Integrating interventions based on cognitive behavioural therapy for insomnia in physical therapist practice for individuals with chronic pain and insomnia: Identifying barriers and formulating implementation strategies

Introduction

Cognitive Behavioural Therapy for Insomnia (CBT-I) is the first-choice treatment for insomnia disorders. Although CBT-I is primarily provided by trained psychologists, evidence shows that other healthcare providers can also successfully apply interventions based on CBT-I principles in absence of complex psychiatric comorbidities. Because insomnia and chronic pain often co-occur, integrating CBT-I-based interventions into physical therapy is relevant.

Objectives

To identify implementation barriers for CBT-I in physical therapist practice and to formulate implementation strategies to address them.

Methods

16 stakeholders (8 physical therapists, 3 psychologists, 2 general practitioners, and 3 individuals with chronic pain and insomnia) were invited for 3 group-interviews and 1 online questionnaire. Implementation barriers were identified through thematic analysis according to the Consolidated Framework for Implementation Research (CFIR). Implementation strategies were matched to barriers and ranked based on evidence and stakeholder feedback.

Results

33 implementation barriers were identified across all CFIR domains, and 13 final strategies were formulated to address these barriers. Key strategies included education and training for physical therapists, structural changes, and raising awareness among general practitioners and the public. Secondary strategies focussed on adaptability of CBT-I, developing supporting tools, and multidisciplinary collaboration.

Conclusion

To overcome barriers for the implementation of CBT-I-based interventions in physical therapy practice, it is important to involve educational institutions, research bodies, policymakers, and patient representatives in crafting effective strategies. The study findings can guide strategy selection promoting the adoption of physical therapist-led CBT-I-based interventions for chronic pain and insomnia.