Sleep Evaluation and Interventions in Stroke Survivors: A Survey of Current Practice in Rehabilitation Professions

Abstract

<h3>Research Objectives</h3> To investigate the sleep management knowledge, attitudes, and behaviors of occupational (OT) and physical therapists (PT) working in inpatient stroke rehabilitation. <h3>Design</h3> National survey of OTs and PTS. <h3>Setting</h3> Inpatient rehabilitation. <h3>Participants</h3> 43 OT and 39 PT respondents. <h3>Interventions</h3> Survey questions on sleep management knowledge, attitudes, and behaviors, types of standardized and informal sleep evaluations utilized, and sleep interventions utilized with inpatient stroke survivors. <h3>Main Outcome Measures</h3> Sleep management knowledge, attitudes, and behaviors, sleep evaluation tools and interventions utilized with inpatient stroke survivors. <h3>Results</h3> While 92% of OTs and PTs believe sleep assessment and interventions are important for stroke survivors, they are not regularly implemented in clinical practice. Respondents felt sleep interventions could positively impact cognition (23.0%), neuroplasticity (21.1%), mood (19.4%), activity tolerance (13.9%), and motor learning (13.2%). For OTs and PTs, sleep assessment was conducted in 0-25% of stroke survivors; 53.3% and 72.2% of the time respectively. Standardized scales to assess sleep were used by only 2.3% of OTs and O% of PTs. For those that assessed sleep, non-standardized interviews were most used (68.0%). No statistical differences (ANOVA) were found between professions, by the highest professional degree obtained, or years of practice (p > 0.05). Sleep interventions most commonly used included environmental modifications (lighting, room temperature, etc.), assistive devices/equipment (weighted blankets, white noise, etc.), and mind-body techniques. The majority of respondents (OT=69.1%, PT=76.9%) reported not receiving sleep management education as part of their entry-level curriculum. Only 2.6% of respondents reported having sleep evaluation and intervention included in their standardized documentation forms. Identified barriers to sleep management included lack of knowledge and training (48.7%), lack of time with patients (30.1%), and reimbursement (7.2%). <h3>Conclusions</h3> While OTs and PTs believe sleep management is important for stroke survivors, it is not regularly implemented in inpatient clinical practice. As the majority of respondents reported not having formal sleep management education in their professional curricula, this should be addressed by entry-level programs. <h3>Author(s) Disclosures</h3> None.