How a sleep clinical pathway in an inpatient rehabilitation centre may help with sleep and recovery.

INTERVENTION: 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. CONDITION: Poor Sleep PRIMARY OUTCOME: Fatigue severity scale (FSS) measures fatigue severity through nine items concerning how fatigue affects motivation, exercise, physical functioning, carrying out duties, interfering with work, family or social life, on a 7‐point Likert scale where 1=strongly disagree and 7 is strongly agree. Responses are summed and divided by number of items for a scale score (range 1‐7). Higher score indicates more severe fatigue. It has excellent validity and reliability. The Hopkins Rehabilitation Engagement Rating Scale (HRERS) is a 5‐item, clinician‐rated measure developed to quantify engagement in acute rehabilitation services. It is a valid and reliable measure and has good internal consistency and interrater reliability. Clinicians (physiotherapist and occupational therapist) will be asked to complete this based on the engagement of the patient in the previous 72 working hours. The Pittsburgh Sleep Quality Index (PSQI) is a widely‐used, 19‐item self‐report questionnaire that measures sleep disturbance for up to a one‐month period. There are 7 sleep component scores (range of 0‐3 for each subscale): subjective sleep quality, sleep latency (i.e. time needed to fall asleep), sleep duration (number of hours of actual sleep per night), habitual sleep efficiency (total sleep time divided by time in bed converted to a score 0‐3), sleep disturbance (waking up in the middle of the night), use of sleeping medications and daytime sleepiness. The sum of these scores yields an overall score (range 0‐21); a lower score reflects better quality of sleep. A score cutoff of 5 is indicative of poor sleep quality and a change in three points suggests clinical effect. This instrument has high test‐retest reliability and good validity. SECONDARY OUTCOME: Actigraphy will provide an objective measure of sleep‐wake parameters.. This is a small watch‐like device that records motor activity continuously for several days. The data from the actigraph allows estimation of sleep‐wake parameters based on presence or absence of motor activity Length of stay in rehabilitation unit. Patient satisfaction with sleep will be measured with 5 point Likert scale (very satisfied, somewhat satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, very dissatisfied). 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).