Blue-Enriched White Light Therapy Reduces Fatigue in Survivors of Severe Traumatic Brain Injury: A Randomized Controlled Trial

Abstract

Objective: Fatigue is one of the disabling sequelae of traumatic brain injury (TBI), with repercussions on quality of life, rehabilitation, and professional reintegration. Research is needed on effective interventions. We evaluated efficacy of blue-enriched white light (BWL) therapy on fatigue of patients with severe TBI. Setting: Physical Medicine and Rehabilitation and Physiology departments of University hospitals. Participants: Adult patients with fatigue symptoms following severe TBI, Fatigue Severity Scale (FSS) score 4 or more, Epworth Sleepiness Scale (ESS) score 10 or more, and/or Pittsburgh Sleep Quality Index (PSQI]) more than 5 were randomly assigned to one of 2 parallel groups: a BWL therapy group, with 30-minute exposure to waking white light enriched with blue for 4 weeks, and a group without light therapy (N-BWL), no light. Design: Randomized controlled trial. ClinicalTrials.gov number: NCT02420275. Main Measures: The primary outcome measure was the response of the FSS to 4 weeks of treatment. In addition, we assessed latency change of the P300 component of event-related potentials before and after therapy. Results: Significant improvement in the FSS score (P = .026) was found in the BWL group compared with the N-BWL group. Conclusion: BWL phototherapy reduces fatigue in patients with severe TBI.

Home-based light therapy for fatigue following acquired brain injury: a pilot randomized controlled trial

“…Our findings contrast with those of prior studies which examined time-limited exposure to blue or bright light LED devices in those with TBI [ 25 , 26 , 28 ] or cancer [ 48 , 49 ], and found significant reductions in fatigue and daytime sleepiness. One potential reason for this difference is the nature of the lighting employed.…”

“…The requirement to attend to a light box for 45 min within two hours of waking may be burdensome, however, and fatigue levels returned to pre-treatment levels once intervention ceased. Similar challenges have been observed in the three other trials in mild [ 26 , 27 ] and severe [ 28 ] TBI utilizing short-wavelength light, which have also observed reductions in fatigue [ 28 ], daytime sleepiness [ 26 , 27 ] and depressive symptoms [ 26 ], and improvements in objective sleep measures [ 26 ]. Only one study has examined light therapy in stroke patients, finding that naturalistic lighting reduced fatigue in patients undergoing inpatient rehabilitation, but there was no control condition or follow-up of patients post-discharge [ 29 ].…”

“…Our study found a significant reduction in subjective sleep disturbance and insomnia symptoms during dynamic light treatment where previous studies did not. Studies in TBI [ 25 , 27 , 28 ] patients utilizing time-limited morning exposure to devices, including that of Sinclair et al, and in stroke patients [ 29 ], using naturalistic light, found no significant reduction in sleep disturbance. This was supported by a recent network meta-analysis which suggested that blue-wavelength light therapy did not significantly reduce sleep disturbance [ 52 ].…”

Blue-wavelength light therapy for post-traumatic brain injury sleepiness, sleep disturbance, depression, and fatigue: A systematic review and network meta-analysis

“…After the duplicate removal, 1,034 records remained for title and abstract screening. We assessed 19 full-text publications and, finally, included four RCTs in this systematic review [21,[34][35][36].…”

“…The wavelengths of blue light therapy and ALT used ranged between λ max = 465 nm and λ max = 480 nm and ranged between λ max = 530 nm and λ max = 578 nm. While three trials provided light therapy using a LED lightbox [21,34,36], one trial gave light therapy using a face-mounted device resembling glasses [35]. All instances of light therapy were self-administered at home in the morning.…”