Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia.
Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia.
Sleep Med Rev. 2022 Jun;63:101620. doi: 10.1016/j.smrv.2022.101620. Epub 2022 Mar 3.
This systematic review (PROSPERO registration CRD42020158010) aimed to: 1) assess how adherence to cognitive behavioural therapy for insomnia (CBT-I) has been measured; 2) evaluate predictors of adherence; and 3) determine whether treatment outcome is associated with adherence. Inclusion criteria included: adults with insomnia; an intervention of CBT-I, including sleep restriction and/or stimulus control; a reported measure of adherence; and written in English. Searches of eight databases returned 2038 publications as of April 2021. The final sample included 102 papers. Publication quality and risk of bias were assessed using Joanna Briggs institute tools. Studies assessed either global adherence or adherence to specific components of CBT-I via questionnaires, sleep diaries, interviews or actigraphy. Twenty-eight papers examined predictors of adherence. Better pre- and post-session sleep, greater psychosocial support, increased self-efficacy, and fewer dysfunctional beliefs about sleep predicted greater adherence. Twenty-eight papers examined whether adherence predicted treatment outcomes. Only insomnia severity index scores post-treatment were consistently predicted by adherence, and only by a few measures of adherence. Overall, there was very little consistency in how adherence was measured, and in predictors and outcome variables assessed. A standardised method for assessing specific adherence constructs is indicated, to fully understand the role of adherence in CBT-I.
本系统评价（PROSPERO 注册 CRD42020158010）旨在：1）评估认知行为疗法治疗失眠症（CBT-I）的依从性如何衡量；2）评估依从性的预测因素；3）确定治疗结果是否与依从性相关。纳入标准包括：失眠症成年人；CBT-I 干预，包括睡眠限制和/或刺激控制；报告的依从性衡量标准；以及用英文书写。截至 2021 年 4 月，对八个数据库的搜索共返回 2038 篇文献。最终样本包括 102 篇论文。使用 Joanna Briggs 研究所工具评估了研究的发表质量和偏倚风险。研究通过问卷、睡眠日记、访谈或活动记录仪评估了整体依从性或 CBT-I 特定成分的依从性。28 篇论文研究了依从性的预测因素。更好的前后睡眠、更多的心理社会支持、更高的自我效能感以及更少的关于睡眠的功能失调信念，都预示着更高的依从性。28 篇论文研究了依从性是否预测治疗结果。只有治疗后失眠严重程度指数评分，且只有少数几种依从性衡量标准，能够始终预测到依从性。总体而言，依从性的衡量方式、预测因素和评估的结果变量之间几乎没有一致性。需要采用标准化方法评估特定的依从性结构，以充分理解依从性在 CBT-I 中的作用。
