Date Presented 03/31/2022
Stroke recovery, with its foundations in neuroplasticity, is affected by sleep. It is important for OT practitioners to actively evaluate sleep and facilitate sleep hygiene interventions with stroke survivors to optimize outcomes. This national survey examined sleep management knowledge, attitudes, and behaviors of OTs and OTAs working in stroke rehabilitation. Although 98% of respondents felt sleep assessment and intervention were important, they are not being regularly implemented.
Primary Author and Speaker: Cindy W. W. Poole
Additional Authors and Speakers: David Levine, Nancy F. Fell, Kloe Kukta, Christine Hostetler, Kendall Jeter, Cara Kingrea
PURPOSE: The American Academy of Sleep Medicine (2017) recommends that adults engage in at least 7 hours of sleep per 24-hour interval. Stroke recovery, with its foundations in neuroplasticity, is impacted by sleep (Fulk, 2020). It is important for occupational therapy practitioners to actively evaluate sleep routines and facilitate sleep hygiene interventions with stroke survivors to optimize health and stroke recovery outcomes. The occupational therapy scope of practice includes occupational sleep evaluation and interventions to promote improved sleep performance, and to facilitate well-being and quality of life (AOTA, 2021).
DESIGN: This quantitative, anonymous, cross-sectional survey was conducted in collaboration with a national rehabilitation provider and administered nationally to OTs and OTAs working with stroke survivors in the inpatient rehabilitation setting. Participants were recruited through regional directors and disseminated via flyers containing the QR code survey link.
METHOD: This survey was administered via QuestionPro (Austin, TX) in Fall, 2021. Descriptive statistics, correlations, and group comparisons were calculated to describe sleep management knowledge, attitudes, and behaviors, and to examine differences by practitioner level (OT vs. OTA), entry-level degree (OTD vs. MS vs. BS), years of clinical experience, and other covariates. Sleep evaluation survey questions were analyzed for OT only, while OT and OTA data were analyzed for sleep intervention questions.
RESULTS: Survey data represented 42 OTs and 12 OTAs; 83.9% female, 12.5% male; race/ethnicity 71.4% white, 7.1% African American, 10.7% Asian, and 3.6% Hispanic. All regions of the United States were represented. The highest OT degree obtained was masters (64.3%), bachelors (16.1%), and professional doctorate (3.6%). Clinical experience ranged from 1-10 years (62.5%), 11-20 years (21.4%), and 21 years or more (16.1%). Respondents felt that sleep is important or very important for stroke recovery (98.1%), and that sleep rehabilitation interventions are important or very important for stroke survivors (88.5%). For OTs, sleep assessment was conducted in 25% or less of patients (53.7%), 26-50% (31.7%), 51-75% (7.3%), and 75%-100% (7.3%). Standardized scales to assess sleep were used by only 2.6% of respondents. For those that assessed sleep, non-standardized interviews were most commonly used (68.0%). No statistical differences (ANOVA) were found by highest OT degree obtained or years of practice (p > 0.05). Sleep interventions were utilized with 25% or less of patients (69.8%), 26-50% (16.9%), 51-75% (9.4%), and 75-100% (3.7%). No formal sleep management instruction in their professional educational program was reported by 62.1%. Perceived barriers to addressing sleep in stroke survivors included lack of knowledge/training in managing sleep (45.0%), lack of time with patients (32.6%), lack of evidence (10.1%), and reimbursement (9.0%).
CONCLUSION: While 98% of OPT’s believe sleep assessment and intervention are important for stroke survivors, they are not regularly implemented in clinical practice. The majority of respondents (62.1%) reported not receiving sleep management as part of their entry-level education. Standardized sleep assessments and interventions to address sleep deficits are not being regularly utilized.
IMPACT STATEMENT: Sleep is important to optimize stroke recovery and should be taught and practiced within the occupational therapy profession. Sleep-focused research studies are needed to establish best practices and explore methods which minimize barriers and optimize knowledge translation from lab to clinic. This study also identifies the academic need for sleep-specific curricular review in OT and OTA programs.
American Academy of Sleep Medicine. (2017). Seven or more hours of sleep per night: A health necessity for adults. https://aasm.org/seven-or-more-hours-of-sleep-per-night-a-health-necessity-for-adults/
Fulk, G. D., Boyne, P., Hauger, M., Ghosh, R., Romano, S., Thomas, J., Slutzky, A., & Klingman, K. (2020). The Impact of Sleep Disorders on Functional Recovery and Participation Following Stroke: A Systematic Review and Meta-Analysis. Neurorehabilitation and neural repair, 34(11), 1050–1061. https://doi.org/10.1177/1545968320962501
American Occupational Therapy Association. (2021). Occupational therapy scope of practice. American Journal of Occupational Therapy, 75(Suppl. 3), 7513410030. https://doi.org/10.5014/ajot.2021.75S3005