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Project

Towards PREcision MEdicine for Osteoarthritis: added value of cognitive behavioural therapy for insomnia (the PREMEO trial)

Knee osteoarthritis (KOA) is the leading and fastest increasing cause of disability in older adults. It is a serious health issue related with a high health care utilisation. The first-line KOA management is nonsurgical care, with education and exercise therapy as key elements. Nevertheless, treatment effects of exercise therapy and  behavioral pain management on improvements in pain, function and quality of life are small to moderate at best. This shows that there is an urgent need for better KOA care. The innovative solution may lie in thinking beyond joints, by targeting KOA subgroups through comorbidity-specific interventions, which fits well in the global move towards precision medicine. With a prevalence rate up to 80%, insomnia is a highly prevalent KOA comorbidity, contributing to symptom severity. If left untreated, it represents a barrier for effective conservative management. Since insomnia is nowadays hardly addressed in the often joint-targeted KOA care, the scientific objectives of the study are to assess 1) if cognitive behavioral therapy for insomnia (CBT-I) integrated in best-evidence usual care,    consisting of education and exercise therapy, (CBTi-UC) is more effective than best-evidence usual care alone (UC), i.e. education and exercise therapy, at 6 months follow-up in improving clinical outcomes and 2) if CBTi-US is more cost-effective than UC in KOA patients with comorbid insomnia. P: 128 KOA patients with morbid insomnia. I: 14-week intervention program (18 sessions). CBT-I (6 sessions) integrated in usual KOA care: education (3 sessions) and exercise therapy (9 sessions). C: 14-week intervention program (18 sessions). Education (3 sessions) and exercise therapy (6 sessions) combined with general information sessions (6 sessions). O: Primary outcome: pain intensity; Secondary outcomes: pain interference, sleep-related outcomes, physical activity/function; Tertiary outcome: inflammation; Quaternary outcome: healthcare utilisation.

Date:11 Jan 2022 →  Today
Keywords:Osteoarthritis, Cognitive Behavioral Therapy, Insomnia, Precision Medicine
Disciplines:Musculo-skeletal systems, Rehabilitation sciences, Rehabilitation, Sleep medicine, Behavioural sciences
Project type:PhD project