Table 7.2 Cognitive Behavioural Therapy for the Management of Fatigue Post ABI
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Author Year Country Study Design Sample Size |
Methods | Outcome |
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Nguyen et al. (2017) Australia RCT PEDro=8 N=24 |
Population: TBI; CBT Group (n=13): Mean Age=45.53yr; Gender: Male=9, Female=4; Mean Time Post Injury=795.15d. Control Group (n=11): Mean Age=41.90yr; Gender: Male=7, Female=4; Mean Time Post Injury=2093.36d. Intervention: Patients in the CBT group received 6 modules of CBT addressing sleep and fatigue over 8 sessions. Therapy content contained a framework that is relevant to TBI and facilitated the acceptance of increased sleep disturbance vulnerability and fatigue secondary to brain trauma. Controls received treatment as usual. Measurements were taken at baseline, 2, and 4mo. Outcome Measure: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Brief Fatigue Inventory (BFI), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS). |
1. The CBT group had significantly improved PSQI scores post-treatment and at follow-up compared to control (p<0.001). 2. The CBT group had significantly improved ISI scores post-treatment (p<0.01) and at follow-up (p<0.001) compared to control. There was also a significant improvement in ISI scores over time for the CBT group (p=0.010), but not the control group. 3. The CBT group had significantly improved BFI scores post-treatment (p<0.05) and at follow-up (p<0.01) compared to control. There was also a significant improvement in BFI scores over time for the CBT group (p=0.016), but not the control group. 4. The FSS and ESS yielded no significant between group differences or time effects for either group. |
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Raina et al. (2016) USA RCT PEDro=4 NIntial=41 NFinal=38 |
Population: TBI; MAX Group (n=17): Mean Age=43.8yr; Gender: Male=8, Female=5; Mean Time Post Injury=9.9 mo. Control Group (n=21): Mean Age=48.1yr; Gender: Male=13, Female=8; Mean Time Post Injury=11.1 mo. Intervention: Participants received either Maximizing Energy (MAX) training (a cognitive behavioural intervention) or online health education which served as a control. MAX training consisted of 2 online 30min 1:1 session per week for 8 wk, delivered via webcam by 2 occupational therapists. Outcome Measure: Modified Fatigue Impact Scale (MFIS), Patient-Reported Outcomes Measurement Information System Fatigue Scale (PROMIS), Fatigue Severity Scale (FSS). |
1. No significant differences between groups were found for MFIS, PROMIS or FSS. |
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(2007) Canada Pre-Post N=11 |
Population: TBI=11; Mean age=27.3yr; Male=6, Female=5; Mean Time Since Injury=25.64mo. Intervention: Patients received cognitive behavioural therapy (CBT) for insomnia (8 wk, 1 hr/wk). Specifically, CBT focused on stimulus control, sleep restriction, cognitive restructuring, sleep hygiene education, and fatigue management. Outcome Measure: Total Wake Time, Sleep Efficiency, Sleep Time, Insomnia Severity Index (ISI), Multidimensional Fatigue Inventory (MFI), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS). |
1. Following CBT, significant improvements were seen in total wake time (p<0.001) and sleep efficiency (p=0.01). 2. Gains were maintained, but no significant changes occurred from the post treatment assessment and 3mo follow-up for total wake time (p=0.06) or sleep efficiency (p=0.24). 3. Sleep time from pre to post treatment did not change significantly (p=0.44); however, there was a significant improvement from baseline to the 3mo follow-up (p<0.015). 4. Significant reductions in scores were seen after treatment on the DBAS, ISI (both p<0.01), and the MFI (p<0.012). |