Is self-management effective for improving the quality of life in adult epileptics? A systematic review and meta-analysis of randomized controlled trials

Abstract

Abstract Introduction Epilepsy is a chronic brain disorder with high morbidity and mortality. Self-management for epileptic patients is a complex and targeted process requiring taking medication, tracking seizures, ensuring medication adherence, managing negative events, adapting to the environment, keeping healthy lifestyle and maintaining good relationship with family and friends. An increasing number of studies have reported that self-management has become an important adjuvant for controlling epilepsy. However there have been no systematic reviews carried out to evaluate the effectiveness of self-management to improve the quality of life in adult epileptics. Methods Randomized controlled trials on self-management for adult epilepsy were included. Web of Science, PubMed, Science Direct, Cochrane Library, CNKI, VIP and Wanfang databases were searched. Reporting quality of trials was assessed by two reviewers independently using the Cochrane Risk of Bias Tool. The study was registered on PROSPERO registration number CRD42017078356. Results Eleven trials involving 1217 participants were identified. Meta-analysis showed that self-management interventions could improve quality of life (SMD 0.69, 95% CI [0.26, 1.11]; I2\u2009=\u200990%), reduce depression (SMD −0.31, 95% CI [−0.60, −0.01]; I2\u2009=\u200978%), increase self-efficacy (SMD 0.52, 95% CI [0.34, 0.69]; I2\u2009=\u200944%) and self-management (MD 3.35, 95% CI [0.33, 6.37]; I2\u2009=\u200987%), and improve medical adherence (MD 0.21, 95% CI [0.06, 0.36]; I2\u2009=\u20090%) for adult epileptics, but had no effect on seizure frequency (MD −0.73, 95% CI [−5.63, 4.16]; I2\u2009=\u200954%) and negative health events (MD −2.30, 95% CI [−8.31, 3.27]; I2\u2009=\u200971%). Reporting and methodological quality was limited for all included trials. Conclusion Self-management may be effective in improving for quality of life in adult epileptics. However, these findings should be interpreted with caution due to the methodological quality of included trials. Furthermore, strict trials with precise methodological design and rigorous reporting on clinical efficacy and adverse events controlling self-management for epilepsy may be promising.