Summary of findings for the main comparison. Summary of findings table.
| Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy | ||||||
| Patient or population: adults and children with epilepsy Setting: all settings Intervention: adherence‐enhancing intervention Comparison: no intervention or other intervention | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with no intervention or other intervention | Risk with adherence‐enhancing intervention | |||||
| Effects on adherence (behavioural interventions) assessed with: MEMS caps and self‐reported Antiretroviral General Adherence Scale (AGAS) Follow‐up: range 1 month to 3 months | Not estimable See comments | Not estimable See comments | ‐ | 89 (2 RCTs) | ⊕⊕⊕⊝2 MODERATE | Only 1 study showed significant improvement in adherence (see Summary of results for each included study Table 2). Due to different interventions and assessment methods no further conclusions can be drawn. |
| Effects on adherence (educational interventions) assessed with: Serum or plasma concentration and Medication Adherence Scale (MAS) Follow‐up: range 4 weeks to 13 months | Not estimable See comments | Not estimable See comments | ‐ | 1153 (8 RCTs) | ⊕⊕⊕⊝1, 2 MODERATE | Only 3 trials presented significant results of improved adherence. Due to different interventions and assessment methods, no further conclusions can be drawn (see Summary of results for each included study Table 2). |
| Effects on adherence (mixed interventions) assessed with: Serum or plasma concentration and Medication Adherence scale (MAS) Follow‐up: range 6 months to 12 months | Not estimable See comments | Not estimable See comments | ‐ | 522 (3 RCTs) | ⊕⊕⊕⊕1 HIGH | Only 2 studies reported significant improvement in adherence. Due to heterogeneity of interventions and assessment methods, no further conclusions can be drawn (see Summary of results for each included study Table 2). |
| Seizure frequency and seizure severity Follow‐up: range 4 months to 12 months | Not estimable See comments | Not estimable See comments | ‐ | 1293 (6 RCTs) | ⊕⊕⊕⊝1, 2 MODERATE | Decreased seizure frequency and/or seizure severity related to improved adherence with AED was described in 4 out of 6 trials presenting this secondary outcome (see Summary of results for each included study Table 2) |
| Self‐efficacy assessed with: the Epilepsy Self‐Efficacy Scale (ESES) and Sherer`s Self‐Efficacy Scale Follow‐up: range 3 months to 6 months | Not estimable See comments | Not estimable See comments | ‐ | 358 (4 RCTs) | ⊕⊕⊝⊝2, 3 LOW | Only 1 study presented significantly important results supporting improvement in self‐efficacy skills. Other studies reporting positive effects as a result of an intervention with mixed reliability (see Summary of results for each included study Table 2) |
| Quality of life assessed with: Quality of Life in Epilepsy Scale (QOLIE‐10) Follow‐up: range 4 months to 6 months | Not estimable See comments | Not estimable See comments | ‐ | 117 (2 RCTs) | ⊕⊕⊕⊕1 HIGH | 1 study reported significant benefit in intervention group, another study failed to present results supporting the added value of an intervention (see Summary of results for each included study Table 2) |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1The majority of studies measuring this outcome were not at high risk of bias. 2The quality of the evidence of the studies measuring this outcome was downgraded due to the lack of precision or lack of consistency, or both. 3The quality of the evidence of the studies measuring this outcome was downgraded due to the lack directness