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. 2020 Feb 27:3:1000029.
doi: 10.2340/20030711-1000029. eCollection 2020.

Effectiveness of a Novel Sleep Clinical Pathway in an Inpatient Musculoskeletal Rehabilitation Cohort: A Pilot Randomized Controlled Trial

Jason Hsu  1   2 , Kirk Kee  3 , Andrew Perkins  3 , Alex Gorelik  4   5 , Jeremy Goldin  3 , Louisa Ng  1   2
Affiliations

Effectiveness of a Novel Sleep Clinical Pathway in an Inpatient Musculoskeletal Rehabilitation Cohort: A Pilot Randomized Controlled Trial

Jason Hsu et al. J Rehabil Med Clin Commun. .

Abstract

Objective: Sleep disturbance in hospital is common. This pilot randomized controlled trial assessed a sleep clinical pathway compared with standard care in improving sleep quality, engagement in therapy and length of stay in musculoskeletal inpatient rehabilitation.

Methods: Participants (n = 51) were randomized to standard care ("control", n =29) or sleep clinical pathway ("intervention", n = 22). Outcome measures included: Pittsburgh Sleep Quality Index (PSQI), Hopkins Rehabilitation Engagement Rating Scale (HRERS), Fatigue Severity Scale (FSS), Patient Satisfaction with Sleep Scale, and actigraphy. Assessment time-points were at admission and before discharge from rehabilitation.

Results: No significant differences were found between groups for any outcome measure. As a cohort (n = 51), there were significant improvements from admission to discharge in sleep quality (PSQI (-2.31; 95% confidence interval (95% CI) -3.33 to -1.30; p <0.001)], fatigue (FSS (-8.75; 95% CI -13.15 to -4.34; p <0.001)], engagement with therapy (HRERS-Physiotherapists (+1.37; 95% CI 0.51-3.17; p =0.037), HRERS-Occupational Therapists (+1.84; 95% CI 0.089-2.65; p = 0.008)), and satisfaction with sleep (+0.824; 95% CI 0.35-1.30; p = 0.001). Actigraphy findings were equivocal.

Conclusion: The sleep clinical pathway did not improve sleep quality compared with standard care. Larger studies and studies with alternate methodology such as "cluster randomization" are needed.

Keywords: actigrap-hy; clinical pathway; musculoskeletal; randomized controlled trial; rehabilitation; sleep.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Participants flow through the study.
Fig. 2
Fig. 2
Sleep issues identified using the clinical pathway (n=22). *Participants could have more than 1 issue. **Pre-existing diagnosis of obstructive sleep apnoea and had a Continuous Positive Airway Pressure machine.
Fig. 3
Fig. 3
Sleep strategies applied using the clinical pathway (n = 22).
See this image and copyright information in PMC

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