Telemedicine versus face-to-face delivery of cognitive behavioral therapy for insomnia: a randomized controlled noninferiority trial
Telemedicine versus face-to-face delivery of cognitive behavioral therapy for insomnia: a randomized controlled noninferiority trial
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DOI：
10.1093/sleep/zsaa136
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发表时间：
2021-01-01
期刊：
影响因子：
5.6
通讯作者：
Eisenberg, Daniel
中科院分区：
文献类型：
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作者：
Arnedt, J. Todd;Conroy, Deirdre A.;Eisenberg, Daniel
研究目的：在一项随机对照的非劣势试验中，我们比较了面对面和远程医疗(通过AASM睡眠(TM)平台)治疗失眠的认知行为疗法(CBT)在治疗后和3个月的随访中改善失眠/睡眠和日间功能的效果。第二个目标是比较治疗的可信度、满意度和治疗联盟。方法：65名慢性失眠患者(46名女性，年龄47.2+/-16.3岁)被随机分为6个疗程，分别通过AASM睡眠(TM)(n=33，CBT-TM)或面对面(n=32，CBT-F2F)进行CBT治疗。参与者在治疗前、治疗后和3个月的随访中完成了睡眠日记、失眠严重程度指数(ISI)和日间功能测量。比较不同治疗方式的治疗可信度、满意度和治疗联盟。结果：根据ISI上4分的非劣势差，在调整混杂因素后，CBT-TM在治疗后(Beta=0.54，SE=1.10，95%CI=1.64~2.72)和随访时(Beta=0.34，SE=1.10，95%CI=1.83~2.53)不逊于CBT-F2F。在治疗后和随访时，除SF-12的身体综合评分外，日间功能测量均有显著改善，不同治疗方式之间没有差异。CBT-TM疗程平均缩短近10分钟，但治疗联盟的参与者评分与CBT-F2F相似。结论：远程医疗CBT治疗失眠的严重程度不逊于面对面，对其他睡眠和日间功能结果也有类似的改善。此外，远程医疗允许更有效地提供治疗，同时不损害治疗联盟。
Study Objectives: In a randomized controlled noninferiority trial, we compared face-to-face and telemedicine delivery (via the AASM Sleep (TM) platform) of cognitive-behavioral therapy (CBT) for insomnia for improving insomnia/sleep and daytime functioning at posttreatment and 3-month follow-up. A secondary objective compared the modalities on treatment credibility, satisfaction, and therapeutic alliance.Methods: A total of 65 adults with chronic insomnia (46 women, 47.2 +/- 16.3 years of age) were randomized to 6 sessions of CBT for insomnia delivered individually via AASM Sleep (TM) (n = 33, CBT-TM) or face-to-face (n = 32, CBT-F2F). Participants completed sleep diaries, the Insomnia Severity Index (ISI), and daytime functioning measures at pretreatment, posttreatment, and 3-month follow-up. Treatment credibility, satisfaction, and therapeutic alliance were compared between treatment modalities. The ISI was the primary noninferiority outcome.Results: Based on a noninferiority margin of four points on the ISI and, after adjusting for confounders, CBT-TM was noninferior to CBT-F2F at posttreatment (beta = 0.54, SE = 1.10, 95% CI = 1.64 to 2.72) and follow-up (beta = 0.34, SE = 1.10, 95% CI = 1.83 to 2.53). Daytime functioning measures, except the physical composite scale of the SF-12, were significantly improved at posttreatment and follow-up, with no difference between treatment formats. CBT-TM sessions were, on average, nearly 10 min shorter, yet participant ratings of therapeutic alliance were similar to CBT-F2F.Conclusions: Telemedicine delivery of CBT for insomnia is not inferior to face-to-face for insomnia severity and yields similar improvements on other sleep and daytime functioning outcomes. Further, telemedicine allows for more efficient treatment delivery while not compromising therapeutic alliance.