osteoarthritis and therapy for sleep

Conditions: Insomnia Related to Osteoarthritis Pain

Summary: osteoarthritis (oa) pain affects 50 percent of older adults, more than half of whom also experience significant sleep disturbance. this randomized trial will determine whether a telephone-based cognitive behavioral treatment targeting insomnia in older adults with chronic severe oa-related insomnia and pain results in substantially greater reductions in insomnia severity and in related improvements in pain, fatigue, mood, quality of life and healthcare costs compared to telephone-delivered education (attention control) about insomnia. the trial will test an intervention that if demonstrated to have long term efficacy is scalable and has the potential for wide-scale deployment in healthcare systems.

twenty-five percent of older adults experience significant osteoarthritis (oa)-related comorbid sleep disturbance. insomnia is associated with substantial negative effects on function, mood, and medical resource utilization. cognitive behavioral therapy for insomnia (cbt-i) is evidence based and has been shown to be efficacious in populations with a variety of comorbid conditions including oa-related chronic pain. however, in-person cbt interventions are unlikely to be widely deployable in healthcare systems. telephone delivery has the advantage of giving patients access to personalized, efficacious cbt-i interventions from home, increasing generalizability, and outreach to minority, rural, and other underserved populations. older (60+ yrs) primary care patients across washington state will be screened for severe persistent oa-related insomnia and pain. two hundred and seventy patients will be randomized to either cbt-i or an education only attention control (eoc). each treatment will consist of six 20-30 minute telephone-based sessions over an eight week period. pre-treatment, post-treatment (2 months and 12 month) assessments will include measures of sleep, pain, fatigue, mood, and quality of life. a cost effectiveness evaluation of the intervention will also be conducted. the proposed research will determine if telephone cbt-i improves oa insomnia and associated outcomes in a state-wide primary care population of older adults, and inform policy decisions about widespread dissemination of telephone cbt-i in this and related patient populations.

Eligibility criteria:
inclusion criteria: * age 60+ with one or more health care visits for oa in the prior 3 years * score of ≥6 on 4-item isi at first screening and ≥11 on full isi at second screening * score of ≥9 on two items from the brief pain inventory (bpi) asking about average pain intensity in the past 2 weeks (0-10 scale) and activity interference due to pain (0-10 scale) at first and second screening exclusion criteria: * not continuously enrolled at group health cooperative for at least one year * prior diagnosis of a primary sleep disorder: sleep apnea with an ahi/rdi score of 15+ or current use of a cpap machine; periodic leg movement disorder; restless leg syndrome; sleep-wake cycle disturbance; or rapid eye movement behavior disorder * diagnosis in the medical record of: rheumatoid arthritis, terminal disease, being considered for major surgery, active chemotherapy or radiation for cancer, or inpatient treatment for congestive heart failure within the previous 6 months * diagnosis of dementia, use of acetylcholinesterase inhibitor and/or memantine for cognitive impairment, or cognitive impairment (\>6 on the short orientation-memory-concentration test) * hearing or speech impairment sufficient to preclude participation in a telephone intervention