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Al-Najjar N, Bray L, Carter B, Castle AP, Collingwood A, Cook G, Crudgington H, Currier J, Dietz KC, Hardy WAS, Hiscock H, Hughes D, Morris C, Roberts D, Rouncefield-Swales A, Saron H, Spowart C, Stibbs-Eaton L, Tudur Smith C, Watson V, Whittle L, Wiggs L, Wood E, Gringras P, Pal DK. Changing Agendas on Sleep, Treatment and Learning in Epilepsy (CASTLE) Sleep-E: a protocol for a randomised controlled trial comparing an online behavioural sleep intervention with standard care in children with Rolandic epilepsy. BMJ Open 2023; 13:e065769. [PMID: 36898757 PMCID: PMC10008377 DOI: 10.1136/bmjopen-2022-065769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION Sleep and epilepsy have an established bidirectional relationship yet only one randomised controlled clinical trial has assessed the effectiveness of behavioural sleep interventions for children with epilepsy. The intervention was successful, but was delivered via face-to-face educational sessions with parents, which are costly and non-scalable to population level. The Changing Agendas on Sleep, Treatment and Learning in Epilepsy (CASTLE) Sleep-E trial addresses this problem by comparing clinical and cost-effectiveness in children with Rolandic epilepsy between standard care (SC) and SC augmented with a novel, tailored parent-led CASTLE Online Sleep Intervention (COSI) that incorporates evidence-based behavioural components. METHODS AND ANALYSES CASTLE Sleep-E is a UK-based, multicentre, open-label, active concurrent control, randomised, parallel-group, pragmatic superiority trial. A total of 110 children with Rolandic epilepsy will be recruited in outpatient clinics and allocated 1:1 to SC or SC augmented with COSI (SC+COSI). Primary clinical outcome is parent-reported sleep problem score (Children's Sleep Habits Questionnaire). Primary health economic outcome is the incremental cost-effectiveness ratio (National Health Service and Personal Social Services perspective, Child Health Utility 9D Instrument). Parents and children (≥7 years) can opt into qualitative interviews and activities to share their experiences and perceptions of trial participation and managing sleep with Rolandic epilepsy. ETHICS AND DISSEMINATION The CASTLE Sleep-E protocol was approved by the Health Research Authority East Midlands (HRA)-Nottingham 1 Research Ethics Committee (reference: 21/EM/0205). Trial results will be disseminated to scientific audiences, families, professional groups, managers, commissioners and policymakers. Pseudo-anonymised individual patient data will be made available after dissemination on reasonable request. TRIAL REGISTRATION NUMBER ISRCTN13202325.
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Affiliation(s)
- Nadia Al-Najjar
- Liverpool Clinical Trials Centre, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Lucy Bray
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Bernie Carter
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Advisory Panel Castle
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Amber Collingwood
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Georgia Cook
- Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Holly Crudgington
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Janet Currier
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Kristina Charlotte Dietz
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Will A S Hardy
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Harriet Hiscock
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Christopher Morris
- University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Deborah Roberts
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Alison Rouncefield-Swales
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Holly Saron
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Catherine Spowart
- Liverpool Clinical Trials Centre, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Lucy Stibbs-Eaton
- Liverpool Clinical Trials Centre, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Catrin Tudur Smith
- Department of Health Data Science, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Victoria Watson
- Department of Health Data Science, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Liam Whittle
- Department of Health Data Science, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Luci Wiggs
- Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Paul Gringras
- Department of Sleep Medicine, Evelina London Children's Hospital, London, UK
| | - Deb K Pal
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Carter B, Bray L, al-Najjar N, Piella AT, Tudur-Smith C, Spowart C, Collingwood A, Crudgington H, Currier J, Hughes DA, Wood E, Martin R, Morris C, Roberts D, Rouncefield-Swales A, Sutherland H, Watson V, Cook G, Wiggs L, Gringras P, Pal D. The impact of parent treatment preference and other factors on recruitment: lessons learned from a paediatric epilepsy randomised controlled trial. Trials 2023; 24:83. [PMID: 36747248 PMCID: PMC9900533 DOI: 10.1186/s13063-023-07091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/30/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In paediatric epilepsy, the evidence of effectiveness of antiseizure treatment is inconclusive for some types of epilepsy. As with other paediatric clinical trials, researchers undertaking paediatric epilepsy clinical trials face a range of challenges that may compromise external validity MAIN BODY: In this paper, we critically reflect upon the factors which impacted recruitment to the pilot phase of a phase IV unblinded, randomised controlled 3×2 factorial trial examining the effectiveness of two antiseizure medications (ASMs) and a sleep behaviour intervention in children with Rolandic epilepsy. We consider the processes established to support recruitment, public and patient involvement and engagement (PPIE), site induction, our oversight of recruitment targets and figures, and the actions we took to help us understand why we failed to recruit sufficient children to continue to the substantive trial phase. The key lessons learned were about parent preference, children's involvement and collaboration in decision-making, potential and alternative trial designs, and elicitation of stated preferences pre-trial design. Despite pre-funding PPIE during the trial design phase, we failed to anticipate the scale of parental treatment preference for or against antiseizure medication (ASMs) and consequent unwillingness to be randomised. Future studies should ensure more detailed and in-depth consultation to ascertain parent and/or patient preferences. More intense engagement with parents and children exploring their ideas about treatment preferences could, perhaps, have helped predict some recruitment issues. Infrequent seizures or screening children close to natural remission were possible explanations for non-consent. It is possible some clinicians were unintentionally unable to convey clinical equipoise influencing parental decision against participation. We wanted children to be involved in decisions about trial participation. However, despite having tailored written and video information to explain the trial to children we do not know whether these materials were viewed in each consent conversation or how much input children had towards parents' decisions to participate. Novel methods such as parent/patient preference trials and/or discrete choice experiments may be the way forward. CONCLUSION The importance of diligent consultation, the consideration of novel methods such as parent/patient preference trials and/or discrete choice experiments in studies examining the effectiveness of ASMs versus no-ASMs cannot be overemphasised even in the presence of widespread clinician equipoise.
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Affiliation(s)
- Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.
| | - Lucy Bray
- grid.255434.10000 0000 8794 7109Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Nadia al-Najjar
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Agnès Tort Piella
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Catrin Tudur-Smith
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Catherine Spowart
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Amber Collingwood
- grid.13097.3c0000 0001 2322 6764Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Holly Crudgington
- grid.13097.3c0000 0001 2322 6764Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | | | - Dyfrig A. Hughes
- grid.7362.00000000118820937Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Eifiona Wood
- grid.7362.00000000118820937Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Rachael Martin
- grid.255434.10000 0000 8794 7109Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Christopher Morris
- grid.8391.30000 0004 1936 8024University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Alison Rouncefield-Swales
- grid.255434.10000 0000 8794 7109Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Heather Sutherland
- grid.255434.10000 0000 8794 7109Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Victoria Watson
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Georgia Cook
- grid.7628.b0000 0001 0726 8331Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Luci Wiggs
- grid.7628.b0000 0001 0726 8331Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Paul Gringras
- Newcomen Children's Neurosciences Centre, Evelina London Children's Hospital, London, UK. .,Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Deb Pal
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK. .,MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK. .,King's College Hospital, London, UK.
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Carroll JH, Cross JH, Hickson M, Williams E, Aldridge V, Collinson A. The CORE-KDT study: a mixed methods protocol to establish core outcomes for refractory childhood epilepsy treated with ketogenic diet therapy. Trials 2022; 23:675. [PMID: 35978413 PMCID: PMC9386954 DOI: 10.1186/s13063-022-06629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/04/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND A core outcome set defines the minimum outcomes that should be included in clinical trials, audit or practice. The aim being to increase the quality and relevance of research by ensuring consistency in the measurement and reporting of outcomes. Core outcome sets have been developed for a variety of disease states and treatments. However, there is no established set of core outcomes for refractory childhood epilepsy treated with ketogenic diet therapy. This should be developed using a patient-centred approach to ensure the outcomes measured are relevant to patients and clinical practice. METHODS This is a mixed methods study of four phases to develop a core outcome set for refractory childhood epilepsy treated with ketogenic diet therapy. In phase 1, a systematic scoping review of the literature will establish which outcomes are measured in trials of refractory epilepsy treated with ketogenic diet therapy. In phase 2, qualitative interviews with parents and carers will aim to identify the outcomes of importance to these stakeholders. Phase 3 will see a comprehensive list of outcomes collated from the first two phases, grouped into domains according to an outcome taxonomy. Phase 4 will invite parents, health care professionals and researchers to participate in a two-round Delphi study to rate the importance of the presented outcomes. Following which, the core outcome set will be ratified at a face to face consensus meeting. DISCUSSION This study will guide outcome measurement in future studies of childhood epilepsy treated with ketogenic diet therapy and clinical practice through audit and service evaluation.
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Affiliation(s)
| | - J. Helen Cross
- UCL Developmental Neurosciences, UCL - NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Mary Hickson
- Faculty of Health, University of Plymouth, Plymouth, Devon UK
| | | | | | - Avril Collinson
- Faculty of Health, University of Plymouth, Plymouth, Devon UK
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Abstract
Although trials with anti-seizure medications (ASMs) have not shown clear anti-epileptogenic or disease-modifying activity in humans to date, rapid advancements in genomic technology and emerging gene-mediated and gene replacement options offer hope for the successful development of disease-modifying therapies (DMTs) for genetic epilepsies. In fact, more than 26 potential DMTs are in various stages of preclinical and/or clinical development for genetic syndromes associated with epilepsy. The scope of disease-modification includes but is not limited to effects on the underlying pathophysiology, the condition's natural history, epilepsy severity, developmental achievement, function, behavior, sleep, and quality of life. While conventional regulatory clinical trials for epilepsy therapeutics have historically focused on seizure reduction, similarly designed trials may prove ill-equipped to identify these broader disease-modifying benefits. As we look forward to this pipeline of DMTs, focused consideration should be given to the challenges they pose to conventional clinical trial designs for epilepsy therapeutics. Just as DMTs promise to fundamentally alter how we approach the care of patients with genetic epilepsy syndromes, DMTs likewise challenge how we traditionally construct and measure the success of clinical trials. In the following, we briefly review the historical and preclinical frameworks for DMT development for genetic epilepsies and explore the many novel challenges posed for such trials, including the choice of suitable outcome measures, trial structure, timing and duration of treatment, feasible follow-up period, varying safety profile, and ethical concerns.
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Affiliation(s)
- Dylan C Brock
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
- Children's Hospital Colorado, Aurora, CO, 80045, USA.
| | - Scott Demarest
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Tim A Benke
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Departments of Neurology, Pharmacology, and Otolaryngology, University of Colorado School of Medicine, CO, 80045, Aurora, USA
- Children's Hospital Colorado, Aurora, CO, 80045, USA
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Liu M, Gao Y, Yuan Y, Shi S, Yang K, Lu C, Wu J, Zhang J, Tian J. Inconsistency and low transparency were found between core outcome set protocol and full text publication: a comparative study. J Clin Epidemiol 2020; 131:59-69. [PMID: 33227446 DOI: 10.1016/j.jclinepi.2020.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/16/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of the study was to assess inconsistencies between individual protocols and associated full-text publications in the development of core outcome sets (COSs). STUDY DESIGN AND SETTING Protocols and subsequent full-text publications were retrieved by searching the following electronic databases: PubMed, Embase, Web of Science, and the Core Outcome Measures in Effectiveness Trials database from inception to October 1, 2019. We summarized changes in the general and methodological characteristics by comparing the protocols with the full-text publications and reported change as information frequency and proportion. RESULTS A total of 24 protocols and 32 corresponding full-text publications that encompassed 14 study topics were identified from databases. In the identified initial list of outcomes, five COSs (20.8%) changed the included study type, none of which explained the reasons for these changes. In addition, eight COSs showed inconsistencies between the protocols and full-text publications in the searched databases, of which, only two studies explained the reasons for these changes. Compared with the protocols, three COSs changed the number of Delphi rounds, eight COSs changed the participants (stakeholder groups), and three COSs changed the consensus definition of the Delphi survey. Only two COSs explained the reason for changing the number of Delphi rounds, and none of the studies explained why the participants changed. For the face-to-face consensus meeting, we found that nine COSs changed the participants and none explained the reasons for these changes. CONCLUSION Our study found many inconsistencies between protocols and the full-text publications concerning COS development. These inconsistencies related to the included study types, databases searched, Delphi surveys, and face-to-face consensus meetings. As it is necessary to publish protocols before developing COSs, transparency regarding any changes to the methods is needed.
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Affiliation(s)
- Ming Liu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Yuan Yuan
- Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Shuzhen Shi
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Kelu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Cuncun Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Jiarui Wu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medical, Beijing University of Chinese Medicine, Beijing 100105, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China.
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Mcneill M, Noyek S, Engeda E, Fayed N. Assessing the engagement of children and families in selecting patient-reported outcomes (PROs) and developing their measures: a systematic review. Qual Life Res 2021; 30:983-95. [DOI: 10.1007/s11136-020-02690-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 01/14/2023]
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Crudgington H, Collingwood A, Bray L, Lyle S, Martin R, Gringras P, Pal DK, Morris C. Mapping epilepsy-specific patient-reported outcome measures for children to a proposed core outcome set for childhood epilepsy. Epilepsy Behav 2020; 112:107372. [PMID: 32906016 PMCID: PMC7689576 DOI: 10.1016/j.yebeh.2020.107372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objectives of the study were to (1) map questions in epilepsy-specific patient-reported outcome measures (PROMs) of children's health-related quality of life (HRQoL) to a proposed core outcome set (COS) for childhood epilepsy research and (2) gain insight into the acceptability of two leading candidate PROMs. METHOD We identified 11 epilepsy-specific PROMs of children's HRQoL (17 questionnaire versions) in a previous systematic review. Each item from the PROMs was mapped to 38 discrete outcomes across 10 domains of the COS: seizures, sleep, social functioning, mental health, cognition, physical functioning, behavior, adverse events, family life, and global quality of life. We consulted with three children with epilepsy and six parents of children with epilepsy in Patient Public Involvement and Engagement (PPIE) work to gain an understanding of the acceptability of the two leading PROMs from our review of measurement properties: Quality of Life in Childhood Epilepsy (QOLCE-55) and Health-Related Quality of Life Measure for Children with Epilepsy (CHEQOL). RESULTS Social Functioning is covered by all PROMs except DISABKIDS and G-QOLCE and Mental Health is covered by all PROMs except G-QOLCE and Hague Restrictions in Childhood Epilepsy Scale (HARCES). Only two PROMs (Epilepsy and Learning Disability Quality of Life (ELDQOL) and Glasgow Epilepsy Outcome Scale (GEOS-YP)) have items that cover the Seizure domain. The QOLCE-55 includes items that cover the domains of Physical Functioning, Social Functioning, Behavior, Mental Health, and Cognition. The CHEQOL parent and child versions cover the same domains as QOLCE-55 except for Physical Functioning and Behavior, and the child version has one item that covers the discrete outcome of Overall Quality of Life and one item that covers the discrete outcome of Relationship with parents and siblings. The QOLCE-55 parent version was acceptable to the parents we consulted with, and CHEQOL parent and child versions were described as acceptable to our child and parent advisory panel members. SIGNIFICANCE Mapping items from existing epilepsy-specific PROMs for children is an important step in operationalizing our COS for childhood epilepsy research, alongside evaluation of their measurement properties. Two leading PROMS, QOLCE-55 and CHEQOL, cover a wide range of domains from our COS and would likely be used in conjunction with assessment tools selected for specific study objectives. The PPIE work provided practical insights into the administration and acceptability of candidate PROMs in appropriate context. We promote our COS as a framework for selecting outcomes and PROMs for future childhood epilepsy evaluative research.
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Affiliation(s)
- Holly Crudgington
- King's College London, Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - Amber Collingwood
- King's College London, Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - Lucy Bray
- Edge Hill University, Faculty of Health, Social Care and Medicine, UK.
| | - Samantha Lyle
- King's College London, Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Rachael Martin
- Edge Hill University, Faculty of Health, Social Care and Medicine, UK.
| | - Paul Gringras
- Evelina London Children's Hospital, UK; King's College London Institute for Women and Children's Health, UK.
| | - Deb K. Pal
- King's College London, Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, UK,Evelina London Children's Hospital, UK,MRC Centre for Neurodevelopmental Disorders, King's College London, UK,King's College Hospital, London, UK
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Retzer A, Sayers R, Pinfold V, Gibson J, Keeley T, Taylor G, Plappert H, Gibbons B, Huxley P, Mathers J, Birchwood M, Calvert M. Development of a core outcome set for use in community-based bipolar trials-A qualitative study and modified Delphi. PLoS One 2020; 15:e0240518. [PMID: 33112874 PMCID: PMC7592842 DOI: 10.1371/journal.pone.0240518] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/28/2020] [Indexed: 01/24/2023] Open
Abstract
Background A core outcome set (COS) is a standardised collection of outcomes to be collected and reported in all trials within a research area. A COS can reduce reporting bias and facilitate evidence synthesis. This is currently unavailable for use in community-based bipolar trials. This research aimed to develop such a COS, with input from a full range of stakeholders. Methods A co-production approach was used throughout. A longlist of outcomes was derived from focus groups with people with a bipolar diagnosis and carers, interviews with healthcare professionals and a rapid review of outcomes listed in bipolar trials on the Cochrane database. An expert panel with personal and/or professional experience of bipolar participated in a modified Delphi process and the COS was finalised at a consensus meeting. Results Fifty participants rated the importance of each outcome. Sixty-six outcomes were included in Round 1 of the questionnaire; 13 outcomes were added by Round 1 participants and were rated in Round 2. Seventy-six percent of participants (n = 38) returned to Round 2 and 60 outcomes, including 4 outcomes added by participants in Round 1, received a rating of 7–9 by >70% and 1–3 by <25% of the sample. Fourteen participants finalised a COS containing 11 outcomes at the consensus meeting: personal recovery; connectedness; clinical recovery of bipolar symptoms; mental health and wellbeing; physical health; self-monitoring and management; medication effects; quality of life; service outcomes; experience of care; and use of coercion. Conclusions This COS is recommended for use in community-based bipolar trials to ensure stakeholder-relevant outcomes, facilitate data synthesis, and transparent reporting. The COS includes guidance notes for each outcome to allow the identification of suitable measurement instruments. Further validation is recommended for use with a wide range of communities and to achieve standardised measurement.
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Affiliation(s)
- Ameeta Retzer
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, and Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
| | - Ruth Sayers
- The McPin Foundation, London, United Kingdom
| | | | - John Gibson
- The McPin Foundation, London, United Kingdom
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Thomas Keeley
- GlaxoSmithKline (formerly of CPROR, University of Birmingham), London, United Kingdom
| | - Gemma Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, United Kingdom
| | - Humera Plappert
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Bliss Gibbons
- Coventry and Warwickshire Partnership NHS Trust and Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Peter Huxley
- Centre for Mental Health and Society, Bangor University, Bangor, United Kingdom
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Maximillian Birchwood
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, and Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR Applied Research Collaboration West Midlands, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
- * E-mail:
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Crudgington H, Rogers M, Morris H, Gringras P, Pal DK, Morris C. Epilepsy-specific patient-reported outcome measures of children's health-related quality of life: A systematic review of measurement properties. Epilepsia 2020; 61:230-248. [PMID: 31953859 PMCID: PMC7065094 DOI: 10.1111/epi.16430] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/23/2019] [Accepted: 12/26/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To identify and appraise published evidence of the measurement properties for epilepsy-specific patient-reported outcome measures (PROMs) of children's health-related quality of life (HRQoL). METHODS We searched multiple databases for studies evaluating the measurement properties of English-language epilepsy-specific PROMs of children's HRQoL. We assessed the methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. We extracted data about the content validity, construct validity, internal consistency, test-retest reliability, proxy reliability, responsiveness, and precision, and assessed the measurement properties with reference to standardized criteria. RESULTS We identified 27 papers that evaluated 11 PROMs. Methodological quality was variable. Construct validity, test-retest reliability, and internal consistency were more commonly assessed. Quality of Life in Childhood Epilepsy (QoLCE) questionnaires are parent-reported and evaluated more than other PROMs; QoLCE-55 has good and replicated evidence for structural and construct validity and internal consistency. Health-Related Quality of Life Measure for Children with Epilepsy (CHEQoL) has both child and parent-reported versions and good evidence of content, structural, and construct validity. SIGNIFICANCE This review identified two leading candidate epilepsy-specific PROMs for measuring health-related quality of life in children. Establishing evidence of the responsiveness of PROMs is a priority to help the interpretation of meaningful change scores.
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Affiliation(s)
- Holly Crudgington
- Basic and Clinical Neuroscience DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Morwenna Rogers
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Hannah Morris
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Paul Gringras
- Evelina London Children's HospitalLondonUK
- KCL Institute for Women and Children's HealthLondonUK
| | - Deb K. Pal
- Basic and Clinical Neuroscience DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Evelina London Children's HospitalLondonUK
- MRC Centre for Neurodevelopmental DisordersKing's College LondonLondonUK
- King's College HospitalLondonUK
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Crudgington H, Rogers M, Bray L, Carter B, Currier J, Dunkley C, Gibbon FM, Hughes D, Lyle S, Roberts D, Tudur Smith C, Gringras P, Pal DK, Morris C. Core Health Outcomes in Childhood Epilepsy (CHOICE): Development of a core outcome set using systematic review methods and a Delphi survey consensus. Epilepsia 2019; 60:857-871. [PMID: 31021436 PMCID: PMC6563436 DOI: 10.1111/epi.14735] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/28/2019] [Accepted: 03/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Establishing a core set of outcomes to be evaluated and reported in intervention trials aims to improve the usefulness of health research. There is no established core outcome set (COS) for childhood epilepsies. The aim of this study was to select a COS to be used in evaluative research of interventions for children with rolandic epilepsy (RE). METHODS We followed guidance from the COMET (Core Outcome Measures in Effectiveness Trials) Initiative. First, we identified outcomes that had been measured in research through a systematic review. Second, young people with RE, parents, and professionals were invited to take part in a Delphi survey in which participants rated the importance of candidate outcomes. Last, a face-to-face meeting was convened to seek consensus on which outcomes were critical to include and to ratify the final COS. RESULTS From 37 eligible papers in the review, we identified and included 48 candidate outcomes in the survey. We sent invitations to 165 people registered to take part in the survey; of these, 102 (62%) completed Round 1, and 80 (78%) completed Round 2 (three young people, 16 parents, 61 professionals). In Round 2 we included four additional outcomes suggested by participants in Round 1. The consensus meeting included two young people, four parents, and nine professionals who were eligible to vote and ratified the COS as 39 outcomes across 10 domains. SIGNIFICANCE Our methodology was a proportionate and pragmatic approach toward producing a COS for evaluating research on interventions aiming to improve the health of children with RE.
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Affiliation(s)
- Holly Crudgington
- Basic and Clinical Neuroscience DepartmentInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
| | - Morwenna Rogers
- University of Exeter Medical School, College of Medicine and HealthUniversity of ExeterExeterUK
| | - Lucy Bray
- Faculty of Health and Social CareEdge Hill UniversityOrmskirkUK
| | - Bernie Carter
- Faculty of Health and Social CareEdge Hill UniversityOrmskirkUK
| | - Janet Currier
- Lay coinvestigator and epilepsy services userLondonUK
| | - Colin Dunkley
- Sherwood Forest Hospitals National Health Service Foundation TrustSutton‐in‐AshfieldUK
| | - Frances M. Gibbon
- Noah's Ark Children's Hospital for WalesCardiff and Vale University Health BoardCardiffUK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines EvaluationBangor UniversityBangorUK
| | - Samantha Lyle
- Basic and Clinical Neuroscience DepartmentInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
| | | | | | - Paul Gringras
- Basic and Clinical Neuroscience DepartmentInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
- Evelina London Children's HospitalLondonUK
| | - Deb K. Pal
- Basic and Clinical Neuroscience DepartmentInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
- Evelina London Children's HospitalLondonUK
- Medical Research Council Centre for Neurodevelopmental DisordersKing's College LondonLondonUK
- King's College HospitalLondonUK
| | - Christopher Morris
- University of Exeter Medical School, College of Medicine and HealthUniversity of ExeterExeterUK
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Abstract
The relationship between sleep and seizure disorders is a particularly vicious cycle. Nocturnal seizures can interrupt sleep while a number of factors, including antiepileptics and sleep disorders that cause sleep fragmentation, can worsen seizures. Understanding and managing seizures and related sleep disturbance is therefore an important and treatable intervention target that could potentially improve children's sleep, but also their learning, mood, behaviour, seizures and parental quality of life.
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Affiliation(s)
| | | | - Paul Gringras
- Children’s Sleep Medicine, Evelina Childrens Hospital, London, UK
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Abstract
OBJECTIVE To evaluate the accessibility of essential medicines in China through a new system which integrated the structure, process, and effect of the National Essential Medicine Policy (NEMP). METHODS A structural equation model was built to verify the reliability of the evaluation system. This study utilized the Delphi method to obtain the structure and process index data, and used the WHO/HAI standard method for the effect index data to evaluate the NEMP. Six regions were selected for empirical analysis so that suggestions for optimization could be put forward. RESULTS The structural equation model consisted of three parts: organization structure, executive process, and effect. The factor loading of the three indicators exceeded 0.5, indicating that this model complied with the preliminary fit criteria. In the organizational structure, rules and regulations and resource investment accounted for a large proportion, indicating that they had a great impact on the effect. As for the executive process, the weight of the seven indicators were similar, and they accounted for a large proportion, indicating that each indicator had a non-negligible impact on the effect. The "p" of all the three hypothesizes was less than .01, especially the "p" of hypothesis 3 was less than .001, indicating that the structure and process of NEMP affected the accessibility of the essential medicines, and three components of the model were positively correlated. LIMITATIONS Some errors may exist in achieving appropriate expert selection because of potential researcher bias in the Delphi approach. The results from only six provinces in China may not be generalized nationwide. CONCLUSION The structural indicators and process indicators have a significant impact on outcome indicators, and they also have correlations. That is, the formulation and implementation of the national drug policy and related supporting measures play an important role in improving the accessibility of essential medicines.
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Affiliation(s)
- Xiaoyu Xi
- a The Research Center of National Drug Policy & Ecosystem of China Pharmaceutical University , Nanjing , PR China
| | - Piaopiao Chen
- a The Research Center of National Drug Policy & Ecosystem of China Pharmaceutical University , Nanjing , PR China
| | - Fan Yang
- a The Research Center of National Drug Policy & Ecosystem of China Pharmaceutical University , Nanjing , PR China
| | - Yifan Yang
- a The Research Center of National Drug Policy & Ecosystem of China Pharmaceutical University , Nanjing , PR China
| | - Lili Chen
- a The Research Center of National Drug Policy & Ecosystem of China Pharmaceutical University , Nanjing , PR China
| | - Ningying Mao
- a The Research Center of National Drug Policy & Ecosystem of China Pharmaceutical University , Nanjing , PR China
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