Effects of Cognitive Behavioral Therapy on Pain and Sleep in Adults with Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Abstract

The objective of this study was to systematically review the literature on the effects of cognitive behavioral therapy (CBT) on insomnia and pain in patients with traumatic brain injury (TBI). PubMed, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases were searched. Outcomes, including pain, sleep quality, and adverse events, were investigated. Differences were expressed using mean differences (MDs) with 95% confidence intervals (CIs). The statistical analysis was performed using STATA 16.0. Twelve trials with 476 TBI patients were included. The included studies did not indicate a positive effect of CBT on pain. Significant improvements were shown for self-reported sleep quality, reported with the Pittsburgh Self-Reported Sleep Quality Index (MD, -2.30; 95% CI, -3.45 to -1.15; P < 0.001 ) and Insomnia Severity Index (MD, -5.12; 95% CI, -9.69 to -0.55; P = 0.028 ). No major adverse events related to CBT were reported. The underpowered evidence suggested that CBT is effective in the management of sleep quality and pain in TBI adults. Future studies with larger samples are recommended to determine significance. This trial is registered with PROSPERO registration number CRD42019147266.

Traumatismes crâniens et sommeil : une revue narrative

“…Cette étude soulignait également la nécessité d'adapter le contenu des séances pour une meilleure accessibilité aux patients avec atteintes cognitives. Une méta analyse récente de la TCC chez les patients post TC confirme une amélioration significative sur les scores ISI et le PQSI [75]. Les modalités de TCC les plus efficace pour ces patients restent à définir, mais devant l'hétérogénéité des tableaux cliniques post TC il est préférable que les séances soient organisées en individuel, menées par un psychologue formé à la TCC (et aux spécificités de la lésion cérébrale), et adaptées au niveau de compréhension du patient et en présence des proches.…”