Care delivery and self-management strategies for adults with epilepsy.

backgroundEpilepsy 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.

objectivesTo 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

resultsThere 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'

conclusionsTwo 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.