COMPARATIVE EFFECTIVENESS OF EXERCISE, COGNITIVE BEHAVIOURAL THERAPY, AND THEIR COMBINATION FOR PEOPLE WITH CHRONIC MUSCULOSKELETAL PAIN AND POOR SLEEP: SLEEPFIT TRIAL

Summary

This study aims to find out which lifestyle approach works best for people with chronic musculoskeletal pain (such as low back pain or hip/knee osteoarthritis) who also have poor sleep. Participants will be randomly assigned to one of three 12-month home-based programs: exercise, cognitive behavioral therapy for insomnia (CBT-I), or a combination of both. Each program includes up to 10 online sessions with a physiotherapist and guidance on managing pain, sleep, and physical activity. We will measure changes in pain, sleep quality, and overall health using questionnaires, wearable devices, sensory tests, and blood samples. The goal is to improve understanding of non-medication treatments for pain and sleep problems.

Eligibility

INCLUSION CRITERIA Participants will be included if they have persistent LBP defined as i) age ≥18 years; ii) sought or seriously considered care from a primary care clinician or specialist for their LBP within the past 6 weeks; iii) have at least moderate LBP-related interference with normal work or daily activity (including both work outside the home and housework), as assessed by item 8 of the 36-item Short Form Health Survey OR hip or knee OA defined by the National Institute for Health and Care Excellence as: i) age ≥45 years; ii) activity-related hip or knee joint pain; and iii) no morning hip or knee stiffness, or morning stiffness ≤30 minutes)

* An average pain of ≥4 on an 11-point numerical rating scale (NRS); 0 equals no pain, 10 equals worst pain possible over the last week
* ≥11 on the Insomnia Severity Index
* Access to a computer/laptop/tablet with internet availability for videoconferencing consultations
* Willing and able to participate in video consultations
* Verification that participants recruited in the US are beneficiaries of the Military Health System.

EXCLUSION CRITERIA

* Self-report engagement in \>120 minute per week of at least moderate intensity physical activity within the past 6 months
* Current or previous engagement in CBT-I in the past 6 months
* Cognitive impairment (based on ≥7 on the Short Orientation Memory Concentration Test
* Received an injection of any substance into the study pain site in the previous 3 months
* Waiting or planning to receive an injection in the study pain site in the next 12 months
* Had within the past 12 months, or waiting or planning surgery in the next 12 months
* Neurological or systemic conditions that may affect physical function (e.g. Parkinson's, Active cancers, multiple sclerosis, rheumatoid arthritis, ankylosing spondylitis)
* Failing the American College of Sports Medicine pre-participation Health Screening Questionnaire without medical clearance to participate
* Unable to give informed consent and/or participate in the intervention and assessment procedures.
* Unable to speak or read English.

Conditions4

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