| Symposium | Symposia 8 Program Schedule
02/15/2024
04:00 pm - 05:25 pm
Room: West Side Ballroom - Salon 1
Symposia 8: Interventions for neuropsychological conditions
Simposium #3
Cognitive Behavioural Therapy versus Health Education for Sleep Disturbance and Fatigue Following Acquired Brain Injury: A Randomised Controlled Trial
Jennie Ponsford, Monash University, Melbourne, Australia
Lucy Ymer, Monash University, Melbourne, Australia
Adam McKay, Monash University, Melbourne, Australia
Dana Wong, LaTrobe University, Melbourne, Australia
Kate Frencham, Monash University, Melbourne, Australia
Category: Acquired Brain Injury (TBI/Cerebrovascular Injury & Disease - Adult)
Keyword 1: fatigue
Keyword 2: sleep disorders
Keyword 3: treatment outcome
Objective:
Sleep disturbance and fatigue are highly prevalent after acquired brain injury (ABI), and associated with poorer functional outcomes. Cognitive behavioural therapy (CBT) is a promising treatment for sleep and fatigue problems after ABI, although adaptation for cognitive impairments and comparison with an active control is needed to establish efficacy. We compared CBT for sleep disturbance and fatigue (CBT-SF) with a health education intervention (HE) to control for non-specific therapy effects.
Participants and Methods:
In a parallel groups, randomised controlled trial, 126 individuals aged 16-71 (M= 47.83, SD= 14.30, 53% male) with traumatic brain injury (TBI) (n=51) and stroke (n=75) and clinically significant sleep and/or fatigue problems were randomised 2:1 to receive 8 weekly individual sessions of either CBT-SF (n=86) or HE (n=40), both adapted for cognitive impairments. Participants were 56 months post-injury on average (SD= 61.44), and individuals with TBI had a mean post-traumatic amnesia duration of 18 days (SD=20.03). Groups did not differ significantly in demographic, injury, or cognitive variables at baseline. Participants were assessed at baseline, post-treatment, 2-months and 4-months post-treatment. Primary outcomes were the Pittsburgh Sleep Quality Index (PSQI) for sleep quality and Fatigue Severity Scale (FSS) for fatigue, with secondary outcomes including measures of mood, quality of life and self-efficacy. Treatment was delivered in person (n=30) or via video telehealth (n=96).
Results:
CBT-SF resulted in significantly larger improvements in sleep quality on PSQI compared to HE after treatment, and treatment gains were maintained at 2-month and 4-month follow-up (p<.001, 95% CI -2.34 – -0.65). There were also significant reductions in fatigue after CBT-SF, maintained at all time points (p<.01, 95% CI 0.10 - 0.38). The HE group showed delayed improvement in sleep quality at 4-months follow-up, and fluctuating improvements in fatigue after treatment and at 4 months, but not at 2-month follow-up. Both groups showed a significant reduction in anxiety and depression symptoms with time (p<.0001, 95% CI -2.15 – -1.25). Immediate post-therapy gains in self-efficacy and mental health related quality of life were observed after CBT-SF and maintained over time, with delayed improvements at 4-month follow-up after HE (p<.0001, 95% CI 0.45 - 0.93; p<.001, 95% CI 2.01 – 7.36). Injury type and in-person vs telehealth delivery did not significantly impact treatment outcomes.
Conclusions:
CBT-SF delivered in person or via telehealth is a beneficial and efficient treatment for sleep disturbance and fatigue after TBI and stroke, achieving more rapid gains than HE, with treatment gains maintained over time. HE may provide delayed benefit for sleep and fatigue, possibly due to healthy lifestyle changes. This study is the largest of its kind, and provides a foundation for translation of this treatment into the broader ABI community.
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