Osteoprotective Knowledge in a Multiethnic Epilepsy Population

John O. Elliott, MPH; Brenda F. Seals, PhD, MPH; Mercedes P. Jacobson, MD


J Neurosci Nurs. 2008;40(1):14-24. 

In This Article

Study Limitations

This investigation was completed at one urban medical center without the use of a control population. To determine whether people with epilepsy truly have a knowledge deficiency regarding osteoprotective factors, it would be necessary to compare them with nonepilepsy patients of similar educational backgrounds and ethnicities. Such a study would allow for analyses controlling for these factors. The previous use of the OKT in more than 700 nonepilepsy patients does, however, provide a strong case for a range of scores to expect.

Because patients at a tertiary academic medical center are often more refractory to treatment, the differences we found may be higher when compared with a well-controlled epilepsy population seen only by primary care practitioners. In this study, we looked at the effects of seizure frequency on knowledge to provide an idea of what these differences may be. To strengthen our comparisons, however, it would have been helpful to assess exercise frequency and dietary calcium intake through a food frequency questionnaire.

The low overall response rate of 42% may be due in part to the length of the survey. Because this questionnaire was part of a larger study that involved a total of 146 questions (Elliott, Jacobson, & Seals, 2006), we felt additional questionnaires may have resulted in less participation or missing data. Only five patients verbally declined to participate, but many more failed to return the survey despite being given a self-addressed stamped envelope. This lack of response may be due to issues of low literacy in our population. Several participants were assisted by the researcher after their clinic visits to overcome difficulties with readability of the questions. Opportunities to address this issue with those patients receiving a mailed survey were much lower. Also, more women (n = 66) completed surveys than men (n = 28), which is not unexpected because osteoporosis is associated more with women in the media. This research is also limited by its cross-sectional nature. However, because no prior studies of osteoporosis knowledge in the epilepsy population exist, it is a useful starting point. Recommendations for future research include the development and evaluation of osteoprotective educational materials specific to epilepsy, as well as assessments of current dietary and exercise habits among people with epilepsy.

The OKT was developed in 1991 when there was a different recommended daily allowance (RDA) for calcium. The OKT should be revised to reflect the current RDA for calcium, which is mentioned in the background section.