Effect of Telephone Cognitive Behavioral Therapy for Insomnia in Older Adults With Osteoarthritis Pain A Randomized Clinical Trial
Effect of Telephone Cognitive Behavioral Therapy for Insomnia in Older Adults With Osteoarthritis Pain A Randomized Clinical Trial
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DOI：
10.1001/jamainternmed.2020.9049
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发表时间：
2021-02-22
影响因子：
39
通讯作者：
Vitiello, Michael V.
中科院分区：
文献类型：
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作者：
McCurry, Susan M.;Zhu, Weiwei;Vitiello, Michael V.
失眠认知行为疗法(CBT-I)的重要性可扩展交付模式是一种有效的治疗方法，需要广泛实施，特别是在缺乏随时获得失眠治疗的农村和服务不足的人群中。目的比较电话CBT-I与单纯教育对照(EOC)在中重度骨性关节炎疼痛中的疗效。设计、设置和参与者这是一项随机临床试验，共有327名60岁及以上的参与者参加，他们是从2016年9月至2018年12月通过华盛顿州凯撒永久医院招募的。参与者每隔3周接受中到重度失眠和骨关节炎(OA)疼痛症状的双重筛查。在基线、治疗后2个月和12个月随访时进行盲法评估。干预：在8周内提供了6次20至30分钟的电话会议。参与者提交了每日日记，并收到了针对小组的教育材料。CBT-I指导包括睡眠限制、刺激控制、睡眠卫生、认知结构调整和家庭作业。EoC小组收到了关于睡眠和OA的信息。主要结果和指标主要结果是治疗后2个月和12个月随访时的失眠严重指数(ISI)评分。次要结果包括疼痛(简明疼痛问卷-简表)、抑郁(8项患者健康问卷得分)和疲劳(Flinders疲劳量表得分)。结果327例受试者平均年龄为70.2岁(6.8岁)，女性244例(74.6%)。在282名有随访的ISI数据的参与者中，CBT-I组和EOC组治疗后2个月的ISI总分分别下降了8.1分和4.8分，调整后的平均组间差异为-3.5分(95%CI，-4.4至-2.6分；P<；.001)。结果维持在12个月的随访期(调整后的平均差为-3.0分；95%可信区间为-4.1至-2.0分；P<；.001)。在12个月的随访中，119名接受CBT-I的参与者中有67人(56.3%)仍处于缓解状态(ISI评分，
Importance Scalable delivery models of cognitive behavioral therapy for insomnia (CBT-I), an effective treatment, are needed for widespread implementation, particularly in rural and underserved populations lacking ready access to insomnia treatment. Objective To evaluate the effectiveness of telephone CBT-I vs education-only control (EOC) in older adults with moderate to severe osteoarthritis pain. Design, Setting, and Participants This is a randomized clinical trial of 327 participants 60 years and older who were recruited statewide through Kaiser Permanente Washington from September 2016 to December 2018. Participants were double screened 3 weeks apart for moderate to severe insomnia and osteoarthritis (OA) pain symptoms. Blinded assessments were conducted at baseline, after 2 months posttreatment, and at 12-month follow-up. Interventions Six 20- to 30-minute telephone sessions provided over 8 weeks. Participants submitted daily diaries and received group-specific educational materials. The CBT-I instruction included sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and homework. The EOC group received information about sleep and OA. Main Outcomes and Measures The primary outcome was score on the Insomnia Severity Index (ISI) at 2 months posttreatment and 12-month follow-up. Secondary outcomes included pain (score on the Brief Pain Inventory-short form), depression (score on the 8-item Patient Health Questionnaire), and fatigue (score on the Flinders Fatigue Scale). Results Of the 327 participants, the mean (SD) age was 70.2 (6.8) years, and 244 (74.6%) were women. In the 282 participants with follow-up ISI data, the total 2-month posttreatment ISI scores decreased 8.1 points in the CBT-I group and 4.8 points in the EOC group, an adjusted mean between-group difference of -3.5 points (95% CI, -4.4 to -2.6 points; P < .001). Results were sustained at 12-month follow-up (adjusted mean difference, -3.0 points; 95% CI, -4.1 to -2.0 points; P < .001). At 12-month follow-up, 67 of 119 (56.3%) participants receiving CBT-I remained in remission (ISI score,