癫痫之旅：一项基于网络的执行功能干预措施对青少年癫痫患者的概念验证试验。
Epilepsy Journey: A proof of concept trial of a Web-based executive functioning intervention for adolescents with epilepsy.
机构信息
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
University of Cincinnati, Cincinnati, Ohio.
出版信息
Epilepsia. 2019 Sep;60(9):1895-1907. doi: 10.1111/epi.16317. Epub 2019 Aug 19.
OBJECTIVE
To examine the preliminary feasibility and acceptability of a Web-based program, Epilepsy Journey, to improve executive function behaviors in adolescents with epilepsy.
METHODS
We conducted a proof of concept single-arm pilot trial of Epilepsy Journey with 31 adolescents (average age = 15.3 ± 1.3 years) who had an epilepsy diagnosis and executive function (EF) deficits on the caregiver-report version of the Behavior Rating Inventory of Executive Function (BRIEF). Epilepsy Journey coupled a gamified problem-solving website comprised of 10 learning modules targeting EF deficits (eg, working memory, organization, problem-solving) with Skype sessions with a trained therapist. Outcomes included feasibility (attrition, sessions completed) and acceptability (satisfaction ratings). Exploratory analyses examined changes in caregiver-, self-, and teacher-reported BRIEF scores from baseline to posttreatment and at 2- and 5-month follow-ups.
RESULTS
Seventy-nine percent of participants completed the program. Satisfaction was high, with 97% of caregivers and adolescents rating the program as helpful and indicating they would recommend it to others. Caregivers and adolescents reported global improvements on the BRIEF, with caregivers reporting significant improvements on all BRIEF subscales. EF symptoms rebounded slightly between the 2- and 5-month follow-ups for some of the self- and caregiver-reported BRIEF scales. Notably, clinically meaningful improvements (eg, clinical/subclinical to normative levels) were reported for several caregiver-reported BRIEF subscales, including the Global Executive Composite (62% to 33-34%) and Metacognitive Index (74% to 41-42%) from baseline to 2- and 5-month follow-up.
SIGNIFICANCE
Findings suggest that a Web-based problem-solving intervention tailored to EF deficits for adolescents with epilepsy is both feasible and acceptable and may contribute to improvements in EF behaviors across domains.
目的
考察基于网络的癫痫之旅项目改善青少年癫痫患者执行功能行为的初步可行性和可接受性。
方法
我们对 31 名青少年（平均年龄=15.3±1.3 岁）进行了癫痫之旅的概念验证单臂试验，这些青少年有癫痫诊断和执行功能（EF）缺陷，表现为 caregiver报告的行为评定量表的执行功能（BRIEF）缺陷。癫痫之旅将一个游戏化的解决问题的网站与 Skype 会议与经过培训的治疗师结合起来，该网站由 10 个针对 EF 缺陷（例如工作记忆、组织、解决问题）的学习模块组成。结果包括可行性（脱落、完成的课程）和可接受性（满意度评分）。探索性分析评估了从基线到治疗后以及 2 个月和 5 个月随访时 caregiver、自我和教师报告的 BRIEF 评分的变化。
结果
79%的参与者完成了该项目。满意度很高，97%的照顾者和青少年认为该项目有帮助，并表示会向他人推荐。照顾者和青少年报告 BRIEF 整体改善，照顾者报告所有 BRIEF 子量表均有显著改善。在 2 个月和 5 个月的随访中，一些自我和照顾者报告的 BRIEF 量表的 EF 症状略有反弹。值得注意的是，几个照顾者报告的 BRIEF 子量表报告了有临床意义的改善（例如，从临床/亚临床到正常水平），包括从基线到 2 个月和 5 个月随访的全球执行综合量表（62%至 33-34%）和元认知指数（74%至 41-42%）。
意义
研究结果表明，针对青少年癫痫患者 EF 缺陷量身定制的基于网络的解决问题干预措施是可行和可接受的，并且可能有助于改善各领域的 EF 行为。
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