Testing an online program for managing insomnia in arthritis
Scientific Study Title:
Adapting and Evaluating an Evidence-Based Online Behavioural Intervention to Manage Insomnia in Patients with Arthritis
Deborah Da Costa, PhD
Associate Professor, Department of Medicine, McGill University; Scientist, Health Centre Metabolic Disorders and Complications Program, Centre for Outcomes Research and Evaluation, Research Institute of Medicine, McGill University; Research Scientist, Arthritis Research Canada.
Diane Lacaille, MDCM, MHSc, FRCPC,
Mary Pack Chair in Rheumatology Research; Scientific Director, Arthritis Research Canada; Professor, Division of Rheumatology, University of British Columbia
Why do this research?
Up to 70 per cent of people living with arthritis report sleep issues, including difficulty falling asleep, staying asleep, and/or waking up early in the morning. These sleep disturbances, also known as insomnia, worsen other symptoms of arthritis including fatigue, pain, and depression which can negatively affect a person’s quality of life.
For most people living with arthritis, insomnia goes unidentified and untreated. Cognitive behavioral therapy (CBTi) helps people improve their self-talk by replacing automatic negative thoughts with positive, realistic thoughts to improve mental health and emotional wellbeing. CBTi is considered first-line treatment and studies with other patient groups show that it can be successfully used over the internet, which makes it more accessible.
No study to date has looked at whether CBTi works for people living with arthritis who are suffering with insomnia, this study fills this important gap in arthritis care. It will provide new knowledge on the benefits of a non drug method for managing insomnia in people living with arthritis. If found helpful, internet-delivered CBTi will help improve access to treatment of insomnia for people living with arthritis, which means better management of sleep and associated clinical symptoms (e.g. fatigue and pain), better quality of life, and reduced healthcare costs.
This proposal is very important due to the COVID-19 pandemic, as stress, financial challenges and lifestyle changes from social limits are expected to affect sleep and other mental health issues, especially for people who are already at risk for these difficulties.
What will be done?
Phase 1: A Canada-wide survey with a large sample of people living with arthritis will identify sleep needs and treatment preferences. The goal is to better customize the internet-based CBTi program for arthritis using the results of this survey.
Phase 2: Revise and test the customized arthritis CBTi program with patient partners to see initial evidence of its potential to improve sleep and other commonly experienced symptoms, including fatigue, pain, depression and anxiety. To do this, we will conduct a randomized controlled pilot study with people living with arthritis to evaluate the program’s effectiveness on sleep metrics and other patient-centred outcomes. We expect that patients assigned to the therapy will report improvements in insomnia and other related symptoms following completion of the program. We also expect that they will maintain these improvements at the three-month follow-up.
Who is involved?
Our multidisciplinary team includes experts in behavioural medicine, insomnia, rheumatology, e-health, biostatistics, and patient advisers.
Phase 1 & 2: Paul Fortin, Université Laval
Phase 2: Josee Savard, Université Laval, Elham Rahme, McGill University
Patricia Patrick, Vancouver Coastal Health
Arthritis Research Canada Patient Advisory Board Patient Partners:
Eileen Davidson, Shanon McQuitty
Astrid Knight, Emilie McGuire
Canadian Initiative for Outcomes in Arthritis Care (CIORA)