Ymer Lucy, McKay Adam, Wong Dana, Frencham Kate, Grima Natalie, Roper Monique, Nguyen Sylvia, Murray Jade, Spitz Gershon, Ponsford Jennie
Monash Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.
Monash Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Epworth Healthcare, Melbourne, VIC, Australia.
J Rehabil Med. 2025 Jan 3;57:jrm41302. doi: 10.2340/jrm.v57.41302.
Evaluate efficacy of cognitive behavioural therapy for sleep and fatigue adapted for brain injury relative to health education control in alleviating sleep disturbance and fatigue after acquired brain injury.
Parallel groups randomized controlled trial.
126 community dwelling adults with stroke or traumatic brain injury.
Participants were randomized 2:1 to receive 8-weeks of cognitive behavioural therapy for sleep and fatigue (n = 86) or health education (n = 40). The Pittsburgh Sleep Quality Index was assessed pre- and post-treatment, and 2 and 4-months post-treatment, with secondary measures of insomnia, fatigue, sleepiness, mood, quality of life, activity levels, self-efficacy, and actigraphy.
Both groups showed improved sleep by 4-month follow-up. However, cognitive behavioural therapy for sleep and fatigue had significantly larger and more rapid improvements than health education immediately post-treatment (β = -1.50, p < 0.001, 95% confidence interval -2.35 to -0.64). There were no significant between-groups differences in fatigue; however, cognitive behavioural therapy for sleep and fatigue showed within-group gains on both fatigue measures immediately post-treatment and over time (β = -0.29, p = 0.047, 95% confidence interval -0.58 to -0.01). Health education had delayed improvements at 4-month follow-up on 1 fatigue measure.
Both cognitive behavioural therapy for sleep and fatigue and health education led to improvement in sleep and fatigue; however, effects were larger and more rapid for cognitive behavioural therapy for sleep and fatigue immediately post-treatment. This supports the efficacy of cognitive behavioural therapy for sleep and fatigue in acquired brain injury but also highlights that health education may result in delayed improvements in symptoms. ANZCTR Trial registration numbers: 1261700087830; 12617000879369.
评估针对脑损伤调整后的认知行为疗法对睡眠和疲劳的疗效，与健康教育对照相比，该疗法在减轻后天性脑损伤后的睡眠障碍和疲劳方面的效果。
平行组随机对照试验。
126名患有中风或创伤性脑损伤的社区居住成年人。
参与者按2:1随机分组，分别接受为期8周的睡眠和疲劳认知行为疗法（n = 86）或健康教育（n = 40）。在治疗前、治疗后以及治疗后2个月和4个月时评估匹兹堡睡眠质量指数，并对失眠、疲劳、嗜睡、情绪、生活质量、活动水平、自我效能和活动记录仪等进行次要测量。
两组在4个月随访时睡眠均有所改善。然而，睡眠和疲劳认知行为疗法在治疗后立即比健康教育有显著更大且更快速的改善（β = -1.50，p < 0.001，95%置信区间 -2.35至 -0.64）。两组在疲劳方面无显著组间差异；然而，睡眠和疲劳认知行为疗法在治疗后立即以及随时间推移在两种疲劳测量上均显示出组内改善（β = -0.29，p = 0.047，95%置信区间 -0.58至 -0.01）。健康教育在4个月随访时对1项疲劳测量的改善有所延迟。
睡眠和疲劳认知行为疗法以及健康教育均能改善睡眠和疲劳；然而，睡眠和疲劳认知行为疗法在治疗后立即效果更大且更快速。这支持了睡眠和疲劳认知行为疗法在后天性脑损伤中的疗效，但也突出表明健康教育可能导致症状改善延迟。澳大利亚和新西兰临床试验注册编号：1261700087830；12617000879369。
