Liu Ting Ting, Zhang Min, Li Hong Ying, Wen Zhang Yu, Liang Lu, Huang Xin Yue, Gan Xia, Mou Lan, Liu Chen Shi, Zhang Ming Ming, Liu Jie
Department of Medical Record and Statistics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Department of Outpatient, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
J Med Internet Res. 2025 May 26;27:e70665. doi: 10.2196/70665.
As the second most common neurological disorder, epilepsy requires long-term management to ensure better seizure control and improved patient outcomes. Health education and sustained care significantly help people with epilepsy manage their condition effectively. Internet hospitals (IHs) have emerged as a promising approach to enhancing health care accessibility. These digital platforms can significantly improve the quality of life for patients with epilepsy. However, despite their growing adoption, research on the application of IHs in the follow-up management of epilepsy remains limited, highlighting the need for further investigation.
This study has 2 primary aims. The first aim was to assess and compare the differences in quality of life, anxiety, and depression between IH follow-up and traditional outpatient follow-up for patients with epilepsy. The second aim was to explore chronic disease management models that are tailored to meet the needs of patients with epilepsy, improving their overall care.
Eligible patients diagnosed with epilepsy were recruited at Sichuan Provincial People's Hospital and randomly assigned to the intervention or control group. Data collected included demographic information, clinical characteristics, and scores from the Quality of Life in Epilepsy-31 (QOLIE-31), Generalized Anxiety Disorder-7 Scale (GAD-7), and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). The control group received traditional outpatient follow-up, while the intervention group was managed via the IH. Both groups received epilepsy health education. After 6 months, changes in quality of life, anxiety, and depression were assessed using the same scales. Data analysis followed the intention-to-treat principle, and a linear mixed model was used to examine the intervention effect on primary and secondary outcomes. The effect sizes of group differences were calculated using Hedges g (0.2-0.4: small, 0.5-0.7: medium, and ≥0.8: large).
A total of 214 patients with epilepsy participated in the study (intervention group: N=107; control group: N=107). At the end of the study, 94.4% (101/107) in the intervention group and 93.5% (100/107) in the control group had completed the follow-up visits. After the intervention, the intention-to-treat analysis revealed evidence for improved quality of life (QOLIE-31 total score; F=13.10, P<.001) with small between-group effects (Hedges g=0.49, 95% CI 0.22-0.76) in favor of the intervention group. We also found evidence of reduced depression, as well as improved seizure worry, overall quality of life, emotional well-being, energy or fatigue, medication side effects, with effects ranging from small to medium (Hedges g=0.42-0.79).
Long-term follow-up through IHs can effectively improve the quality of life and reduce anxiety and depression in patients with epilepsy. This model provides effective support, making it an important tool for managing epilepsy. Therefore, IH management is recommended as a feasible approach for epilepsy follow-up in clinical practice.
Chinese Clinical Trial Registry ChiCTR2500101061; https://www.chictr.org.cn/showprojEN.html?proj=260855.
癫痫作为第二常见的神经系统疾病，需要长期管理以确保更好地控制癫痫发作并改善患者预后。健康教育和持续护理对癫痫患者有效管理病情有显著帮助。互联网医院已成为提高医疗服务可及性的一种有前景的方式。这些数字平台能显著改善癫痫患者的生活质量。然而，尽管其应用日益广泛，但关于互联网医院在癫痫随访管理中的应用研究仍然有限，这凸显了进一步研究的必要性。
本研究有两个主要目的。第一个目的是评估并比较癫痫患者互联网医院随访与传统门诊随访在生活质量、焦虑和抑郁方面的差异。第二个目的是探索适合癫痫患者需求的慢性病管理模式，以改善其整体护理。
在四川省人民医院招募符合条件的癫痫患者，并随机分配至干预组或对照组。收集的数据包括人口统计学信息、临床特征以及癫痫生活质量量表-31（QOLIE-31）、广泛性焦虑障碍-7量表（GAD-7）和癫痫神经疾病抑郁量表（NDDI-E）的评分。对照组接受传统门诊随访，而干预组通过互联网医院进行管理。两组均接受癫痫健康教育。6个月后，使用相同量表评估生活质量、焦虑和抑郁的变化。数据分析遵循意向性分析原则，并使用线性混合模型检验干预对主要和次要结局的影响。使用Hedges g计算组间差异的效应大小（0.2 - 0.4：小，0.5 - 0.7：中，≥0.8：大）。
共有214例癫痫患者参与研究（干预组：N = 107；对照组：N = 107）。研究结束时（干预组：N = 101/107，94.4%；对照组：N = 100/107，93.5%）完成了随访。干预后，意向性分析显示生活质量有改善的证据（QOLIE-31总分；F = 13.10，P <.001），组间效应较小（Hedges g = 0.49，95% CI 0.22 - 0.76），有利于干预组。我们还发现有抑郁减轻以及癫痫担忧、整体生活质量、情绪健康、精力或疲劳、药物副作用改善的证据，效应大小从小到中（Hedges g = 0.42 - 0.79）。
通过互联网医院进行长期随访可有效改善癫痫患者的生活质量，减轻焦虑和抑郁。该模式提供了有效的支持，使其成为管理癫痫的重要工具。因此，建议在临床实践中将互联网医院管理作为癫痫随访的一种可行方法。
中国临床试验注册中心ChiCTR2500101061；https://www.chictr.org.cn/showprojEN.html?proj=260855
