional status, quality of life, epilepsy self-management competency, epilepsy stigma, social support and self-efficacy assessed respectively with the PHQ-9, SF-36, QOLIE-31, ESMS, ESS, MSPSS, and ESES. Associations between SMART session attendance and outcomes were also evaluated.

RESULTS

Among PWE who received the SMART intervention (mean age 39.1 ± 11.6 years; mean epilepsy onset 25.1 ± 15.4 years; 11.1% rural), no significant changes were observed in seizure counts or psychosocial measures between 6 and 12 or 18 months (all p > 0.05), indicating descriptive consistency of outcomes during extended follow-up. Higher engagement in SMART groups (attending ≥7/8 sessions) was associated with higher ESMS and MSPSS scores at 6 months (p = 0.034), ESMS (p = 0.015) and MSPSS (p < 0.006) at 12 months, and ESMS at 18 months (p = 0.048) versus low session attendance (< 7/8 sessions).

SIGNIFICANCE: These findings provide preliminary evidence that improvements in clinical and psychosocial outcomes observed at the end of the SMART intervention did not measurably change 18 months post-intervention. Higher SMART session attendance was associated with greater improvements with self-management skills (ESMS) and social support (MSPSS). Conclusions regarding long-term benefit should be interpreted as descriptive and exploratory given the post hoc design, modest sample size, and non-randomized attendance. The results support further investigation of strategies to enhance engagement and to evaluate the long-term role of self-management interventions as part of comprehensive epilepsy care.