Cognitive behavioural therapy versus health education for sleep disturbance and fatigue after acquired brain injury: A pilot randomised trial - 12/10/21
, Adam McKay a, b, c, Dana Wong a, b, d, Kate Frencham b, Natalie Grima a, b, Joanna Tran b, Sylvia Nguyen b, c, Moira Junge a, Jade Murray a, b, Gershon Spitz a, b, Jennie Ponsford a, b
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Highlights |
• | Sleep disturbance and fatigue are highly prevalent after acquired brain injury. |
• | Cognitive behavioural therapy improves sleep disturbance and fatigue after injury. |
• | This 8-week treatment is adapted to support individuals with cognitive impairments. |
• | Benefits of cognitive behavioural therapy extend over and above health education. |
• | Additional treatment benefits include improved self-efficacy and quality of life. |
Abstract |
Background |
Sleep disturbance and fatigue are highly prevalent after acquired brain injury (ABI) and are associated with poor functional outcomes. Cognitive behavioural therapy (CBT) is a promising treatment for sleep and fatigue problems after ABI, although comparison with an active control is needed to establish efficacy.
Objectives |
We compared CBT for sleep disturbance and fatigue (CBT-SF) with a health education (HE) intervention to control for non-specific therapy effects.
Methods |
In a parallel-group, pilot randomised controlled trial, 51 individuals with traumatic brain injury (n = 22) and stroke (n = 29) and clinically significant sleep and/or fatigue problems were randomised 2:1 to 8 weeks of a CBT-SF (n = 34) or HE intervention (n = 17), both adapted for cognitive impairments. Participants were assessed at baseline, post-treatment, and 2 and 4 months post-treatment. The primary outcome was the Pittsburgh Sleep Quality Index; secondary outcomes included measures of fatigue, sleepiness, mood, quality of life, activity levels, self-efficacy and actigraphy sleep measures.
Results |
The CBT-SF led to significantly greater improvements in sleep quality as compared with HE, during treatment and at 2 months [95% confidence interval (CI) -24.83; -7.71], as well as significant reductions in fatigue maintained at all time points, which were not evident with HE (95% CI -1.86; 0.23). HE led to delayed improvement in sleep quality at 4 months post-treatment and in depression (95% CI -1.37; -0.09) at 2 months post-treatment. CBT-SF led to significant gains in self-efficacy (95% CI 0.15; 0.53) and mental health (95% CI 1.82; 65.06).
Conclusions |
CBT-SF can be an effective treatment option for sleep disturbance and fatigue after ABI, over and above HE. HE may provide delayed benefit for sleep, possibly by improving mood.
Trial Registration |
Australia New Zealand Clinical Trials Registry: ACTRN12617000879369 (registered 15/06/2017) and ACTRN12617000878370 (registered 15/06/2017).
Le texte complet de cet article est disponible en PDF.Keywords : Cognitive behavioural therapy, Acquired brain injury, Sleep, Fatigue, Health education
Plan
Vol 64 - N° 5
Article 101560- septembre 2021 Retour au numéro
Article précédent
- Simplified evaluation of CONsciousness disorders (SECONDs) in individuals with severe brain injury: A validation study
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- A controlled clinical efficacy trial of multimodal cognitive rehabilitation on episodic memory functioning in older adults with traumatic brain injury
- Eduardo Cisneros, Elaine de Guise, Sylvie Belleville, Michelle McKerral
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