Behavioral Interventions to Improve Sleep Outcomes in Individuals With Multiple Sclerosis: A Systematic Review.

BACKGROUND: Sleep disturbances are common in individuals with multiple sclerosis. The objective of this systematic review was to determine effective behavioral interventions to improve their sleep. METHODS: Literature searches were performed in December 2021 in Ovid MEDLINE, Elsevier Embase, and Web of Science, along with hand searching for grey literature and cited references. Four reviewers independently reviewed titles and abstracts (2 reviewers for each article; n = 830) and the full-text articles (n = 81). Consensus for inclusion was achieved by a fifth reviewer. Thirty-seven articles were eligible for inclusion. Four reviewers extracted relevant data from each study (2 reviewers for each article) using a standard data extraction table. Consensus was achieved for completeness and accuracy of the data extraction table by a fifth reviewer. The same 4 reviewers conducted a quality appraisal of each article to assess the risk of bias and quality of the articles, and consensus was achieved by a fifth reviewer as needed. Descriptive data were used for types of interventions, sleep outcomes, results, and key components across interventions. RESULTS: Overall, the cognitive behavioral therapy for insomnia, cognitive behavioral therapy/psychotherapy, and education/self-management support interventions reported positive improvements in sleep outcomes. Quality appraisal scores ranged from low to high, indicating potential for bias. CONCLUSIONS: Variability in the intervention type, intervention dose, outcomes used, training/expertise of interventionist, specific sample, and study quality made it difficult to compare and synthesize results. Further research is necessary to demonstrate the efficacy of most of the interventions.

Barriers and Facilitators to Implementing Sleep Health into Outpatient Physical Therapist Practice: A Survey Study.

AIMS: While challenges and barriers to incorporating health promotion into physical therapist (PT) practice have been previously described, none have specifically assessed the challenges and barriers to incorporating sleep health into PT practice. The objective of this study was to elucidate the perceived barriers and facilitators of incorporating sleep health into outpatient PT practice. METHODS: An electronic survey was developed via qualitative interview and expert feedback. Invitation to participate was posted on two professional organization's discussion boards and sent via email to alumni, clinical instructors, and PT colleagues. Descriptive analyses were conducted. RESULTS: 128 individuals (72% female, age 39.6 ± 10.3 years) completed the survey. The top three barriers were: "Patient's low motivation to change their sleep behavior" (87%), and "Lack of sleep assessment resources" and "Lack of sleep intervention resources" (both 82%). The top three facilitators were: "Growing knowledge of importance of sleep in PT practice" (86%), "Shift in PT practice to emphasis on health promotion and wellness" (84%), and "Shift in PT practice to person-centered focus" (80%). CONCLUSION: Understanding factors contributing to the "knowledge-to-action" sleep health gap in PT practice will aid in the development of strategies to mitigate the barriers and strengthen the facilitators.

Telehealth-Delivered Cognitive Behavioral Therapy for Insomnia in Individuals with Multiple Sclerosis: A Pilot Study.

Background: Over 50% of individuals with multiple sclerosis (MS) have moderate or severe sleep disturbances, insomnia being the most common. In-person cognitive behavioral therapy for insomnia (F2F-CBTi) is currently the first-line treatment for insomnia. However, given potential limitations to access including mobility difficulty, fatigue, or living in a rural area, telehealth-delivered CBT-I (tele-CBTi) has been considered as an alternative treatment. The purpose of this study was to assess the feasibility and treatment effect of tele-CBTi in people with MS and compare it to outcomes from a F2F-CBTi study in individuals with MS. Methods: 11 individuals with MS and symptoms of insomnia participated in 6 weekly CBT-I sessions with a trained CBT-I provider via live video. Insomnia severity (ISI), sleep quality (PSQI), and fatigue severity (FSS and MFIS) were assessed pre- and posttreatment as primary outcomes. Sleep onset latency (SOL), sleep efficiency (SE) and total sleep time (TST) from the PSQI, depression (PHQ-9), anxiety (GAD-7), sleep self-efficacy (SSES), and quality of life (MSIS-29) were also assessed pre- and posttreatment as secondary outcomes. Results: Participants resided in 9 different states. Retention and adherence rates were 100%. There were significant improvements in ISI, PSQI, MFIS, FSS, SOL, SSES, PHQ-9, and MSIS-29, but not SE, TST, or GAD-7. There were no significant differences between the F2F-CBTi group and tele-CBTi group for magnitude of change in the primary outcomes (ISI, PSQI, MFIS, and FSS) or the secondary outcomes (SOL, SE, TST, SSES, PHQ-9, GAD-7, and MSIS-29). Conclusions: Tele-CBTi is feasible and has outcome measures that are similar to that of in-person CBT-I treatment. Tele-CBTi may increase access to insomnia treatment in individuals with MS.