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Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care : lessons learnt from a mixed-methods feasibility study
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Tang, Nicole K. Y., Moore, Corran, Parsons, Helen, Sandhu, Harbinder, Patel, Shilpa, Ellard, David R., Nichols, Vivien P., Madan, Jason, Collard, Victoria Elizabeth Janet, Sharma, Uma and Underwood, Martin (2020) Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care : lessons learnt from a mixed-methods feasibility study. BMJ Open, 10 (3). e034764. doi:10.1136/bmjopen-2019-034764 ISSN 2044-6055.
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WRAP-implementing-hybrid-cognitive-behavioural-therapy-pain-related-insomnia-primary-care-Tang-2020.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (589Kb) | Preview |
Official URL: http://dx.doi.org/10.1136/bmjopen-2019-034764
Abstract
Objectives: To test the feasibility of implementing a brief but intensive hybrid cognitive behavioural therapy (Hybrid CBT) for pain-related insomnia.
Design: Mixed-methods, with qualitative process evaluation on a two-arm randomised controlled feasibility trial.
Setting: Primary care.
Participants: Twenty-five adult patients with chronic pain and insomnia.
Intervention: Hybrid CBT or self-help control intervention.
Primary and secondary outcome measures: Primary outcomes measures were the Insomnia Severity Index and interference scale of the Brief Pain Inventory (BPI). Secondary outcomes measures were the present pain intensity rating from the BPI, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale and EQ-5D-5L.
Results: Fourteen participants were randomised to receive Hybrid CBT, 11 to receive the self-help control treatment. Of the 14 in the Hybrid CBT group, 9 (64%) completed all four treatment sessions (4 discontinued due to poor health; 1 due to time constraints). Adherence to the self-help control treatment was not monitored. The total number of participants completing the 12-week and 24-week follow-ups were 12 (6 in each group; Hybrid CBT: 43%; self-help: 55%) and 10 (5 in each group; Hybrid CBT: 36%; self-help: 45%). Based on the data available, candidate outcome measures appeared to be sensitive to changes associated with interventions. Thematic analysis of pre-postintervention interview data revealed satisfaction with treatment content among those who completed the Hybrid CBT, whereas those in the self-help control treatment wanted more contact hours and therapist guidance. Other practical suggestions for improvement included shortening the duration of each treatment session, reducing the amount of assessment paperwork, and minimising the burden of sleep and pain monitoring.
Conclusion: Important lessons were learnt with regard to the infrastructure required to achieve better patient adherence and retention. Based on the qualitative feedback provided by a subset of treatment completers, future trials should also consider lowering the intensity of treatment and streamlining the data collection procedure.
Trial registration number: ISRCTN17294365.
| Item Type: | Journal Article | ||||||
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| Subjects: | Q Science > QP Physiology R Medicine > RB Pathology R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Science > Psychology | ||||||
| Library of Congress Subject Headings (LCSH): | Cognitive therapy, Insomnia, Insomnia -- Treatment, Sleep disorders, Sleep disorders -- Treatment, Chronic pain , Sleep -- Physiological aspects | ||||||
| Journal or Publication Title: | BMJ Open | ||||||
| Publisher: | BMJ | ||||||
| ISSN: | 2044-6055 | ||||||
| Official Date: | 18 March 2020 | ||||||
| Dates: |
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| Volume: | 10 | ||||||
| Number: | 3 | ||||||
| Article Number: | e034764 | ||||||
| DOI: | 10.1136/bmjopen-2019-034764 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 23 March 2020 | ||||||
| Date of first compliant Open Access: | 24 March 2020 | ||||||
| RIOXX Funder/Project Grant: |
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