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Efficacy of Scalable CBT for Insomnia in Older Adults with Osteoarthritis Pain

可扩展 CBT 对患有骨关节炎疼痛的老年人失眠的疗效

基本信息

批准号：
9442937
负责人：
SUSAN M MCCURRY
金额：
$ 18.26万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-01 至 2021-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9442937
关键词：
Adherence Affect Aftercare Area Arthritis Chronic Chronic Insomnia Clinic Clinical Trials Cognitive Therapy Comorbid Insomnia Comorbidity Cost Analysis Cost Savings Degenerative polyarthritis Economic Burden Education Effectiveness Elderly Enrollment Evidence based treatment Fatigue Funding Goals Health Health Care Costs Health Planning Healthcare Healthcare Systems Home environment Human Resources Impairment Individual Internet Intervention Learning Life Style Measures Mediation Mediator of activation protein Medical Menopause Mental Depression Methods Minority Modeling Moods Older Population Outcome Pain Patient Care Patients Persons Policies Population Population Heterogeneity Primary Care Physician Primary Health Care Publishing Quality of life Randomized Recording of previous events Recruitment Activity Reporting Research Resources Rural Rural Community Services Severities Site Sleep Sleep disturbances Sleeplessness Smoking Cessation Intervention Societies Symptoms Telephone Testing Theoretical model Underserved Population United States National Institutes of Health Vasomotor Visit Washington Woman Work aged associated symptom attentional control base chronic pain cost cost effective cost effectiveness cost-effectiveness evaluation depressive symptoms evidence base experience follow-up functional disability health care service utilization improved medical specialties outreach pain symptom patient population physical symptom population health randomized trial relative cost screening secondary outcome skills treatment effect

项目摘要

Twenty-five percent of older adults experience significant osteoarthritis (OA)-related comorbid sleep disturbance. Insomnia is associated with substantial negative effects on function, mood, and medical resource utilization. Cognitive behavioral therapy for insomnia (CBT-I) is evidence- based and has been shown to be efficacious in populations with a variety of comorbid conditions including OA-related chronic pain. However, in-person CBT interventions are unlikely to be widely deployable in healthcare systems. Telephone delivery has the advantage of giving patients access to personalized, efficacious CBT-I interventions from home, increasing generalizability, and outreach to minority, rural, and other underserved populations. Previous small trials of telephone CBT-I have reported positive insomnia outcomes, but no large randomized trials have assessed its long-term efficacy, impact on related outcomes in a primary care patient population, or cost-effectiveness. This proposal builds upon our successful completion of two randomized trials of CBT for insomnia with older adults: Lifestyles, a trial of group CBT in older adults with OA-related insomnia and pain, and MsFLASH04, a trial of telephone CBT-I for insomnia in menopausal women with comorbid vasomotor symptoms. Older (60+ yrs) primary care patients across Washington State will be screened for severe persistent OA-related insomnia and pain. Two hundred and seventy patients will be randomized to either CBT-I or an education only attention control (EOC). Each treatment will consist of six 20-30 minute telephone-based sessions over an eight week period. Pre-treatment, post-treatment (2 months), and 9 and 18 month assessments will include measures of sleep, pain, fatigue, mood, and quality of life. A cost effectiveness evaluation of the intervention will also be conducted. We hypothesize: 1) CBT-I will produce significantly greater initial and long-term improvements in sleep outcomes relative to EOC; 2) CBT-I will produce significantly greater initial and long-term improvements in pain, fatigue and mood relative to EOC; and 3) CBT-I will produce long-term reductions in health care utilization and costs relative to EOC. We will also explore whether changes in insomnia severity explain observed effects of CBT-I on secondary outcomes (mediator analysis), and whether CBT-I effects on insomnia differ by baseline insomnia, pain, or depression symptom severity (moderator analysis). The proposed research will determine if telephone CBT-I improves OA insomnia and associated outcomes in a state-wide primary care population of older adults, and inform policy decisions about widespread dissemination of telephone CBT-I in this and related patient populations.

25%的老年人经历明显的骨关节炎（OA）相关合并症