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

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.