Exploring predictors of treatment outcome in cognitive behavior therapy for sleep disturbance following acquired brain injury

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Purpose: To identify predictors of treatment response to cognitive behavior therapy (CBT) for sleep disturbance following acquired brain injury (ABI). Methods: Classification and regression tree (CART) analysis was conducted on individual patient data from two pilot randomized controlled trials (RCTs): one in traumatic brain injury (TBI), the other in stroke. The combined sample comprised 32 participants; 15 receiving CBT and 17 allocated to treatment as usual (TAU). The outcome was reliable improvement on the Pittsburgh Sleep Quality Index (PSQI). Results: Study group was a statistically significant predictor of outcome, with CBT participants more likely to achieve reliable improvements than TAU (OR = 4.88, p = 0.042). Study group (CBT vs. TAU) exhibited an area under the ROC curve (AUROC) of 69%. In separate CART analyzes, verbal memory (CVLT-II >45.5), age (<47.5) and baseline depression (HADS-D > 6) predicted positive outcomes in CBT recipients. Each of these variables added a small (∼5%) but not statistically significant amount to AUROC over study group. Conclusions: In this ABI sample, better memory, younger age, and higher baseline depression were associated with positive treatment response to CBT although individually these variables were not better than group alone in predicting outcomes. The present findings generate hypotheses for further investigation in future studies. Implications for rehabilitationCognitive behavior therapy improves sleep quality over treatment as usual in persons with acquired brain injury.Individuals who are younger in age with better memory and co-morbid symptoms of depression are more likely to respond to the treatment.These findings are based on a small sample and can be considered hypothesis generating for future clinical studies.

Original languageEnglish
Pages (from-to)1906-1913
Number of pages8
JournalDisability and Rehabilitation
Volume40
Issue number16
DOIs
Publication statusPublished - 18 Apr 2017

Keywords

  • acquired brain injury
  • Classification and regression trees
  • cognitive behavior therapy
  • predictors
  • sleep
  • treatment outcome

Cite this

@article{56290019e9a64a608a9d80fa88ea912d,
title = "Exploring predictors of treatment outcome in cognitive behavior therapy for sleep disturbance following acquired brain injury",
abstract = "Purpose: To identify predictors of treatment response to cognitive behavior therapy (CBT) for sleep disturbance following acquired brain injury (ABI). Methods: Classification and regression tree (CART) analysis was conducted on individual patient data from two pilot randomized controlled trials (RCTs): one in traumatic brain injury (TBI), the other in stroke. The combined sample comprised 32 participants; 15 receiving CBT and 17 allocated to treatment as usual (TAU). The outcome was reliable improvement on the Pittsburgh Sleep Quality Index (PSQI). Results: Study group was a statistically significant predictor of outcome, with CBT participants more likely to achieve reliable improvements than TAU (OR = 4.88, p = 0.042). Study group (CBT vs. TAU) exhibited an area under the ROC curve (AUROC) of 69{\%}. In separate CART analyzes, verbal memory (CVLT-II >45.5), age (<47.5) and baseline depression (HADS-D > 6) predicted positive outcomes in CBT recipients. Each of these variables added a small (∼5{\%}) but not statistically significant amount to AUROC over study group. Conclusions: In this ABI sample, better memory, younger age, and higher baseline depression were associated with positive treatment response to CBT although individually these variables were not better than group alone in predicting outcomes. The present findings generate hypotheses for further investigation in future studies. Implications for rehabilitationCognitive behavior therapy improves sleep quality over treatment as usual in persons with acquired brain injury.Individuals who are younger in age with better memory and co-morbid symptoms of depression are more likely to respond to the treatment.These findings are based on a small sample and can be considered hypothesis generating for future clinical studies.",
keywords = "acquired brain injury, Classification and regression trees, cognitive behavior therapy, predictors, sleep, treatment outcome",
author = "Sylvia Nguyen and Dean McKenzie and Adam McKay and Dana Wong and Rajaratnam, {Shantha M.W.} and Gershon Spitz and Gavin Williams and Darren Mansfield and Jennie Ponsford",
year = "2017",
month = "4",
day = "18",
doi = "10.1080/09638288.2017.1315461",
language = "English",
volume = "40",
pages = "1906--1913",
journal = "Disability and Rehabilitation",
issn = "0963-8288",
publisher = "Taylor & Francis",
number = "16",

}

TY - JOUR

T1 - Exploring predictors of treatment outcome in cognitive behavior therapy for sleep disturbance following acquired brain injury

AU - Nguyen, Sylvia

AU - McKenzie, Dean

AU - McKay, Adam

AU - Wong, Dana

AU - Rajaratnam, Shantha M.W.

AU - Spitz, Gershon

AU - Williams, Gavin

AU - Mansfield, Darren

AU - Ponsford, Jennie

PY - 2017/4/18

Y1 - 2017/4/18

N2 - Purpose: To identify predictors of treatment response to cognitive behavior therapy (CBT) for sleep disturbance following acquired brain injury (ABI). Methods: Classification and regression tree (CART) analysis was conducted on individual patient data from two pilot randomized controlled trials (RCTs): one in traumatic brain injury (TBI), the other in stroke. The combined sample comprised 32 participants; 15 receiving CBT and 17 allocated to treatment as usual (TAU). The outcome was reliable improvement on the Pittsburgh Sleep Quality Index (PSQI). Results: Study group was a statistically significant predictor of outcome, with CBT participants more likely to achieve reliable improvements than TAU (OR = 4.88, p = 0.042). Study group (CBT vs. TAU) exhibited an area under the ROC curve (AUROC) of 69%. In separate CART analyzes, verbal memory (CVLT-II >45.5), age (<47.5) and baseline depression (HADS-D > 6) predicted positive outcomes in CBT recipients. Each of these variables added a small (∼5%) but not statistically significant amount to AUROC over study group. Conclusions: In this ABI sample, better memory, younger age, and higher baseline depression were associated with positive treatment response to CBT although individually these variables were not better than group alone in predicting outcomes. The present findings generate hypotheses for further investigation in future studies. Implications for rehabilitationCognitive behavior therapy improves sleep quality over treatment as usual in persons with acquired brain injury.Individuals who are younger in age with better memory and co-morbid symptoms of depression are more likely to respond to the treatment.These findings are based on a small sample and can be considered hypothesis generating for future clinical studies.

AB - Purpose: To identify predictors of treatment response to cognitive behavior therapy (CBT) for sleep disturbance following acquired brain injury (ABI). Methods: Classification and regression tree (CART) analysis was conducted on individual patient data from two pilot randomized controlled trials (RCTs): one in traumatic brain injury (TBI), the other in stroke. The combined sample comprised 32 participants; 15 receiving CBT and 17 allocated to treatment as usual (TAU). The outcome was reliable improvement on the Pittsburgh Sleep Quality Index (PSQI). Results: Study group was a statistically significant predictor of outcome, with CBT participants more likely to achieve reliable improvements than TAU (OR = 4.88, p = 0.042). Study group (CBT vs. TAU) exhibited an area under the ROC curve (AUROC) of 69%. In separate CART analyzes, verbal memory (CVLT-II >45.5), age (<47.5) and baseline depression (HADS-D > 6) predicted positive outcomes in CBT recipients. Each of these variables added a small (∼5%) but not statistically significant amount to AUROC over study group. Conclusions: In this ABI sample, better memory, younger age, and higher baseline depression were associated with positive treatment response to CBT although individually these variables were not better than group alone in predicting outcomes. The present findings generate hypotheses for further investigation in future studies. Implications for rehabilitationCognitive behavior therapy improves sleep quality over treatment as usual in persons with acquired brain injury.Individuals who are younger in age with better memory and co-morbid symptoms of depression are more likely to respond to the treatment.These findings are based on a small sample and can be considered hypothesis generating for future clinical studies.

KW - acquired brain injury

KW - Classification and regression trees

KW - cognitive behavior therapy

KW - predictors

KW - sleep

KW - treatment outcome

UR - http://www.scopus.com/inward/record.url?scp=85017578805&partnerID=8YFLogxK

U2 - 10.1080/09638288.2017.1315461

DO - 10.1080/09638288.2017.1315461

M3 - Article

VL - 40

SP - 1906

EP - 1913

JO - Disability and Rehabilitation

JF - Disability and Rehabilitation

SN - 0963-8288

IS - 16

ER -