Predictors of Response to Cognitive Behavioural Therapy for Sleep Disturbance and Fatigue After Acquired Brain Injury: A Secondary Analysis of a Randomised Controlled Trial.

Abstract

Objective: To investigate factors associated with response to cognitive behavioural therapy for sleep disturbance and fatigue (CBT-SF) in individuals with acquired brain injury.

Setting: Community dwelling.

Participants: Eighty-six participants with a traumatic brain injury (TBI) or stroke who received CBT-SF in a parent randomised controlled trial.

Design: Participants took part in a parent randomized controlled trial comparing an 8-week CBT-SF program with a health education control, face-to-face or via videoconferencing, and adapted for cognitive impairments. They were assessed at baseline, post-treatment, 2-months post-treatment, and 4-months post-treatment. A secondary analysis was conducted to identify which demographic, injury-related, neuropsychological and pre-treatment variables, as well as mode of treatment delivery, were associated with response to CBT-SF.

Intervention: Cognitive Behavioural Therapy for Sleep Disturbance and Fatigue MAIN OUTCOME MEASURES: Pittsburgh Sleep Quality Index and Fatigue Severity Scale.

Results: Greater improvements in sleep after CBT-SF were associated with higher baseline sleep disturbance, less time since injury, and telehealth mode of delivery. Larger reductions in fatigue were associated with less time since injury and with higher education. Injury type (TBI, stroke) and cognitive variables were not associated with treatment outcomes.

Conclusion: These findings highlight that an adapted CBT-SF intervention can be equally effective for individuals with TBI and stroke, however, gains are greater earlier after injury. Although individuals with severe symptoms at baseline show greatest benefit, the intervention can be effective across a range of symptom presentations.