Research Assistant Dartmouth-Hitchcock Medical Center
Rationale: HOBSCOTCH (HOme-Based Self-management and COgnitive Training CHanges lives) is a behavioral intervention addressing cognitive dysfunction in adults with epilepsy. It has previously demonstrated efficacy in improving quality of life (QOL) and objective cognition. The current study presents longitudinal data from the multi-site, pragmatic replication trial. Methods: Participants were block-randomized into three groups: in-person (HOB-IP, n=20), virtual treatment (HOB-V, n=17), or six-month waitlist control (n=48). Participants were followed for six-months after completing the 12-week intervention. Groups were compared on measures of QOL (QOLIE-31), objective cognition (BTACTm), and subjective cognition (NeuroQOL-Cognitive Function), collected every three months. Results: This analysis focused on HOBSCOTCH in-person results. Differences between the in-person and virtual groups are discussed in another abstract. HOB-IP, showed significant improvements in QOL compared to controls (p< 0.001) immediately post-intervention. Objective cognition remained unchanged, but self-reported cognitive function was improved following the intervention (p< 0.001). At three months post-HOBSCOTCH, overall QOL scores dropped from a 12.4 point treatment effect to a 5.2 point effect, which was not statistically significant compared to controls (p=0.1). NeuroQOL scores dropped from a 6.2 treatment effect to a 2.4 point effect (p=0.13). A within-group analysis tracked outcomes out to six months post-intervention. Statistically significant improvements were seen in both QOL (p=0.002) and subjective cognition (p< 0.001) post-HOBSCOTCH compared to baseline. By three months post-treatment, subjective cognition scores were still improved (p=0.012), but overall QOL was not. At six months post, both outcome measures lost significance but remained elevated from baseline and appeared to stabilize. Conclusions: This is the first study to evaluate the longitudinal effects of HOBSCOTCH. While the intervention conveys significant short-term benefits, the effects diminished over time, suggesting that self-directed use of the program was uncommon. Because the biggest drop in overall QOL occurred three months post-treatment, booster sessions may help sustain benefits. Funding: Please list any funding that was received in support of this abstract.: This study was funded by a grant from the Centers for Disease Control and Prevention.