Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study
Objectives To test the feasibility of implementing a brief but intensive hybrid cognitive behavioural therapy (Hybrid CBT) for pain-related insomnia.Design Mixed-methods, with qualitative process evaluation on a two-arm randomised controlled feasibility trial.Setting Primary care.Participants Twenty...
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BMJ Publishing Group
2020-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/3/e034764.full |
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| author | Martin Underwood Helen Parsons Harbinder Kaur Sandhu Vivien P Nichols Nicole K Y Tang Jason Madan David R Ellard Corran Moore Victoria Elizabeth Janet Collard Uma Sharma |
| author_facet | Martin Underwood Helen Parsons Harbinder Kaur Sandhu Vivien P Nichols Nicole K Y Tang Jason Madan David R Ellard Corran Moore Victoria Elizabeth Janet Collard Uma Sharma |
| author_sort | Martin Underwood |
| collection | DOAJ |
| description | Objectives To test the feasibility of implementing a brief but intensive hybrid cognitive behavioural therapy (Hybrid CBT) for pain-related insomnia.Design Mixed-methods, with qualitative process evaluation on a two-arm randomised controlled feasibility trial.Setting Primary care.Participants Twenty-five adult patients with chronic pain and insomnia.Intervention Hybrid CBT or self-help control intervention.Primary and secondary outcome measures Primary outcomes measures were the Insomnia Severity Index and interference scale of the Brief Pain Inventory (BPI). Secondary outcomes measures were the present pain intensity rating from the BPI, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale and EQ-5D-5L.Results Fourteen participants were randomised to receive Hybrid CBT, 11 to receive the self-help control treatment. Of the 14 in the Hybrid CBT group, 9 (64%) completed all four treatment sessions (4 discontinued due to poor health; 1 due to time constraints). Adherence to the self-help control treatment was not monitored. The total number of participants completing the 12-week and 24-week follow-ups were 12 (6 in each group; Hybrid CBT: 43%; self-help: 55%) and 10 (5 in each group; Hybrid CBT: 36%; self-help: 45%). Based on the data available, candidate outcome measures appeared to be sensitive to changes associated with interventions. Thematic analysis of pre-postintervention interview data revealed satisfaction with treatment content among those who completed the Hybrid CBT, whereas those in the self-help control treatment wanted more contact hours and therapist guidance. Other practical suggestions for improvement included shortening the duration of each treatment session, reducing the amount of assessment paperwork, and minimising the burden of sleep and pain monitoring.Conclusion Important lessons were learnt with regard to the infrastructure required to achieve better patient adherence and retention. Based on the qualitative feedback provided by a subset of treatment completers, future trials should also consider lowering the intensity of treatment and streamlining the data collection procedure.Trial registration number ISRCTN17294365. |
| format | Article |
| id | doaj-art-9ab6f8c62d0a4bfea1067058553f0580 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-9ab6f8c62d0a4bfea1067058553f05802024-12-07T06:30:12ZengBMJ Publishing GroupBMJ Open2044-60552020-03-0110310.1136/bmjopen-2019-034764Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility studyMartin Underwood0Helen Parsons1Harbinder Kaur Sandhu2Vivien P Nichols3Nicole K Y Tang4Jason Madan5David R Ellard6Corran Moore7Victoria Elizabeth Janet Collard8Uma Sharma9Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UKWarwick Clinical Trials Unit, University of Warwick, Coventry, UK3 Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UKClinical Trials Unit, University of Warwick Warwick Medical School, Coventry, UKDepartment of Psychology, University of Warwick, Coventry, UK2 Warwick Medical School, University of Warwick, Coventry, UKWarwick Clinical Trials Unit, University of Warwick, Coventry, UKDepartment of Psychology, University of Leicester, Leicester, Leicestershire, UKDepartment of Psychology, University of Warwick, Coventry, West Midlands, UKPatient Representative, Coventry, West Mindlands, UKObjectives To test the feasibility of implementing a brief but intensive hybrid cognitive behavioural therapy (Hybrid CBT) for pain-related insomnia.Design Mixed-methods, with qualitative process evaluation on a two-arm randomised controlled feasibility trial.Setting Primary care.Participants Twenty-five adult patients with chronic pain and insomnia.Intervention Hybrid CBT or self-help control intervention.Primary and secondary outcome measures Primary outcomes measures were the Insomnia Severity Index and interference scale of the Brief Pain Inventory (BPI). Secondary outcomes measures were the present pain intensity rating from the BPI, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale and EQ-5D-5L.Results Fourteen participants were randomised to receive Hybrid CBT, 11 to receive the self-help control treatment. Of the 14 in the Hybrid CBT group, 9 (64%) completed all four treatment sessions (4 discontinued due to poor health; 1 due to time constraints). Adherence to the self-help control treatment was not monitored. The total number of participants completing the 12-week and 24-week follow-ups were 12 (6 in each group; Hybrid CBT: 43%; self-help: 55%) and 10 (5 in each group; Hybrid CBT: 36%; self-help: 45%). Based on the data available, candidate outcome measures appeared to be sensitive to changes associated with interventions. Thematic analysis of pre-postintervention interview data revealed satisfaction with treatment content among those who completed the Hybrid CBT, whereas those in the self-help control treatment wanted more contact hours and therapist guidance. Other practical suggestions for improvement included shortening the duration of each treatment session, reducing the amount of assessment paperwork, and minimising the burden of sleep and pain monitoring.Conclusion Important lessons were learnt with regard to the infrastructure required to achieve better patient adherence and retention. Based on the qualitative feedback provided by a subset of treatment completers, future trials should also consider lowering the intensity of treatment and streamlining the data collection procedure.Trial registration number ISRCTN17294365.https://bmjopen.bmj.com/content/10/3/e034764.full |
| spellingShingle | Martin Underwood Helen Parsons Harbinder Kaur Sandhu Vivien P Nichols Nicole K Y Tang Jason Madan David R Ellard Corran Moore Victoria Elizabeth Janet Collard Uma Sharma Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study BMJ Open |
| title | Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study |
| title_full | Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study |
| title_fullStr | Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study |
| title_full_unstemmed | Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study |
| title_short | Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study |
| title_sort | implementing a hybrid cognitive behavioural therapy for pain related insomnia in primary care lessons learnt from a mixed methods feasibility study |
| url | https://bmjopen.bmj.com/content/10/3/e034764.full |
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