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Psychosocial profiles and their predictors in epilepsy using patient‐reported outcomes and machine learning
Author(s) -
Josephson Colin B.,
Engbers Jordan D. T.,
Wang Meng,
Perera Kevin,
Roach Pamela,
Sajobi Tolulope T.,
Wiebe Samuel
Publication year - 2020
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.16526
Subject(s) - psychosocial , relative risk , medicine , population , confidence interval , epilepsy , psychiatry , quality of life (healthcare) , psychology , physical therapy , environmental health , nursing
Objective To apply unsupervised machine learning to patient‐reported outcomes to identify clusters of epilepsy patients exhibiting unique psychosocial characteristics. Methods Consecutive outpatients seen at the Calgary Comprehensive Epilepsy Program outpatient clinics with complete patient‐reported outcome measures on quality of life, health state valuation, depression, and epilepsy severity and disability were studied. Data were acquired at each patient's first clinic visit. We used k‐means++ to segregate the population into three unique clusters. We then used multinomial regression to determine factors that were statistically associated with patient assignment to each cluster. Results We identified 462 consecutive patients with complete patient‐reported outcome measure (PROM) data. Post hoc analysis of each cluster revealed one reporting elevated measures of psychosocial health on all five PROMs ("high psychosocial health" cluster), one with intermediate measures ("intermediate" cluster), and one with poor overall measures of psychosocial health ("poor psychosocial health" cluster). Failing to achieve at least 1 year of seizure freedom (relative risk [RR] = 4.34, 95% confidence interval [CI] = 2.13‐9.09) predicted placement in the "intermediate" cluster relative to the "high" cluster. In addition, failing to achieve seizure freedom, social determinants of health, including the need for partially or completely subsidized income support (RR = 6.10, 95% CI = 2.79‐13.31, P < .001) and inability to drive (RR = 4.03, 95% CI = 1.6‐10.00, P = .003), and a history of a psychiatric disorder (RR = 3.16, 95% CI = 1.46‐6.85, P = .003) were associated with the "poor" cluster relative to the "high" cluster. Significance Seizure‐related factors appear to drive placement in the "intermediate" cluster, with social determinants driving placement in the "poor" cluster, suggesting a threshold effect. Precision intervention based on cluster assignment, with an initial emphasis on improving social support and careful titration of medications for those reporting the worst psychosocial health, could help optimize health for patients with epilepsy.