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

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