INSPIRES-2: Improving Sleep and Learning in Rehabilitation After Stroke, Part 2
Study Details
Study Description
Brief Summary
This study will explore whether sleep in stroke survivors is improved with digital cognitive behavioural therapy for insomnia (Sleepio), in comparison to treatment as usual, and will explore whether changes in sleep relate to changes in overnight consolidation of motor learning.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Stroke is one of the leading causes of adult disability. Rehabilitation of movement after stroke depends on motor learning. Motor learning involves not only improvement during practice but also offline improvement, or consolidation, that occurs after practice. Consolidation of learning depends on good sleep quality. However, sleep is disrupted long-term after stroke and patients with poorer sleep show worse rehabilitation outcomes.
Cognitive behavioural therapy for insomnia (CBT) is the recommended first line treatment for sleep problems. "Sleepio" is a digital CBT programme which is effective across a range of clinical populations. This study aims to test the efficacy of digital CBT for reducing insomnia symptoms after stroke, in comparison with usual care alone. To explore the possibility that sleep interventions might enhance rehabilitation outcomes via their impact on consolidation of motor learning, the study will additionally test for differences in consolidation between groups, and explore whether changes in sleep measures are associated with changes in consolidation.
Participants will be randomised to either receive digital CBT for insomnia (in addition to usual care) or receive treatment as usual alone (2:1 treatment to control ratio). The primary outcome is the score on the 8-item Sleep Condition Indicator, 10 weeks following randomisation. Secondary outcomes include behavioural measures of overnight motor consolidation assessed as the change in motor task performance from training to retest, sleep disruption assessed with actigraphy, and depression and fatigue using the Patient Health Questionnaire (PHQ9) and the Fatigue Severity Scale respectively.
In addition to this, to explore the feasibility of delivering rehabilitation following the sleep improvement programme, an optional 4 weeks of upper limb motor training at home will be offered to all participants (regardless of group allocation) after follow-up. Outcomes of adherence to the training and upper limb function will be assessed.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Behavioural: Digital cognitive behavioural therapy for insomnia 6-10 weeks of digital cognitive behavioural therapy for insomnia (Sleepio) delivered online. |
Behavioral: Digital Cognitive Behavioural Therapy for Insomnia
6-10 weeks of digital cognitive behavioural therapy for insomnia (Sleepio) delivered online, in addition to usual care.
Other Names:
|
| No Intervention: Treatment as usual Participants will receive treatment as usual. |
Outcome Measures
Primary Outcome Measures
- Sleep Condition Indicator [10 weeks after randomisation]
Questionnaire assessing self-reported insomnia symptoms, range 0-32, higher numbers indicate less symptoms of insomnia
Secondary Outcome Measures
- Change in motor performance from training to retest [10 weeks after randomisation]
Behavioural motor consolidation assessment, assessed as accuracy (range 0-50, higher numbers indicate better accuracy of motor performance)
- Patient Health Questionnaire [10 weeks after randomisation]
Questionnaire assessing symptoms of depression, range 0-20, higher values indicate more depressive symptoms
- Fatigue Severity Scale [10 weeks after randomisation]
Questionnaire assessing fatigue, range 9-63, higher score indicates more severe fatigue
Other Outcome Measures
- Adherence of at home motor training [14 weeks following randomisation]
Assessment of number of sessions performed, number of repetitions etc.
- Upper limb ability [14 weeks following randomisation]
Assessed with Action Research Arm Test, range 0-57, higher score indicates better upper limb ability
- Upper limb function [14 weeks following randomisation]
Assessed with Box and Blocks Test, scored as the number of blocks transferred in 60 seconds
- Upper limb dexterity [14 weeks following randomisation]
Assessed with Nine hole peg test, scored as the number of pegs placed in 30 seconds
Eligibility Criteria
Criteria
Inclusion Criteria:
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Willing and able to give informed consent for participation in the study
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Aged 18 years or above.
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Clinical diagnosis of stroke affecting the upper limb, with sufficient movement to perform the motor learning task
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Discharged from inpatient care
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Interest in accessing a programme with the aim of improving sleep quality
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Reliable access to the internet
Exclusion Criteria:
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Other neurological condition affecting movement (e.g. Parkinson's Disease, Multiple Sclerosis)
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Diagnosed, untreated, sleep disorder (e.g. Sleep Apnea)
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Uncontrolled seizures
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Planned inpatient admission (e.g. for rehabilitation) in the next 4 months that would impact ability to engage with the Sleepio programme
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Engagement in psychological therapy for insomnia in the past 12 months
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Pregnancy
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of Oxford | Oxford | United Kingdom | OX39DU |
Sponsors and Collaborators
- University of Oxford
- Big Health Inc.
Investigators
- Principal Investigator: Melanie K Fleming, Dr, University of Oxford
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- PID 16015