Randomized controlled trial of cognitive behavioral therapy versus health education for sleep disturbance and fatigue following stroke and traumatic brain injury.
Lucy Ymer, Adam McKay, Dana Wong and 7 others
PMID 39749423WHAT IT FOUND
Cognitive behavioral therapy improved sleep quality more than health education immediately after treatment.
However, there were no significant differences between the two groups at 2 or 4 months follow-up. Both groups showed similar long-term gains, suggesting health education may be sufficient for sustained improvement.
Key findings
01CBT-SF produced significantly larger improvements in sleep quality (PSQI) than health education immediately post-treatment, but this difference disappeared at 2 and 4 months follow-up.
02There were no significant between-group differences in fatigue outcomes (FSS) at any post-treatment time point, although CBT-SF showed earlier within-group improvements.
0344.2% of CBT-SF participants achieved clinically meaningful change in sleep quality immediately post-treatment compared to 17.5% in the health education group, but these proportions became similar at follow-up.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study lacked a waitlist control, so it cannot rule out natural recovery over time as a cause for the improvements seen in both groups. Strict inclusion criteria excluded individuals with severe cognitive impairments, non-English speakers, and those with untreated sleep apnea, limiting generalizability to the broader ABI population. The sample combined TBI and stroke patients, and while injury type was not a significant covariate, secondary analyses are planned to explore differences further. Objective sleep measures (actigraphy) did not show significant changes, meaning the findings rely on self-reported outcomes which may be influenced by cognitive impairment. The 2:1 randomization resulted in a smaller HE group, which may affect the precision of estimates for that arm.
Declared interests
The authors declared no conflicts of interest. The study was funded by the National Health and Medical Research Council.
The easy way to misread this
Do not conclude that CBT is superior to health education in the long term. The significant advantage of CBT for sleep quality was only present immediately after treatment and disappeared by 2 months follow-up. Both groups achieved similar outcomes by 4 months.