Title: Enhancing Parental Self-management of Child’s Seizure Disorder by a Structured Educational Intervention: a Randomized Controlled Trial
Authors: Ms Merin Sara Mathew, Ms Milu Elsa Paul, Dr Anna Mathew, Dr M C Mathew, Mrs. Susan Sosa Jacob, Mr Saravana Kumar Velusamy
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.77
Seizure disorder is a chronic paediatric condition which requires parental commitment to self-management to ensure quality of life for the child and the family. Hence this prospective, parallel group, randomized controlled clinical trial was planned to study whether structured education enhances parental self-management of their child’s seizure disorder. Sixty four parents of children, below 18 years of age, attending the Developmental Paediatrics and Child Neurology outpatient department, in a tertiary care centre in South India, who gave written informed consent were recruited into the study after institutional ethical committee approval was received. The department is located in a rural area and serves children with special needs who come from various parts of this state and the neighbouring states. The instrument used to assess efficacy of self-management was the Paediatric Epilepsy Self- Management Questionnaire (PEMSQ) (in the local language) after permission was obtained from the author. The first contact PEMSQ was administered on recruitment to the study by an independent assessor. The participants were randomized by permuted block randomization into two groups, the intervention group and the comparator group. Allocation was concealed from the assessor. After 72 hours the follow up PEMSQ was administered by the blinded assessor. The improvement in the follow up score compared to the first contact score was recorded and compared to find if there was a significant difference between the two groups. The non-parametric Wilcoxon Mann Whitney U test was used to compare the scores statistically using SPSS version 16. Our study showed significant improvement in the parental scores for self-management using the PEMSQ. There was also improvement in all the four PEMSQ sub-scalesi. knowledge of seizure disorder, ii. commitment to adherence to treatment, iii. beliefs about efficacy of drugs, and iv. barriers to treatment Thus we conclude that there is a significant enhancement of parental self-management following the structured education given to the intervention group compared to the comparator group. 1. Naik N, Expert Committee on Pediatric Epilepsy, Indian Academy of Pediatrics. Guidelines for Feb 4;291(5):615-20. 2. Morita DA, Glauser TA, Modi AC. Development and validation of the Pedia-tric Epilepsy Side Effects Questionnaire. Neurology. 2012 Sep 18;79(12):1252-8. 3. Modi AC, Pai AL, Hommel KA, Hood KK, Cortina S, Hilliard ME, Guilfoyle SM, Gray WN, Drotar D. Pediatric self-management: a framework for research, practice, and policy. Pediatrics. 2012 Feb;129(2):e473-85. 4. Modi A C, Wu YP, Rausch JR, Peugh JL, Glauser TA. Antiepileptic Drug Non-adherence predicts Pediatric Epilepsy Seizure Outcomes. Neurology. 2014 Oct 29. Pii: 10.1212/WNL.0000000000001-023.[Epub ahead of print] 5. Modi A C, Monahan S, Daniels D, Tracy A, Glauser TA. Development and Validation of the Pediatric Epilepsy Medication Self-Management Questionn-aire. Epilepsy Behav. 2010 May ; 18(1-2): 94–99. 6. Aneja S1, Sharma S. Newer anti-epileptic drugs. Indian Pediatr. 2013 Nov 8;50(11):1033-40. 7. Modi AC, Rausch JR, Glauser TA. Patterns of Non-adherence to Antiepileptic Drug Therapy in Children With Newly Diagnosed Epilepsy .. JAMA 2011 April 27; 305(16): 1669–1676. 8. Schilling LS, Grey M, Knafl KA. The concept of self-management of type 1 diabetes in children and adolescnets: An evolutionary concept analysis. Journal of Advanced Nursing. 2002; 37(1):87– 99. 9. Al-Aqueel S, Al-Sabhan J. Strategies for improving adherence to antiepileptic drug treatment in patients with epilepsy. Cochrane Database Syst Rev. 2011 Jan 19;(1). 10. Sample size calculated by nMaster software,version 2.0 produced by the Department of Biostatistics,Christian Medical College, Vellore 632 002,TN. 11. Efird J. Blocked Randomization with Randomly Selected Block Sizes. Intl J Environ Res Public Health 2011;8(1): 15-20. 12. Glauser T, Ben-Menachem E, Bourgeois B,et al, Treatment Guidelines:Evidence based analysis of antiepileptic drug effic-acy and effectiveness as initial monoth-erapy for epileptic seizures and syndro-mes; Epilepsia 2006; Vol-47,1094-1120. 13. Carpay HA, Arts WF, Geerts AT, Stroink H, Brouwer OF, Boudewyn Peters AC, van Donselaar CA. Epilepsy in childhood: an audit of clinical practice. Arch Neurol. 1998 May;55(5):668-73.Abstract
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