Date Presented 04/01/2022

The presentation will provide comprehensive resources about sleep deprivation among fast-track joint replacement surgical patients. It will discuss various assessment tools to measure quality and quantity of sleep and occupation-based interventions to improve sleep and occupational performance among postsurgical patients in acute care hospitals.

Primary Author and Speaker: Manisha Sheth

PURPOSE: One of the most recurrent complaints after total joint replacement is difficulty sleeping.The stress response to surgery, personal factors and environmental factors can affect quality and quantity of sleep in the hospital setting [1]. Sleep and rest are recognized as core occupations [2]. The aim of this study was to evaluate the effectiveness of occupational therapy (OT) interventions on sleep and occupational performance for those clients who underwent fast-track joint replacement surgery in an acute care hospital.

DESIGN: The researcher used quasi experimental design with two groups of clients. Total of 76 (n = 76) participants were selected using convenience sampling. There were 36 participants in the experimental group and 40 participants in the control group.Inclusionary criteria for the study included those adult participants who were undergoing elective fast track hip/knee replacement surgery and were able to read and write in English.

INSTRUMENT: Quality of sleep was measured using the Richard Campbell Sleep Questionnaire (RCSQ),the quantity of sleep was measured with the self-reported duration of sleep (SRDS) and the activities of daily living was measured by Functional Independence Measure (FIM) scores. All 76 participants completed the survey before and after surgery. The FIM scores were measured by the researcher.

INTERVENTION: All participants (control and experimental group) received routine occupational therapy interventions. On the first day post-surgery, each client received instruction on lower body dressing, toileting, toilet transfers, use of adaptive devices and DME. On the second day post-surgery and continuing until discharge, clients were seen for ADL performances and were trained in safe methods to get in and out of a tub or shower, car and bed. Clients and their caregivers were provided with written and verbal instructions to follow at home after discharged from the hospital. In addition to routine OT interventions, each participant in the experimental group received a sleep kit that contained an eye mask and ear plugs as well as a handout containing information about the recommended daytime routine and nighttime modifications. Occupation based intervention included recommendation to modify clients’ daytime routine (personal factors) such as diet, physical activities and nap time and to modify the night time routine (environmental factors) such as reduction in light and noise exposure at bedtime and maintaining room-temperature between 60-70°F in the hospital room.

DATA ANALYSIS: Using the Student t-tests and one-way analysis of variance (ANOVA), researchers analyzed collected data with a significance level set at p < 0.05. Results showed a statistically significant (p < .05) increase in RCSQ and SRDS scores on the day of discharge in the experimental group. The experimental group had significant improvement in the quality and quantity of sleep however the FIM scores on the day of discharge did not show significant difference between the two groups.

CONCLUSION AND IMPACT STATEMENT: This preliminary study demonstrated that participation in an occupation based intervention that includes modifications in the daytime routine and nighttime environment improves quality and quantity of sleep for clients in post-surgical acute care setting. Because sleep, like nutrition and physical activity, is a critical determinant of health and well-being, prevention and intervention strategies that address sleep needs at the level of the individual, family, and population lie within the scope of practice for occupational therapy and represent another way in which the profession approaches clients from a holistic perspective to them live life to its fullest [3].


Krenk, L., Jennum, P., & Kehlet, H. (2013). Activity, sleep and cognition after fast- track hip or knee arthroplasty. Journal of Arthroplasty, 28(8), 1265–1269.

American Occupational Therapy Association (AOTA). (2020). Occupational Therapy Practice Framework: Domain and Process. The American Journal of Occupational Therapy, 74, 7412410010.

Tester, N., & Jackson Foss, J. (2018). The issue is—Sleep as an occupational need. American Journal of Occupational Therapy, 72, 7201347010.