App-delivered Cognitive-behavioral Therapy for Insomnia Among Patients With Musculoskeletal Complaints

NCT ID: NCT05572697

Last Updated: 2026-01-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

105 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-10-07

Study Completion Date

2025-11-30

Brief Summary

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The aim of this randomized clinical trial is to evaluate the effectiveness of app-delivered cognitive-behavioral therapy for insomnia adjunct to inpatient multimodal rehabilitation for individuals with comorbid insomnia and chronic pain, compared with rehabilitation (usual care) only.

Detailed Description

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Insomnia is highly prevalent among patients receiving treatment for long-term musculoskeletal complains. Cognitive-behavioral therapy for insomnia (CBT-I) may be effective for improving sleep quality and pain-related outcomes in these patients, but the availability of this therapy is limited by few trained therapists. In this randomized clinical trial we will evaluate the effectiveness of app-delivered CBT-I adjunct to inpatients multimodal rehabilitation for individuals with comorbid insomnia and chronic pain, compared with rehabilitation (usual care) only. Patients referred to Unicare Helsefort (Norway) with long-term chronic musculoskeletal complains and insomnia are invited to the study. The rehabilitation program consists of 2+2 weeks of inpatient multimodal rehabilitation, where the patients are at home for two weeks between the rehabilitation stays. Participants in the intervention group will receive the (CBT-I) while participating in rehabilitation, while the control group will receive rehabilitation without the app (usual care).

Based on sample size calculation recruiting 15 clusters with 2:1 randomization will achieve 80 % power to detect a 4-point difference between the intervention and usual treatment group on the insomnia severity index (ISI).

Edit 25.08.23: We noted in the review process of a protocol paper that the description of our sample size calculation implied that 150 participants would be included in the study, rather than that 150 potential participants would be screened and that we anticipated that 5 from each group of the 15 clusters would be eligible (i.e. 75 included in the study). We have also revisited the sample size calculations to account for dropouts and low adherence rates known to be a problem in digital interventions. We expect a dropout rate of approximately 20 % and that around 50 % of the participants in the intervention group will complete at least four of the dCBT-I modules. Given that the per-protocol analysis is of particular interest in this study, we aim to recruit 21 clusters to account for the fact that we expect an average of four participants per cluster in the control group to complete the follow-up, and an average of two participants in the intervention group to complete at least four of the modules and attend the follow-up. As total sample size is hard to predict and the sample size is based on number of clusters we have not changed the total enrollment number.

Conditions

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Insomnia Pain, Chronic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Cluster randomized clinical trial with two parallel arms
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Outcomes will be measured by registry data and questionnaires. Researchers will not have access to the randomization key before analyses are performed but blinding is not possible due to different number of participants in the two groups (as randomization is 2:1). The randomization procedure will be performed by the Clinical Research Unit (Klinforsk) at The Faculty of Medicine and Health Sciences at the Norwegian University of Science and Technology (NTNU) by use of a computer-generated block randomization. The randomization will be on group level to avoid contamination between participants in the same rehabilitation group.

Study Groups

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Digital Cognitive-behavioral therapy for insomnia (dCBT-I)

In addition to the standard rehabilitation program, participants will receive the sleep intervention delivered via a smartphone app. We will use a Norwegian a program named Assistert Selvhjelp (In English: "Assisted Self-Help"). The app is fully automated and requires no contact with healthcare personnel. It can also be assessed on computers, but in the present project we will use the app-delivered version. It is based on the principles from face-to-face CBT-I including several modules consisting of sleep hygiene, stimulus control sleep restriction, cognitive therapy, and relaxation training. The modules also consist of learning material (e.g., quizzes and materials explaining and educating the patients about important sleep dimensions).

Group Type EXPERIMENTAL

Digital Cognitive-behavioral therapy for insomnia (dCBT-I)

Intervention Type BEHAVIORAL

6 week sleep intervention delivered via a smartphone app while taking part in inpatient multimodal rehabilitation for chronic pain lasting 2+2 weeks.

Usual care

Participants randomized to usual care will receive the standard inpatient rehabilitation program. This is a traditional rehabilitation program consisting of physical activity, mindfulness excises, psychoeducation and acceptance and commitment therapy. One of the educational sessions is about sleep. Although this educational session overlaps with some of the content included in the intervention (e.g., sleep hygiene, stimulus control), it does not include any of the interactive features of the app.

Group Type ACTIVE_COMPARATOR

Usual care

Intervention Type BEHAVIORAL

Inpatient multimodal rehabilitation for chronic pain lasting 2+2 weeks.

Interventions

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Digital Cognitive-behavioral therapy for insomnia (dCBT-I)

6 week sleep intervention delivered via a smartphone app while taking part in inpatient multimodal rehabilitation for chronic pain lasting 2+2 weeks.

Intervention Type BEHAVIORAL

Usual care

Inpatient multimodal rehabilitation for chronic pain lasting 2+2 weeks.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Taking part in inpatient rehabilitation due to long-term musculoskeletal complaints
* Insomnia Severity Index (ISI) score \>11.

Exclusion Criteria

* Not having a smartphone or tablet.
* Individuals with work schedules that includes night shifts during the intervention
* Pregnancy
* Inadequate opportunity to sleep or living circumstances that prevent modification of sleep patterns such as having an infant
* Currently receiving psychological treatment for insomnia
* Medical history of contraindicating use of CBT-I such as epilepsy, recent cardiac surgery, and an attack phase of multiple sclerosis
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Norwegian University of Science and Technology

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Lene Aasdahl

Role: PRINCIPAL_INVESTIGATOR

Norwegian University of Science and Technology

Solveig K Grudt

Role: STUDY_CHAIR

Norwegian University of Science and Technology

Locations

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Unicare Helsefort

Rissa, Hasselvika, Norway

Site Status

Countries

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Norway

References

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Skarpsno ES, Simpson MR, Seim A, Hrozanova M, Bakoy MA, Klevanger NE, Aasdahl L. App-Delivered Cognitive-Behavioral Therapy for Insomnia Among Patients with Comorbid Musculoskeletal Complaints and Insomnia Referred to 4-Week Inpatient Multimodal Rehabilitation: Protocol for a Randomized Clinical Trial. Nat Sci Sleep. 2023 Oct 11;15:799-809. doi: 10.2147/NSS.S419520. eCollection 2023.

Reference Type DERIVED
PMID: 37850197 (View on PubMed)

Provided Documents

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Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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496297

Identifier Type: -

Identifier Source: org_study_id