Insomnia, Low Back Pain, Osteo Arthritis Knee and Hip
Conditions
Keywords
Chronic musculoskeletal pain, Low back pain, Hip osteoarthritis, Knee osteoarthritis, Poor sleep, Insomnia, Cognitive Behavioral Therapy for Insomnia (CBT-I), Exercise therapy, Lifestyle intervention, Non-pharmacological treatment, Randomized controlled trial, Sleep quality, Pain management, Physiotherapy, Wearable activity monitor, Sleep EEG
Brief 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.
Detailed description
Chronic musculoskeletal pain, such as low back pain and osteoarthritis of the hip or knee, is common and often associated with poor sleep, reduced function, and lower quality of life. Lifestyle factors like exercise and sleep management can influence pain and well-being, but it is unclear which approach works best for people with both chronic pain and sleep problems. This randomized controlled trial will compare the effectiveness of three 12-month home-based lifestyle interventions: Exercise program Cognitive Behavioral Therapy for Insomnia (CBT-I) Combination of exercise and CBT-I Participants will be adults with chronic low back pain and/or hip or knee osteoarthritis lasting at least 6 months, who also report poor sleep. Eligible participants will be randomly assigned to one of the three groups. All groups will receive up to 10 online consultations with a physiotherapist over 9 months, plus tailored guidance on pain, sleep, and physical activity. Assessments will occur at baseline, 2 months, 6 months, and 12 months, and will include: Online questionnaires on pain, sleep, and quality of life Wearable activity and sleep monitoring Sensory testing Blood samples to explore biological markers related to pain and sleep Sleep EEG recordings at baseline and 6 months The primary aim is to determine which lifestyle intervention provides the greatest improvement in pain and sleep outcomes. Secondary aims include understanding changes in physical function, mood, and biological markers. Findings will help guide future non-medication treatments for people with chronic pain and sleep difficulties.
Interventions
BEHAVIORALAerobic physical activity
This intervention consists of a structured, individualised aerobic physical activity program delivered via videoconferencing by a physiotherapist. The program focuses exclusively on aerobic-based activities and does not include any sleep-specific or cognitive behavioural components. Exercise prescription will be tailored and progressively adjusted based on participant tolerance, goals, and clinical guidelines.
BEHAVIORALCBT-I
This intervention consists of cognitive behavioural therapy for insomnia (CBT-I) delivered via videoconferencing by a physiotherapist trained in CBT-I principles. The program targets sleep-related behaviours and cognitions using evidence-based CBT-I strategies, including sleep restriction, stimulus control, cognitive restructuring, and sleep hygiene education. No structured physical activity or exercise prescription is included.
BEHAVIORALCombined aerobic physical activity and CBT-I
This intervention integrates both a structured aerobic physical activity program and cognitive behavioural therapy for insomnia (CBT-I) within the same physiotherapist-delivered videoconferencing consultations. Participants receive both aerobic physical activity alongside CBT-I strategies targeting sleep behaviours and cognitions. The combined intervention delivers both components concurrently and differs from the single-component interventions by addressing physical aerobic activity and sleep within an integrated treatment framework.
Sponsors
University of Sydney
The University of Queensland
Uniformed Services University of the Health Sciences
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Masking description
Biostatistician
Intervention model description
This is a parallel-group randomized controlled trial comparing three lifestyle interventions for adults with chronic musculoskeletal pain and poor sleep. Participants will be randomly assigned to one of three groups: 1. Aerobic physical activity; 2. Cognitive Behavioral Therapy for Insomnia (CBT-I); 3. Combination of aerobic physical activity and CBT-I
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Average Pain severity | Baseline and 2, 6 (primary time-point) and 12 months | Average pain severity at the designated study site will be measured using a 0-10 Numerical Rating Scale, with higher scores indicating greater pain. Assessments will be conducted at baseline and at 2, 6, and 12 months. Primary intervention efficacy will be evaluated by between-group differences in change in average NRS pain from baseline to 6 months. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Worst pain severity | Baseline and 2, 6 and 12 months | Worst pain severity at the designated study site over the past week will be assessed using the numeric rating scale, ranging from 0 ("no pain") to 10 ("worst pain possible"). |
| Pain interference (PROMIS Short Form 8a) | Baseline, 2 mths, 6 and 12 months. | Scored using 8 questions (5-point Likert Scale) related to the consequences of pain on relevant aspects of a person's life and may include the extent to which pain hinders engagement with social, cognitive, emotional, physical, and recreational activities in the past 7 days. 5-point Likert scale. Ranges from 0-10; where 0 = 'no pain' and 10 = 'worst pain possible' |
| Health-related quality of life (EQ-5D-5L) | Baseline, 2 mths, 6 and 12 months. | Scored using 5 items (5-point Likert Scale) about mobility, self-care, pain, usual activities, and psychological status over the past week, with a Likert scale ranging from no problem to extreme pain or discomfort.Score ranges from 0 to 100. Higher scores indicate a better quality of life. |
| Insomnia (Insomnia Severity Index) | Baseline, 2 mths, 6 and 12 months. | Scored using a 7-items (5-point Likert scale) that captures disturbances in sleep consistent with insomnia. Score ranges 0 to 28. Higher scores indicating greater insomnia severity. |
| Sleep-related impairment (PROMIS-Sleep-related Impairment Short Form 8a) | Baseline, 2 mths, 6 and 12 months. | Scored using 8 items (5-point Likert scale) on perceptions of alertness, sleepiness, and tiredness during usual waking hours, and perceived functional impairments during wakefulness associated with sleep or impaired alertness. Ranging from "very poor/not at all" to "very good/very much". Score ranges from 8 to 40. Higher scores indicate greater sleep-related impairments. |
| Physical Function (PROMIS-Physical Function Short Form 8c v2.0) | Baseline, 2 mths, 6 and 12 months. | Scored using 8 items on 5 point Likert scales, capturing capacity to perform activities such as household chores, walking, climbing stairs, and lifting, as well as whether health limits these activities Ranging from "without any difficulty/not at all" to "unable to do/cannot do". Score ranges from 8 to 40. Higher scores indicate less physical dysfunction. |
| Satisfaction with the intervention | 2 mths, 12 months | Self-reported. Evaluation as perceived satisfaction. Ranging from "strongly agree" to "strongly disagree". Score range from 0 to 44 with higher score indicating less satisfaction. |
Countries
Australia, United States
Contacts
CONTACTAlan A Nguyen, BSc/B.A
CONTACTMichelle Hall, PhD, MSc, BSc (Hons)
Outcome results
None listed