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Original report

The effectiveness of a novel sleep clinical pathway in an inpatient musculoskeletal rehabilitation cohort: A pilot randomized controlled trial

Jason Hsu, Kirk Kee, Andrew Perkins, Alex Gorelik , Jeremy Goldin, Louisa Ng
Rehabilitation Medicine, Royal Melbourne Hospital, Australia.
DOI: 10.2340/20030711-1000029


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

Lay Abstract

Sleep disturbance in hospital is common. This study examined the effectiveness of “sleep clinical path­ways” to help sleep in rehabilitation ward patients after hip and knee replacements. Fifty-one patients were divided randomly into 2 groups. One group received usual care, whilst the other group received care from doctors who were guided by these “pathways”. The pathways prompted the doctors to look for conditions that could affect sleep and gave them suggestions on how to manage these conditions. However, the results showed that using these pathways did not improve the sleep of patients compared with the usual care control group. Sleep improved in all patients over the course of the study.


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