"The Days Are Long But the Nights Are Even Longer": A Mixed-Method Study of Sleep Disturbances Among Patients in an Inpatient Rehabilitation Program.
Miia Rahja, Kate Laver, Dylan A Mordaunt and 4 others
PMID 37744205WHAT IT FOUND
Patients on an inpatient rehabilitation ward reported significantly poorer sleep than before admission, with 75% classified as poor sleepers.
However, sleep quality did not predict functional recovery speed. Staff identified noise, pain, and lack of routine sleep assessments as key barriers.
Key findings
01Patients reported significantly poorer sleep quality during their rehabilitation stay compared to before admission, with a mean difference of 1.44 on the Pittsburgh Sleep Quality Index, which is clinically meaningful.
02There was no significant relationship between self-reported sleep disturbance or fatigue and the speed of functional recovery as measured by FIM efficiency scores.
03Staff interviews revealed that while they recognized barriers like noise and pain, there was no systematic process for assessing sleep history at admission, and roles for managing sleep were unclear.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was conducted on a single ward, so results may not generalize to other settings, especially stroke rehabilitation wards where patients were excluded. Sleep data relied entirely on self-report, which can be inaccurate, and no objective measures like actigraphy were used. The exclusion of patients with stroke, traumatic brain injury, and sleep apnea limits the applicability to a large portion of the typical inpatient rehabilitation population. There was potential selection bias, as 100 eligible patients declined to participate or were unavailable. The FIM efficiency score may not be sensitive enough to detect subtle functional changes related to sleep, particularly those affecting cognition or mood.
The easy way to misread this
Do not assume that improving sleep will directly accelerate functional recovery scores like the FIM. This study found no statistical correlation between sleep quality and FIM efficiency, suggesting that while sleep is important for patient well-being and perceived fatigue, its impact on measurable physical function recovery in this specific population was not demonstrated.