None listed
Conditions
Brief summary
Sleep is important for health, quality of life and general well being. Patients in rehabilitation often sleep poorly but the reasons for this are not well understood. It is important to better understand why patients sleep poorly in rehabilitation and how this can be managed. Through this study, it is hoped that a “clinical pathway” which consists of guides for clinicians will help clinicians understand and better address sleep problems. Patients will be divided into two groups randomly, with one group receiving care based on the “clinical pathway” and the other group receiving usual care without use of the “clinical pathway”. Sleep is starting to emerge as an important consideration in the overall management of rehabilitation patients however there is paucity of current literature relating to the efficacy of treatment of sleep disorders to guide treatment. For clinicians who actively manage sleep issues, most rely on evidence obtained in non-rehabilitation patients and commonly use hypnotic agents, Behavioural interventions and where appropriate devices such as continuous positive airway pressure (CPAP). Currently available clinical pathways for the treatment of sleep disorders focus predominantly on the management of obstructive sleep apnoea and do not extrapolate well to sleep disorders in a rehabilitation setting. This study aims to determine the feasibility and effectiveness of a sleep optimisation clinical pathway within the rehabilitation setting when compared to usual care on sleep quality, patient satisfaction with sleep, engagement with rehabilitation therapy, fatigue and length of inpatient rehabilitation stay through a randomized controlled trial with blinded patients and outcome assessors.
Interventions
The intervention group will receive management of their sleep disturbance through clinician use of a sleep assessment and management clinical pathway which will be recorded in the medical history of the patient.
This pathway has been developed collaboratively by the rehabilitation and sleep clinicians at the Royal Melbourne Hospital and consists of two parts – a simplified sleep history and a pathway providing sleep optimisation strategies. Guidelines and resources used included the National S
The intervention group will receive management of their sleep disturbance through clinician use of a sleep assessment and management clinical pathway which will be recorded in the medical history of the patient. This pathway has been developed collaboratively by the rehabilitation and sleep clinicians at the Royal Melbourne Hospital and consists of two parts – a simplified sleep history and a pathway providing sleep optimisation strategies. Guidelines and resources used included the National Sleep Foundation, the Australian National Stroke Foundation, and elements of the Pittsburgh Sleep Quality Index. Rehabilitation clinicians (with a focus particularly on medical, nursing and pharmacy staff) will be invited to a one hour group face-to-face education session, conducted by a sleep physician on managing sleep in hospitals, including use of the pathway. Sleep hygiene written educational material in three languages (English, Greek and Italian) sourced from the National Sleep Foundation will be made available on the wards for clinicians to provide to the patients. The pathway will be activated on notification of randomisation for the intervention group and reviewed weekly until discharge which can range between two to six weeks on average.
Sponsors
Rehabilitation Department - Royal Melbourne Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Ability and willingness to give informed consent, poor sleep quality (scoring = 5 on the Pittsburgh Sleep Quality Index after a negative answer to the initial screening question of “do you currently sleep well?”), musculoskeletal diagnosis (as per rehabilitation sub-group).
Exclusion criteria
Patients will be excluded if they are not able or willing to complete the Pittsburgh Sleep Quality Index due to medical or behavioural instability (such as agitated and aggressive) or severe cognitive communication deficits.
Outcome results
None listed