Wednesday , April 21 2021

Phone CBT-I improves sleep, fatigue and some pain symptoms



February 22, 2021

2 min read

Source / Disclosures

Announcements:
McCurry reports receiving grants from the National Institute of Aging during the study. Please see the study for relevant financial disclosures from other authors.


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Cognitive behavioral therapy offered over the phone was effective in improving sleep, fatigue, and, to a lesser extent, pain in older adults with comorbid insomnia and osteoarthritis, data shows.

“Scalable delivery models of cognitive behavioral therapy for insomnia (CBT-I), an effective treatment, are needed for widespread implementation, particularly in rural and disadvantaged populations that do not have access to insomnia treatment,” Susan M. McCurry, PhD, a research professor at the University of Washington School of Nursing, and colleagues enrolled JAMA internal medicine.

Insomnia Severity Index score dropped 3 points among those receiving CBT-I vs EOC.  Flinders Fatigue Scale score dropped -1.8 points among those who received CBT-I against EOC

Reference: McCurry SM, et al. JAMA Intern Med, 2021; doi: 10.1001 / jamainternmed.2020.9049.

The researchers conducted the Osteoarthritis and Therapy for Sleep (OATS) study, a randomized clinical trial they called “the largest controlled evaluation of telephone CBT-I to date.” They recruited 327 patients from Washington (mean age = 70.2 years; 74.6% women, 66% from medically underserved / health professional deficiency areas) with chronic sleep and osteoarthritis symptoms.

All patients received six 20- to 30-minute telephone sessions over 8 weeks and submitted daily sleep diaries. CBT-I participants received instruction regarding sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and homework, while participants in education-only control (EOC) were instructed on sleep and osteoarthritis. Blind assessments took place at baseline, 2 months after treatment and 12 months after completion of study.

“Interventionists were not blinded to treatment tasks; however, all outcomes were collected by blind investigators, ‘McCurry and colleagues wrote. “Results were based on self-report, but for purposes of clinical practice and possible scalability of treatment, these are important measures of effectiveness.”

McCurry and colleagues wrote that among the 136 patients in the CBT-I group and 146 patients in the EOC group who had 12 months of data available, total 2-month post-treatment Insomnia Severity Index scores 8.1 points in ‘ the CBT-I group decreased and 4.8 points in the EOC group (adjusted mean between group difference = -3.5 points; 95% CI, -4.4 to -2.6). These results were maintained at 12 months (adjusted mean difference = punten3 points; 95% CI, ,14.1 to punten2 points).

In addition, after 12 months, 67 of 119 (56.3%) patients in the CBT-I group remained in remission (Insomnia Severity Index score = 7 points) against 33 of 128 (25.8%) patients in the EOC group. Flinders Fatigue Scale scores were also significantly reduced in the CBT-I group versus the EOC group at 2 months after treatment (mean between group difference = -2 points; 95% CI, -3.1 to -0.9 points ) and 12-month follow -up (mean difference between group = -1.8 points; 95% CI, –3.1 to –0.6 points). The researchers also reported significant differences after treatment for pain; however, these differences were not maintained after 12 months.

McCurry and colleagues concluded that the results “have broad implications” because most study participants were from medically underserved / health professional deficits, “where access to individualized specialized treatment, such as CBT-I, was at its best. and is often non-existent. ”

Given much evidence that CBT-I is effective for individuals with other comorbid conditions, including older adults with chronic pain, we believe that OATS trial findings are likely to be generalizable beyond the current [osteoarthritis] study population, ”McCurry and colleagues wrote.


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