Abstract
OBJECTIVE: To determine the feasibility and optimal design of a randomised controlled trial (RCT) of Seizure First Aid Training For Epilepsy (SAFE).
DESIGN: Pilot RCT with embedded microcosting.
SETTING: Three English hospital emergency departments (EDs).
PARTICIPANTS: Patients aged ≥16 with established epilepsy reporting ≥2 ED visits in the prior 12 months and their significant others (SOs).
INTERVENTIONS: Patients (and their SOs) were randomly allocated (1:1) to SAFE plus treatment-as-usual (TAU) or TAU alone. SAFE is a 4-hour group course.
MAIN OUTCOME MEASURES: Two criteria evaluated a definitive RCT's feasibility: (1) ≥20% of eligible patients needed to be consented into the pilot trial; (2) routine data on use of ED over the 12 months postrandomisation needed securing for ≥75%. Other measures included eligibility, ease of obtaining routine data, availability of self-report ED data and comparability, SAFE's effect and intervention cost.
RESULTS: Of ED attendees with a suspected seizure, 424 (10.6%) patients were eligible; 53 (12.5%) patients and 38 SOs consented. Fifty-one patients (and 37 SOs) were randomised. Routine data on ED use at 12 months were secured for 94.1% patients. Self-report ED data were available for 66.7% patients. Patients reported more visits compared with routine data. Most (76.9%) patients randomised to SAFE received it and no related serious adverse events occurred. ED use at 12 months was lower in the SAFE+TAU arm compared with TAU alone, but not significantly (rate ratio=0.62, 95% CI 0.33 to 1.17). A definitive trial would need ~674 patient participants and ~39 recruitment sites. Obtaining routine data was challenging, taking ~8.5 months.
CONCLUSIONS: In satisfying only one predetermined 'stop/go' criterion, a definitive RCT is not feasible. The low consent rate in the pilot trial raises concerns about a definitive trial's finding's external validity and means it would be expensive to conduct. Research is required into how to optimise recruitment from the target population.
TRIAL REGISTRATION NUMBER: ISRCTN13871327.
Original language | English |
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Article number | e035516 |
Journal | BMJ Open |
Volume | 10 |
Issue number | 4 |
DOIs | |
Publication status | Published - 16 Apr 2020 |
Bibliographical note
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.Keywords
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Caregivers/education
- Emergency Service, Hospital
- Epilepsy/therapy
- Feasibility Studies
- Female
- First Aid
- Humans
- Male
- Middle Aged
- Patient Education as Topic/economics
- Pilot Projects
- Routinely Collected Health Data
- Seizures/therapy
- Self-Management/education
- United Kingdom
- Young Adult