Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
The research study was conducted to identify how disruptions in sleep affect daily occupational performance after brain injury and to acknowledge of the role of OT in addressing sleep deficits through semistructured interviews and a multicomponent sleep program. The study was one of few studies to document the effectiveness of OT-directed sleep interventions, offering support for future OT practitioners and researchers to address sleep.
Primary Author and Speaker: Brandi Fulwider
PURPOSE: The purpose of the research study was to identify how disruptions in sleep affect daily occupational performance and to acknowledge of the role of occupational therapy in addressing sleep deficits through nonpharmacological sleep interventions. The research questions included: 1) Does participating in a multicomponent sleep program for individuals in a community re-entry program after BI improve sleep participation, 2) Which sleep interventions, if any, are beneficial for participants, 3) What factors affect sleep participation for the population, and 4) What are the occupational implications of disrupted sleep after brain injury? Disruptions in sleep can lead to negative effects on mental and physical health and can cause significant disruption in participation in daily occupations and leisure interests. Even though sleep is listed as an area of occupation in the Occupational Therapy Practice Framework, sleep has not always been addressed by occupational therapists. Literature identifies the role of occupational therapy in addressing sleep deficits, but there is limited evidence on the effectiveness of occupational therapy interventions for sleep. This research study examined the effectiveness of occupational therapy-directed sleep interventions after brain injury.
DESIGN: The study used an embedded mixed methods design with semi-structured interviews during the qualitative strand and a single-subject research design during a multicomponent sleep program for the quantitative strand. Participants were adults who were members of a community re-entry program after brain injury who had designated family support, had no more than mild-moderate cognitive impairment, had at least ‘sub-threshold insomnia,' and were willing to wear a sleep tracking device on the wrist during nighttime sleep.
METHOD: Semi-structured interviews were utilized for qualitative data collection. Quantitative outcome measures included the Consensus Sleep Diary and the Fitbit Inspire HR to track nightly sleep. The Insomnia Severity Index, the Epworth Sleepiness Scale, and the Functional Outcomes of Sleep Questionnaire were utilized to measure additional outcomes related to sleep. Qualitative data was analyzed using Moustakas' phenomenological approach. Quantitative data was analyzed using the two standard deviation band method and visual analysis techniques. Data was mixed using sequential analysis methods.
RESULTS: Based on the findings of the study, participating in a multicomponent sleep program was beneficial for study participants in regards to improving sleep quantity, with the most significant improvements noted in total sleep time and sleep efficiency. Two of the three participants also had improvements in the severity of insomnia, overall sleepiness, and functional outcomes related to sleep. Each of the sleep intervention phases were beneficial for participants in a cumulative effect over time, and participants identified various factors related to physiological and psychological functioning, environmental factors, and behaviors and evening routines that either supported or inhibited sleep.
CONCLUSION: Results were overall positive and participants reported satisfaction with individual study results, further supporting the role of occupational therapy practitioners and researchers in evaluating and addressing sleep in occupational therapy education, practice, and research. The research study is one of few studies documenting the effectiveness of occupational therapy-directed sleep interventions, which will likely significantly influence future occupational therapy practice and research in regards to evaluating sleep participation and supporting healthy sleep habits for clients.
References
Fung, C., Wiseman-Hakes, C., Stergiou-Kita, M., Nguyen, M., & Colantonio, A. (2013). Time to wake up: Bridging the gap between theory and practice for sleep in occupational therapy. British Journal of Occupational Therapy, 76, 384-386. https://doi.org/10.4276/030802213X13757040168432
Green, A. & Brown, C. (2015). An occupational therapist’s guide to sleep and sleep problems. Philadelphia, PA: Jessica Kingsley Publishers.
Tester, N. J., & Foss, J. J. (2018). The issue is - Sleep as an occupational need. American Journal of Occupational Therapy, 72, 7201347010. https://doi.org/10.5014/ajot.2018.020651
