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J Allied Health. Author manuscript; available in PMC 2016 September 28. Published in final edited form as: J Allied Health. 2015 ; 44(1): 41–50.
A Survey of Physical Therapists’ Perception and Attitude About Sleep Catherine F. Siengsukon, PT, PhD1, Mayis Al-dughmi, PT1, and Neena K. Sharma, PT, PhD1 1Department
of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS
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Abstract Purpose—The purpose of this study was to assess the attitude and perception of physical therapists (PTs) on the perceived need to assess sleep of their patients and provide education about sleep to their patients as well as to determine the perceived need for PTs to be educated on sleep topics. Methods—An electronic survey was sent to internship site coordinators. Descriptive analyses and logistic regressions were conducted.
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Results—The response rate was 28%. Most respondents (93%) agree poor sleep is associated with impaired function. Eighty-two percent agree that PTs should assess patients’ sleep habits and sleep quality, and 95% agree that addressing sleep issues may impact PT outcomes. The majority did not receive education about sleep during entry-level PT education (75%) or following graduation (86%). Most respondents (95%) think PTs should receive education about sleep. Conclusion—PTs recognize that sleep impacts outcomes, and patients’ sleep should be assessed. However, PTs have not received education about sleep although the majority think PTs should receive education about sleep. Therefore, entry-level PT education programs may consider incorporating education about sleep, and the development of continuing education courses is also needed. The attitude and perception of other health care professionals warrants investigation.
Introduction
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Sleep is critical for many different processes in the body including healing1–3, pain modulation4–6, cardiovascular health7–9, modulating anxiety and depression10,11, cognitive function12–14, and learning and memory.15–17 Sleep deprivation and a variety of sleep disorders result in reduced workplace productivity18,19, negatively impacts public safety20, and affects personal well-being, including performance deflcits, excessive daytime sleepiness, depressed mood, and impairments in concentration and memory.21–23 It is estimated that almost 40 million Americans have a chronic sleep disorder.24,25 Sleep issues cost US employers $18 billion as a result of reduced productivity.26–28 Around 62 % of US adults experience a sleep problem several nights a week and 30% suffer from
Address Correspondence to: Catherine F. Siengsukon, PT, Ph.D., University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS 66160, Phone: 913-588-6913, Fax: 913-588-4568, [email protected].
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insomnia in the course of any given year.29,30 Sleep disorders and reduced sleep quality should be considered a public health concern.
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Despite the importance of sleep for adequate body function and the impact poor sleep can have on outcomes as well as the prevalence of sleep issues, sleep disturbances are often overlooked by the medical community. Sleep assessment is not typically part of a physical therapist’s (PT) evaluation or other non-physician health care professional’s evaluation as sleep assessment would generally be considered under the practice domain of a physician. However, due to the critical impact sleep has on body function, particularly in cognitive function, pain modulation, and learning and memory, PTs and other health care professionals are in a prime position to assess sleep as well as provide education about ways to improve sleep within the scope of their practice. Because of the nature of the PTs prolonged patient engagement and in depth appraisal of functional activities and lifestyle factors, PTs may notice sleep issues and could refer a patient to a sleep specialist if warranted. Furthermore, when a patient’s sleep is disrupted or their quality of sleep is reduced, this can interfere with their performance in therapy and ultimately their outcomes.31,32 Several studies have used surveys to assess the perception, attitude and knowledge of other health care professions including physicians33,34, nurses35,36, pharmacists37, and psychologists.38 Overall, the health care professionals rated their knowledge as fair to poor and reported they spend more time counseling patients on diet and exercise over sleep need.33,39 Only one paper40 has provided an overview of sleep assessment and why the evaluation of sleep and basic sleep recommendations need to be considered as fundamental clinical competencies in contemporary physical therapy care.
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There is little emphasis on the need to assess sleep across medical professions. However, it remains unknown if PTs perceive a need to assess sleep of their patients. In addition, it remains unknown if PTs are currently educating patients about sleep. Furthermore, despite the critical role of sleep and potential health consequence of poor sleep, PTs are not typically educated about sleep or the health benefits of sleep as part of their entry-level education program, but it is unknown if PTs perceive a need for sleep education. Therefore, the purpose of this study was to assess the attitude and perception of PTs on the need to assess sleep of their patients and provide education about sleep to their patients as well as the perceived need for PTs to be educated on sleep topics.
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Study Design This study was a cross-sectional survey of PTs who serve as internship site coordinators for students in the Doctor of Physical Therapy program at the University of Kansas Medical Center. Survey Instrument An electronic survey was developed in four steps: 1. A review of literature revealed questionnaires used to assess sleep knowledge and attitude of physicians.33,38,41 2.
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Following receipt of permission to use questions from their surveys, the authors (CS and NS) developed questions for the survey used in the current study. Some questionnaire items were used verbatim from the prior questionnaires, but other items were modified to be relevant for PTs. Additional questions were also added to meet the purpose of the survey of this current study. 3. Following initial development of the survey, a consultation with a statistician was completed to verify the methods of developing the survey, delivery of the survey, and statistical analysis. Revision of the survey occurred following the statistical consultation. 4. Five PTs with either sleep expertise or survey development experience were asked to review the survey questions to verify the survey’s face validity. Additional modifications were made based on the feedback of these experts. 5. The last step was sending the survey in electronic format to 15 PTs. Ten of these individuals completed the survey and provided feedback. Based on responses and feedback, additional minor modifications were made to improve clarify and question intention.
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The final version of the electronic survey consisted of 77–87 questions in six sections. The total number of questions presented to participants depended on answers provided which then prompted different questions to follow. The first section consisted of 8–12 questions concerning demographics including sex, age, current employment status, employment setting, years of experience, and state of licensure and practice. The second section consisted of 26 questions regarding PTs’ attitude regarding sleep including attitude about other people’s sleep habits and attitude about sleep as a professional. Reponses were provided on a 5 point Likert scale from strongly disagree to strongly agree with a 6th option of “unsure”. The third section consisted of 4–6 questions concerning sleep education of PTs including if education about sleep was provided during entry-level physical therapy education or anywhere other than entry-level physical therapy education, how much education about sleep was received during entry-level physical therapy education, which topics about sleep were covered during entry-level physical therapy education, and which topics should be provided to PTs and where (in PT school or as continuing education). The fourth section asked 2–6 questions about PT assessment of patients’ sleep including if PTs routinely assess patients’ sleep, what type of assessment is done, or why assessment is not done. The fifth section consisted of 7 questions concerning education provided to patients about sleep including what type of education routinely provided to patients, if education about sleep improves outcomes, or why education is not routinely provided. The last section consisted of 30 questions to assess PTs knowledge of sleep. The optional answers for the knowledge questions were “true”, “false”, and “unsure”. The data of this last section is not included in analysis.
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Target Population Individuals who serve as internship site coordinators for students in the Doctor of Physical Therapy program at KUMC (n=297) were selected to participate in this study. Instructions were provided with the survey that only PTs were eligible to complete the survey. People who received the survey but are not PTs were instructed to not complete the survey.
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Data Collection
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An email was sent to 297 email addresses in the KUMC database of internship site coordinators with a brief explanation of the purpose of the survey and a link with instructions to access the electronic survey. A week following the initial email, a reminder email was sent with a reminder the survey should be completed within the week, giving individuals two weeks total to complete the survey. A link provided in the email took participants to the survey, secured on the KUMC network. A more detailed explanation of the purpose of the study was provided. It was also stated that by completing the survey, the participants were providing consent to participate in the study. This study was conducted in accordance with the KUMC IRB. Data Analysis
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Data were downloaded from the electronic survey into an excel spreadsheet and entered into SPSS. Descriptive analysis was conducted. Means and standard deviations were calculated for continuous variables. Frequency distribution was calculated for categorical data. Two binary stepwise logistic regressions were conducted to determine which factors best predict the positive response “yes” on the question “Do you routinely assess your patient’s sleep habits or quality of sleep?”, and on the question “Do you routinely educate your patients about the importance of sleep?” Eight predictor variables were chosen for the 2 models as follows: sex, age, degree earned in PT school, numbers of years since graduation from PT school, and the four different age ranges of patients (birth to 3 years, 3 years to school age, 21 to 65 years, more than 65 years).
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Results Survey response rate Of the 297 emails sent, 28 were undeliverable. Of the 269 emails delivered, 80 individuals’ responses were included in the original data set. However, 4 data sets were removed because the individuals completed only the demographic information but did not answer any questions beyond the demographic section. The remaining 76 individuals were included in data analysis, with a response rate of 28%. Some individuals left some questions unanswered, so the n is included to reflect the number of individuals who answered each question. Demographics
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Demographic information is provided in Table 1. Of the 76 respondents included in data analysis, 83% were female. The average age of respondents was 41.99 years old (SD 10.94). The distribution of entry-level physical therapy education revealed 27 individuals (36%) received a Bachelor’s degree, 26 (34%) received a Master’s, and 23 (30%) received a Doctorate. The variety in degrees earned is also reflected by the numbers of years that have passed since graduation of entry-level physical therapy education. The majority of the respondents (84%) work full time as a PT providing direct patient care. Most of the respondents currently practice in Kansas (44 respondents) followed by Missouri (17
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respondents) and some respondents listed more than one state they are currently practicing. The respondents treat a variety of age ranges of patients from birth to older than 65 years of age. The most common type of practice setting selected was “outpatient clinic” (41 respondents) followed by “acute care/hospital” (30 respondents) with other settings also represented. PT’s Attitude Regarding Sleep
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Reponses to questions assessing the respondents’ attitude regarding sleep is included in Table 2. The “strongly agree” and “agree” responses have been collapsed into “agree” for discussion of the results. Overall, PTs agree that sleep impacts health, function and PT outcomes and PTs should assess the sleep quality of their patients. Of primary interest, 96% of respondents agree that sleep is important to people’s heath, and 93% agree that poor sleep is associated with impaired function. When specifically asked about physical therapy practice, 82% of respondents agree that PTs should ask their patients’ about their sleep habits and sleep quality, and 51% agree PTs should perform objective assessments (such as use questionnaires) to assess their clients’ sleep habits and sleep quality. Ninety-five percent agree that addressing sleep issues may impact physical therapy outcomes. PT Education on Sleep
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The majority of PTs did not receive education about sleep during entry-level physical therapy education (75%) and have not received education about sleep following completion of their entry-level physical therapy education (86%; Table 3). Of the 25% who did receive education during entry-level physical therapist education about sleep, only 2 respondents had more education than only one lecture or the mention of sleep during entry-level physical therapist education. Of the topics of sleep education provided during entry-level physical therapist education, the top five topics of highest frequency were impact of sleep on learning, basic physiology of sleep, common causes of sleep issues, common medical treatments of sleep disorders, and impact of sleep on cognitive function. Of the 11% that stated they received education about sleep following their entry-level physical therapist education, the top two types of education were from personal research or reading and from an in-service or seminar from a sleep professional or medical staff. PT Perception of Need for Sleep Education
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The majority of respondents agree that PTs should receive education about sleep, and believe several topics about sleep should be taught in entry-level physical therapist education. Specifically, 95% of respondents answered “yes” to the question “Do you think PT’s should receive education about sleep?” The top five topics that respondents think should be taught during entry-level physical therapy education are basic physiology of sleep (93%), common causes of sleep issues (85%), common medical treatments of sleep disorders (85%), epidemiology and causes of common sleep disorders (76%), prevention of common sleep disorders (75%), promotion of healthy sleep habits and quality of sleep (75%; Figure 1). Some topics respondents thought should be taught as continuing education, including advanced physiology of sleep (76%) and assessment of sleep quality (54%; Figure 1). One to five percent of respondents do not think various topics should be taught to PTs (Figure 1). J Allied Health. Author manuscript; available in PMC 2016 September 28.
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PT Assessment of Patients’ Sleep
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A small majority of PTs are routinely assessing their patient’s sleep habits or quality of sleep (57%), asking subjective information (93%) and using a sleep questionnaire (98%, Table 4). However, only 16% routinely refer patients to a sleep specialist for additional assessment. In the clinical experience of the respondents who do routinely assess their patient’s sleep habits or quality, the following are the six most common diagnoses of individuals that typically have sleep issues: acute back pain, chronic back pain, post-op, acute neck pain, chronic neck pain, and fibromyalgia (Figure 2). Of the 43% of individuals who do not routinely assess their patient’s sleep habits or quality of sleep, the most common reason provided was “I do not know how to assess sleep habits or sleep quality” (Table 4). PT Patient Education on Sleep
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A small majority of respondents routinely educate their patients about the importance of sleep (55%), and 87% believe educating patients to improve their sleep quality impacts their outcomes (Table 5). However, only 43% routinely educate their patients about the health benefits of sleep, and 45% routinely educate their patients how to improve their sleep quality. Of those respondents who do not routinely educate their patients about sleep, the most selected reason was “I do not know how to educate patients about sleep or sleep hygiene techniques.” Factors Impacting PT Assessment and Treatment of Sleep
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The two overall logistic regression models of routine assessment and sleep education where not significant: p= 0.643 and p= 0.488 respectively. In the first model of predicting routine assessment of sleep, none of the variables had a significant effect on the model but age of the respondent had the lowest p-value in the model (p= 0.075) followed by the number of years since graduation (p= 0.255) and primarily treating patients who are older than 65 years (p= 0.344; Table 6a). In the second model of predicting routine education of patients about sleep, none of the variables were significant, but primarily treating patients who are 21 to 65 years old had the lowest p-value (p= 0.19) followed by primarily treating patients who are older than 65 years (p= 0.495; Table 6b).
Discussion
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This survey provides the first assessment of physical therapists’ perception and attitude about the need to assess the sleep of their clients and educate their clients about sleep. The results also provide the first assessment of the amount of education PTs receive about sleep and the perceived need to be educated about sleep. The results of this survey could lead to changes to entry-level PT curriculum to incorporate education about sleep disorders, assessment of sleep, and methods PT may use to address sleep issues. Furthermore, the development of continuing education courses is warranted to provide sleep education to practicing PTs. The demographic information of the participants illustrates that the sample in this study is representative of PTs currently practicing. Sixty-three percent of respondents were female which is closely aligned to US sex distribution of PTs; around 70% of PTs are female in the
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US.42 Also, a very similar number of participants were distributed across type of degree received in entry-level physical therapy education and the number of years ago the participants graduated from entry-level physical therapy education which gives confidence that each type of degrees and all years of experience are well represented. One major limitation of this study is the sample of participants primarily practices in Midwestern states. An additional study is needed to survey PTs across the US to determine the generalizability of the findings of the current study. Also, while individuals from a wide variety of practice settings were included in this study, there were a few practice settings that were not represented in this survey. A larger scale study would also improve likelihood that PTs from all practice settings would be included.
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Assessing PTs’ attitude and perception of the need to assess sleep of their clients is an important first step in understanding the role PTs are currently taking in assessing and addressing sleep issues in their clients. Furthermore, the results of this survey provide insight into PTs’ perception on the need to assess and address sleep of clients. Overwhelmingly, PTs agree that sleep is important for health and agree that poor sleep impairs function. Furthermore, a large majority agree that clients’ sleep habits and sleep quality should be considered by a PT. A large majority of respondents also agree that PTs should counsel patients on improving sleep quality, including using positioning strategies. An overwhelming majority agree that addressing sleep issues may impact physical therapy outcomes.
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Not surprisingly, the vast majority of PTs did not receive education about sleep in PT school and are not receiving education about sleep while practicing as a PT. Furthermore, the majority of respondents agreed that PTs should be assessing and addressing sleep and that 95% of respondents think PTs should receive education about sleep. Also, the most frequent reason provided for not routinely assessing patient’s sleep or educating patients about sleep was “I do not know how.” Therefore, PT programs should consider integrating topics about sleep into their curriculum. Furthermore, continuing education programs should be developed to provide this education to practicing PTs.
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Despite a lack of formal education on sleep topics, the vast majority of respondents routinely asks their patients about their sleep habits and quality of sleep and routinely administers a sleep questionnaire. However, it is concerning that only 16% of these individuals routinely refer patients to a sleep specialist. This could be that indeed, only a few number of individuals have a sleep issue that warrants a referral to a sleep specialist. However, considering that 25% of the population has a sleep issue or disorder43, it is more likely that despite assessing for sleep issues, sleep issues are being missed by PTs or are identified but not being refered to a specialist for treatment. It is encouraging that many PTs are assessing sleep, but future education is likely needed to ensure accurate assessment of sleep issues and basic identification of possible sleep disorders that would require a referral to a sleep specialist. Also despite a lack of formal education on sleep topics, many PTs are providing education to their patients about the importance of sleep, about the health benefits of quality sleep, how to improve their sleep quality, and positioning strategies to achieve quality sleep. Of PTs who
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do routinely provide education about sleep to their patients, on overwhelming 87% believe education provided to patients to improve their sleep quality impacts their outcomes. Studies are needed to determine if providing sleep education to patients does in fact improve their outcomes, hasten recovery rate, decrease cost of providing care, and decrease length of care. Education provided to patients about sleep and sleep hygiene could potentially be a low-cost means to improve outcomes.
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From the logistic regression analyses, the routine assessment of patients’ sleep is impacted by the PTs age and the numbers of years since graduation, although neither of these factors were statistically significant. This may be due to PTs who graduated more recently from entry-level physical therapy education (and are likely younger) are more likely to have been educated about the emerging evidence indicating the impact of sleep quality on body function. Also, PTs are more likely to assess sleep if they typically treat patients who are older than 65 (although not statistically significant) because sleep parameters and sleep quality change with age44,45 so the prevalence of reported sleep issues occur more often in older adults.46,47 The routine education of patients regarding sleep is impacted (although not statistically significant) by the age of patients the PT primarily treats. PTs who primarily treat patients who are 21 to 65 years old are most likely to educate their patients about sleep followed by those who primarily treat patients who are older than 65 years. This is also likely due to the higher incidence of reported sleep issues that occur with age as well as the change in sleep parameters and quality that occurs with age.48,49
Conclusion
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This is the first survey to assess PTs perception and attitude about the need to assess the sleep of their patients and educate their patients about sleep. This is also the first survey to assess the amount of education PTs receive about sleep and the perceived need to be educated about sleep. This survey provides information about education on sleep PTs received during entry-level physical therapy education which informs the need to include education about sleep into entry-level PT curriculum. Furthermore, results of this survey provide insight into PT’s perceived need to receive education about sleep which indicates a need to develop continuing education courses for currently practicing PTs. Also, PTs listed people with LBP, neck pain, and Fibromyalgia and those post-op as commonly presenting with sleep issues. Thus, the assessment and treatment of sleep disturbances of patients with these should be particularly considered. Considering the impact of sleep on rehab and recovery, the attitude and perception of other health care professionals also warrants investigation.
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Acknowledgments The authors acknowledge: the contribution of Kendra Gagnon, Carla Sabus, Steven Jernigan, Rupali Singh, and Julie Hereford to the development of the survey, feedback provided by Sandra Billinger and Carla Sabus to earlier versions of the manuscript, Tennille Fincham in Teaching & Learning Technologies at KUMC for developing the online survey format, Michael Sateia, MD, for granting permission to use portions of the Dartmouth Sleep Knowledge and Attitude Survey, Klara Papp, PhD, for granting permission to use portions of their survey, and Thomas Heffron from the American Academy of Sleep Medicine for granting permission to use questions from the ASKME survey. This work was partially supported by Frontiers; The Heartland Institute for Clinical and Translational Research (University of Kansas Medical Center’s CTSA; KL2 TR000119-02 & UL1 TR000001-02) to NKS.
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Percent of respondents who think various sleep topics should be taught in PT school, as continuing education, or should not be taught.
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Figure 2.
In the clinical experience of respondents who do routinely assess their patient’s sleep habits or quality (N=43 or 57% of respondents), the number of respondents who think individuals with various diagnoses typically have sleep issues.
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63(83) 13(17)
N (%)
F M
41.99 (10.94) n=76
Age (years)
27(36) 26(34) 23(30)
Bachelor Master Doctorate
N (%)
What degree did you receive in PT school?
15(23) 10(15) 13(2) 10(15) 10(15) 7(11) 11
1–5 6–10 11–15 16–20 21–25 26–30 >30
N (%)
How many years ago did you graduate from PT school?
64(84) 10(13) 1(1) 1(1)
Full time Part time Prn not providing direct patient care
N (%)
What is your current employment status as a PT providing direct patient care?
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Sex
1 1 1 44 17 2 3 1 2 1 5 1 1
Alaska Colorado Florida Kansas Missouri Nebraska Nevada Ohio Oklahoma Pennsylvania Texas Utah Washington
N
What state(s) are you currently practicing?
9 13 31 57 45
Birth to 3yrs 3yrs to schoolage Schoolage to 21 21–65yrs 65 yrs or older
N
What age range(s) of patients do you primarily treat?
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Demographics.
30 14 1 41 5 2 0 1 0 0 1 0 0 8 7
Acute care/hospital Rehabilitation unit/facility Sub-acute rehab Outpatient clinic School setting Wellness/prevention/sports/fitness Extended care facility/nursing home/SNF Industrial/Workplace/Occupational Environments Hospice Local, State, and Federal Government Research Center Faculty in PT/PTA program Not currently practicing as a clinician Supervisor or administrator Other
N
What type of setting best describes your current primary work setting?
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Table 1 Siengsukon et al. Page 14
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Author Manuscript 74 75 76 76 76
In general, people get enough sleep
Poor sleep is associated with impaired function
Most people don’t pay much attention to sleep
Excessive sleepiness is a public health problem
Insomnia is a common health problem
16 (21) 7 (9)
76 75 75 76 76 76 76 76 75 76 76
Most people seek medical help for their sleep disorders
Sleeping medication is over-prescribed
Sleep apnea is underdiagnosed
Daytime sleepiness is an important medical symptom
Sleep disorders may contribute to medical problems
Sleepinesss is an important factor in many motor vehicle accidents
Consultation with a sleep medicine specialist is useful for patients with sleep problems
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Overnight sleep studies provide useful diagnostic information
Most sleep disorders are treatable
CPAP is an effective treatment for sleep apnea
Primary care doctors should counsel patients regarding sleep hygiene
23 (30)
13 (17)
22 (29)
19 (25)
30 (39)
14 (18)
8 (11)
2 (3)
0 (0)
76
28 (37)
10 (13)
6 (8)
4 (5)
42 (56)
3 (4)
70 (92)
N (%) Strongly Agree
I should routinely ask patients about sleep problems
What I think about sleep as a professional
76
Sleep is important to people’s health
What I think about other people’s sleep habits
N
47 (62)
47 (62)
50 (67)
52 (68)
45 (59)
47 (62)
44 (58)
51 (67)
45 (60)
36 (48)
5 (7)
38 (50)
44 (58)
42 (55)
54 (71)
28 (37)
6 (8)
3 (4)
N (%) Agree
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Physical Therapists’ Attitude Regarding Sleep
1 (1)
6 (8)
8 (11)
3 (4)
5 (7)
5 (7)
1 (1)
8 (11)
11 (15)
20 (27)
7 (9)
3 (4)
16 (21)
18 (24)
6 (8)
1(1)
3 (4)
1 (1)
N (%) Neither
0 (0)
2 (3)
0 (0)
0 (0)
1 (1)
0 (0)
0 (0)
1 (1)
3 (4)
6 (8)
60 (79)
7 (9)
2 (3)
6 (8)
10 (13)
3 (4)
54 (73)
0 (0)
N (%) Disagree
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
3 (4)
0 (0)
0 (0)
1 (1)
0 (0)
1 (1)
8 (11)
2 (3)
N (%) Strongly Disagree
5 (7)
8 (1)
10 (13)
5 (7)
3 (4)
5 (7)
1 (1)
2 (3)
8 (11)
11 (15)
1 (1)
0 (0)
4 (5)
3 (4)
2 (3)
0 (0)
0 (0)
0 (0)
N (%) Unsure
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Physical Therapists’ Attitude Regarding Sleep.
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Table 2 Siengsukon et al. Page 15
Author Manuscript 0 (0) 0 (0) 23 (30) 6 (8)
15 (20) 20 (26) 22 (30) 27 (36)
76 76 76
76 76 76 75
Most sleep problems are psychiatric PT’s should ask their patients’ about their sleep habits and sleep quality PT’s should perform objective assessments (such as use questionnaires) to assess their clients’ sleep habits and sleep quality PT’s should counsel patients regarding methods to improve sleep quality PT’s should counsel patients on positioning to improve sleep Assessing my patients’ sleep habits and quality is important Addressing sleep issues may impact physical therapy outcomes
N (%) Strongly Agree
76
Sleep disorders are less important than other medical disorders
N
44 (59)
44 (58)
53 (70)
41 (54)
33 (43)
47 (62)
2 (3)
4 (5)
N (%) Agree
2 (3)
7 (9)
3 (4)
10 (13)
23 (30)
3 (4)
11 (14)
11 (14)
N (%) Neither
2 (3)
3 (4)
0 (0)
7 (9)
10 (13)
3 (4)
47 (62)
49 (64)
N (%) Disagree
0 (0)
0 (0)
0 (0)
0 (0)
1 (1)
0 (0)
10 (13)
10 (13)
N (%) Strongly Disagree
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Physical Therapists’ Attitude Regarding Sleep
0 (0)
0 (0)
0 (0)
3 (4)
3 (4)
0 (0)
6 (8)
2 (3)
N (%) Unsure
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Author Manuscript 57 (75) 19 (25)
65 (86) 11 (14)
Have you had education about sleep anywhere other than PT school (such as continuing education, advanced degree, etc.)
Did you receive education in PT school about sleep?
N (%)
PT Education on Sleep
No Yes
No Yes
9 6 2 2 11 0 11 2 10 2 1 0 1 6 8 2 0 0 1 10 13
If Yes, which topics about sleep did you receive education in PT school?
2 4 1 4 1
If Yes, how much education about sleep did you receive in PT school?
If Yes, what type of education did you receive?
Basic physiology of sleep Advanced physiology of sleep Common causes of sleep issues Epidemiology and causes of common sleep disorders Common medical treatments of sleep disorders Prevention of common sleep disorders Assessment of sleep quality Assessment of sleepiness Screening for potential sleep disorders Interventions to address patients’ sleep issues Promotion of healthy sleep habits and quality of sleep Impact of sleep on cardiovascular disease Impact of sleep on diabetes Impact of sleep on dementia Impact of sleep on stroke risk Impact of sleep on cognitive function Impact of sleep on learning
Mentioned during PT school One lecture A series of lectures Unsure
Continuing education or CCU Personal research or reading On the job Inservice or seminar from sleep professional/MD Family member with sleep apnea
Education about sleep PTs have received. One individual specified education was received about sleep in two manners, so each response was calculated resulting in 12 responses total.
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Table 3 Siengsukon et al. Page 17
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Table 4
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PT Assessment of Patients’ Sleep PT Assessment of Patients’ Sleep
N (%)
Do you routinely assess your patient's sleep habits or quality of sleep?
33 (43) 43 (57)
No Yes
N (%)
Of those who answered “yes” to “Do you routinely assess your patient's sleep habits or quality of sleep? Do you routinely ask subjective information about your patient's sleep habits or quality of sleep?
3 (7) 40 (93)
No Yes
Do you routinely administer a sleep questionnaire?
1 (2) 42 (98)
No Yes
Do you use other methods to assess your patients' sleep not already listed or described in the survey?
41 (95) 2 (5)
No Yes
Do you routinely refer your patients to a sleep specialist for additional assessment?
36 (84) 7 (16)
No Yes
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Of those who answered “no” to “Do you routinely assess your patient's sleep habits or quality of sleep? Why do you not routinely assess your patient's sleep habits or quality of sleep?
N
I do not have time
7
I do not know how to assess sleep habits or sleep quality
25
I do not think sleep is important to assess
2
I think assessing sleep is beyond a PT's scope of practice
6
Other
8
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Table 5
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PT Patient Education About Sleep. PT Patient Education
N (%)
Do you routinely educate your patients about the importance of sleep?
34(45) 41 (55)
No Yes
Do you routinely educate your patients about the health benefits of quality sleep?
42 (57) 32 (43)
No Yes
Do you routinely educate your patients how to improve their sleep quality?
41 (55) 33 (45)
No Yes
(If answered “yes” to any of questions above) Do you think educating your patients to improve their sleep quality impacts their outcomes?
6 (13) 40 (87)
No Yes
Do you routinely educate your patients on positioning strategies to achieve quality sleep?
27 (36) 47 (64)
No Yes
If you do not routinely educate your patients about sleep, why do you not?
N
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I do not have time
15
I do not know how to educate patients about sleep or sleep hygiene techniques
23
I do not think it is important to educate my patients about sleep
1
I do not think most patients need sleep education
1
I think providing education about sleep or sleep hygiene is beyond a PT's scope of practice
6
Other
9
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Table 6
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a. The predictor variables for the model “Do you routinely assess your patient’s sleep habits or quality of sleep?” Predictor variables
B
Sig.
Exp(B)
Age
−.139
.075
.870
Gender
−.333
.805
.717
Degree earned
.046
.937
1.047
Years since graduation
.541
.255
1.718
Patient age (birth to 3 years)
.686
.798
1.985
Patient age (3 years to school age)
1.420
.577
4.138
Patient age (21 to 65 years)
−.327
.777
.721
−1.002
.344
.367
Patient age (more than 65 years)
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b. The predictor variables for the model “Do you routinely educate your patients about the importance of sleep?” Predictor variables
B
Sig.
Exp(B)
Age
.020
.856
1.021
Gender
.551
.602
1.739
−.122
.839
.894
.033
.955
1.034
Patient age (birth to 3 years)
17.506
.999
40057627.838
Patient age (3 years to school age)
19.844
.999
415189247.566
1.329
.190
3.776
.553
.495
1.738
Degree earned Years since graduation
Patient age (21 to 65 years) Patient age (more than 65 years)
Author Manuscript Author Manuscript J Allied Health. Author manuscript; available in PMC 2016 September 28.
J Allied Health. Author manuscript; available in PMC 2016 September 28. Published in final edited form as: J Allied Health. 2015 ; 44(1): 41–50.
A Survey of Physical Therapists’ Perception and Attitude About Sleep Catherine F. Siengsukon, PT, PhD1, Mayis Al-dughmi, PT1, and Neena K. Sharma, PT, PhD1 1Department
of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS
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Abstract Purpose—The purpose of this study was to assess the attitude and perception of physical therapists (PTs) on the perceived need to assess sleep of their patients and provide education about sleep to their patients as well as to determine the perceived need for PTs to be educated on sleep topics. Methods—An electronic survey was sent to internship site coordinators. Descriptive analyses and logistic regressions were conducted.
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Results—The response rate was 28%. Most respondents (93%) agree poor sleep is associated with impaired function. Eighty-two percent agree that PTs should assess patients’ sleep habits and sleep quality, and 95% agree that addressing sleep issues may impact PT outcomes. The majority did not receive education about sleep during entry-level PT education (75%) or following graduation (86%). Most respondents (95%) think PTs should receive education about sleep. Conclusion—PTs recognize that sleep impacts outcomes, and patients’ sleep should be assessed. However, PTs have not received education about sleep although the majority think PTs should receive education about sleep. Therefore, entry-level PT education programs may consider incorporating education about sleep, and the development of continuing education courses is also needed. The attitude and perception of other health care professionals warrants investigation.
Introduction
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Sleep is critical for many different processes in the body including healing1–3, pain modulation4–6, cardiovascular health7–9, modulating anxiety and depression10,11, cognitive function12–14, and learning and memory.15–17 Sleep deprivation and a variety of sleep disorders result in reduced workplace productivity18,19, negatively impacts public safety20, and affects personal well-being, including performance deflcits, excessive daytime sleepiness, depressed mood, and impairments in concentration and memory.21–23 It is estimated that almost 40 million Americans have a chronic sleep disorder.24,25 Sleep issues cost US employers $18 billion as a result of reduced productivity.26–28 Around 62 % of US adults experience a sleep problem several nights a week and 30% suffer from
Address Correspondence to: Catherine F. Siengsukon, PT, Ph.D., University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS 66160, Phone: 913-588-6913, Fax: 913-588-4568, [email protected].
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insomnia in the course of any given year.29,30 Sleep disorders and reduced sleep quality should be considered a public health concern.
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Despite the importance of sleep for adequate body function and the impact poor sleep can have on outcomes as well as the prevalence of sleep issues, sleep disturbances are often overlooked by the medical community. Sleep assessment is not typically part of a physical therapist’s (PT) evaluation or other non-physician health care professional’s evaluation as sleep assessment would generally be considered under the practice domain of a physician. However, due to the critical impact sleep has on body function, particularly in cognitive function, pain modulation, and learning and memory, PTs and other health care professionals are in a prime position to assess sleep as well as provide education about ways to improve sleep within the scope of their practice. Because of the nature of the PTs prolonged patient engagement and in depth appraisal of functional activities and lifestyle factors, PTs may notice sleep issues and could refer a patient to a sleep specialist if warranted. Furthermore, when a patient’s sleep is disrupted or their quality of sleep is reduced, this can interfere with their performance in therapy and ultimately their outcomes.31,32 Several studies have used surveys to assess the perception, attitude and knowledge of other health care professions including physicians33,34, nurses35,36, pharmacists37, and psychologists.38 Overall, the health care professionals rated their knowledge as fair to poor and reported they spend more time counseling patients on diet and exercise over sleep need.33,39 Only one paper40 has provided an overview of sleep assessment and why the evaluation of sleep and basic sleep recommendations need to be considered as fundamental clinical competencies in contemporary physical therapy care.
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There is little emphasis on the need to assess sleep across medical professions. However, it remains unknown if PTs perceive a need to assess sleep of their patients. In addition, it remains unknown if PTs are currently educating patients about sleep. Furthermore, despite the critical role of sleep and potential health consequence of poor sleep, PTs are not typically educated about sleep or the health benefits of sleep as part of their entry-level education program, but it is unknown if PTs perceive a need for sleep education. Therefore, the purpose of this study was to assess the attitude and perception of PTs on the need to assess sleep of their patients and provide education about sleep to their patients as well as the perceived need for PTs to be educated on sleep topics.
Methods Author Manuscript
Study Design This study was a cross-sectional survey of PTs who serve as internship site coordinators for students in the Doctor of Physical Therapy program at the University of Kansas Medical Center. Survey Instrument An electronic survey was developed in four steps: 1. A review of literature revealed questionnaires used to assess sleep knowledge and attitude of physicians.33,38,41 2.
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Following receipt of permission to use questions from their surveys, the authors (CS and NS) developed questions for the survey used in the current study. Some questionnaire items were used verbatim from the prior questionnaires, but other items were modified to be relevant for PTs. Additional questions were also added to meet the purpose of the survey of this current study. 3. Following initial development of the survey, a consultation with a statistician was completed to verify the methods of developing the survey, delivery of the survey, and statistical analysis. Revision of the survey occurred following the statistical consultation. 4. Five PTs with either sleep expertise or survey development experience were asked to review the survey questions to verify the survey’s face validity. Additional modifications were made based on the feedback of these experts. 5. The last step was sending the survey in electronic format to 15 PTs. Ten of these individuals completed the survey and provided feedback. Based on responses and feedback, additional minor modifications were made to improve clarify and question intention.
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The final version of the electronic survey consisted of 77–87 questions in six sections. The total number of questions presented to participants depended on answers provided which then prompted different questions to follow. The first section consisted of 8–12 questions concerning demographics including sex, age, current employment status, employment setting, years of experience, and state of licensure and practice. The second section consisted of 26 questions regarding PTs’ attitude regarding sleep including attitude about other people’s sleep habits and attitude about sleep as a professional. Reponses were provided on a 5 point Likert scale from strongly disagree to strongly agree with a 6th option of “unsure”. The third section consisted of 4–6 questions concerning sleep education of PTs including if education about sleep was provided during entry-level physical therapy education or anywhere other than entry-level physical therapy education, how much education about sleep was received during entry-level physical therapy education, which topics about sleep were covered during entry-level physical therapy education, and which topics should be provided to PTs and where (in PT school or as continuing education). The fourth section asked 2–6 questions about PT assessment of patients’ sleep including if PTs routinely assess patients’ sleep, what type of assessment is done, or why assessment is not done. The fifth section consisted of 7 questions concerning education provided to patients about sleep including what type of education routinely provided to patients, if education about sleep improves outcomes, or why education is not routinely provided. The last section consisted of 30 questions to assess PTs knowledge of sleep. The optional answers for the knowledge questions were “true”, “false”, and “unsure”. The data of this last section is not included in analysis.
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Target Population Individuals who serve as internship site coordinators for students in the Doctor of Physical Therapy program at KUMC (n=297) were selected to participate in this study. Instructions were provided with the survey that only PTs were eligible to complete the survey. People who received the survey but are not PTs were instructed to not complete the survey.
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Data Collection
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An email was sent to 297 email addresses in the KUMC database of internship site coordinators with a brief explanation of the purpose of the survey and a link with instructions to access the electronic survey. A week following the initial email, a reminder email was sent with a reminder the survey should be completed within the week, giving individuals two weeks total to complete the survey. A link provided in the email took participants to the survey, secured on the KUMC network. A more detailed explanation of the purpose of the study was provided. It was also stated that by completing the survey, the participants were providing consent to participate in the study. This study was conducted in accordance with the KUMC IRB. Data Analysis
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Data were downloaded from the electronic survey into an excel spreadsheet and entered into SPSS. Descriptive analysis was conducted. Means and standard deviations were calculated for continuous variables. Frequency distribution was calculated for categorical data. Two binary stepwise logistic regressions were conducted to determine which factors best predict the positive response “yes” on the question “Do you routinely assess your patient’s sleep habits or quality of sleep?”, and on the question “Do you routinely educate your patients about the importance of sleep?” Eight predictor variables were chosen for the 2 models as follows: sex, age, degree earned in PT school, numbers of years since graduation from PT school, and the four different age ranges of patients (birth to 3 years, 3 years to school age, 21 to 65 years, more than 65 years).
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Results Survey response rate Of the 297 emails sent, 28 were undeliverable. Of the 269 emails delivered, 80 individuals’ responses were included in the original data set. However, 4 data sets were removed because the individuals completed only the demographic information but did not answer any questions beyond the demographic section. The remaining 76 individuals were included in data analysis, with a response rate of 28%. Some individuals left some questions unanswered, so the n is included to reflect the number of individuals who answered each question. Demographics
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Demographic information is provided in Table 1. Of the 76 respondents included in data analysis, 83% were female. The average age of respondents was 41.99 years old (SD 10.94). The distribution of entry-level physical therapy education revealed 27 individuals (36%) received a Bachelor’s degree, 26 (34%) received a Master’s, and 23 (30%) received a Doctorate. The variety in degrees earned is also reflected by the numbers of years that have passed since graduation of entry-level physical therapy education. The majority of the respondents (84%) work full time as a PT providing direct patient care. Most of the respondents currently practice in Kansas (44 respondents) followed by Missouri (17
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respondents) and some respondents listed more than one state they are currently practicing. The respondents treat a variety of age ranges of patients from birth to older than 65 years of age. The most common type of practice setting selected was “outpatient clinic” (41 respondents) followed by “acute care/hospital” (30 respondents) with other settings also represented. PT’s Attitude Regarding Sleep
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Reponses to questions assessing the respondents’ attitude regarding sleep is included in Table 2. The “strongly agree” and “agree” responses have been collapsed into “agree” for discussion of the results. Overall, PTs agree that sleep impacts health, function and PT outcomes and PTs should assess the sleep quality of their patients. Of primary interest, 96% of respondents agree that sleep is important to people’s heath, and 93% agree that poor sleep is associated with impaired function. When specifically asked about physical therapy practice, 82% of respondents agree that PTs should ask their patients’ about their sleep habits and sleep quality, and 51% agree PTs should perform objective assessments (such as use questionnaires) to assess their clients’ sleep habits and sleep quality. Ninety-five percent agree that addressing sleep issues may impact physical therapy outcomes. PT Education on Sleep
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The majority of PTs did not receive education about sleep during entry-level physical therapy education (75%) and have not received education about sleep following completion of their entry-level physical therapy education (86%; Table 3). Of the 25% who did receive education during entry-level physical therapist education about sleep, only 2 respondents had more education than only one lecture or the mention of sleep during entry-level physical therapist education. Of the topics of sleep education provided during entry-level physical therapist education, the top five topics of highest frequency were impact of sleep on learning, basic physiology of sleep, common causes of sleep issues, common medical treatments of sleep disorders, and impact of sleep on cognitive function. Of the 11% that stated they received education about sleep following their entry-level physical therapist education, the top two types of education were from personal research or reading and from an in-service or seminar from a sleep professional or medical staff. PT Perception of Need for Sleep Education
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The majority of respondents agree that PTs should receive education about sleep, and believe several topics about sleep should be taught in entry-level physical therapist education. Specifically, 95% of respondents answered “yes” to the question “Do you think PT’s should receive education about sleep?” The top five topics that respondents think should be taught during entry-level physical therapy education are basic physiology of sleep (93%), common causes of sleep issues (85%), common medical treatments of sleep disorders (85%), epidemiology and causes of common sleep disorders (76%), prevention of common sleep disorders (75%), promotion of healthy sleep habits and quality of sleep (75%; Figure 1). Some topics respondents thought should be taught as continuing education, including advanced physiology of sleep (76%) and assessment of sleep quality (54%; Figure 1). One to five percent of respondents do not think various topics should be taught to PTs (Figure 1). J Allied Health. Author manuscript; available in PMC 2016 September 28.
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PT Assessment of Patients’ Sleep
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A small majority of PTs are routinely assessing their patient’s sleep habits or quality of sleep (57%), asking subjective information (93%) and using a sleep questionnaire (98%, Table 4). However, only 16% routinely refer patients to a sleep specialist for additional assessment. In the clinical experience of the respondents who do routinely assess their patient’s sleep habits or quality, the following are the six most common diagnoses of individuals that typically have sleep issues: acute back pain, chronic back pain, post-op, acute neck pain, chronic neck pain, and fibromyalgia (Figure 2). Of the 43% of individuals who do not routinely assess their patient’s sleep habits or quality of sleep, the most common reason provided was “I do not know how to assess sleep habits or sleep quality” (Table 4). PT Patient Education on Sleep
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A small majority of respondents routinely educate their patients about the importance of sleep (55%), and 87% believe educating patients to improve their sleep quality impacts their outcomes (Table 5). However, only 43% routinely educate their patients about the health benefits of sleep, and 45% routinely educate their patients how to improve their sleep quality. Of those respondents who do not routinely educate their patients about sleep, the most selected reason was “I do not know how to educate patients about sleep or sleep hygiene techniques.” Factors Impacting PT Assessment and Treatment of Sleep
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The two overall logistic regression models of routine assessment and sleep education where not significant: p= 0.643 and p= 0.488 respectively. In the first model of predicting routine assessment of sleep, none of the variables had a significant effect on the model but age of the respondent had the lowest p-value in the model (p= 0.075) followed by the number of years since graduation (p= 0.255) and primarily treating patients who are older than 65 years (p= 0.344; Table 6a). In the second model of predicting routine education of patients about sleep, none of the variables were significant, but primarily treating patients who are 21 to 65 years old had the lowest p-value (p= 0.19) followed by primarily treating patients who are older than 65 years (p= 0.495; Table 6b).
Discussion
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This survey provides the first assessment of physical therapists’ perception and attitude about the need to assess the sleep of their clients and educate their clients about sleep. The results also provide the first assessment of the amount of education PTs receive about sleep and the perceived need to be educated about sleep. The results of this survey could lead to changes to entry-level PT curriculum to incorporate education about sleep disorders, assessment of sleep, and methods PT may use to address sleep issues. Furthermore, the development of continuing education courses is warranted to provide sleep education to practicing PTs. The demographic information of the participants illustrates that the sample in this study is representative of PTs currently practicing. Sixty-three percent of respondents were female which is closely aligned to US sex distribution of PTs; around 70% of PTs are female in the
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US.42 Also, a very similar number of participants were distributed across type of degree received in entry-level physical therapy education and the number of years ago the participants graduated from entry-level physical therapy education which gives confidence that each type of degrees and all years of experience are well represented. One major limitation of this study is the sample of participants primarily practices in Midwestern states. An additional study is needed to survey PTs across the US to determine the generalizability of the findings of the current study. Also, while individuals from a wide variety of practice settings were included in this study, there were a few practice settings that were not represented in this survey. A larger scale study would also improve likelihood that PTs from all practice settings would be included.
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Assessing PTs’ attitude and perception of the need to assess sleep of their clients is an important first step in understanding the role PTs are currently taking in assessing and addressing sleep issues in their clients. Furthermore, the results of this survey provide insight into PTs’ perception on the need to assess and address sleep of clients. Overwhelmingly, PTs agree that sleep is important for health and agree that poor sleep impairs function. Furthermore, a large majority agree that clients’ sleep habits and sleep quality should be considered by a PT. A large majority of respondents also agree that PTs should counsel patients on improving sleep quality, including using positioning strategies. An overwhelming majority agree that addressing sleep issues may impact physical therapy outcomes.
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Not surprisingly, the vast majority of PTs did not receive education about sleep in PT school and are not receiving education about sleep while practicing as a PT. Furthermore, the majority of respondents agreed that PTs should be assessing and addressing sleep and that 95% of respondents think PTs should receive education about sleep. Also, the most frequent reason provided for not routinely assessing patient’s sleep or educating patients about sleep was “I do not know how.” Therefore, PT programs should consider integrating topics about sleep into their curriculum. Furthermore, continuing education programs should be developed to provide this education to practicing PTs.
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Despite a lack of formal education on sleep topics, the vast majority of respondents routinely asks their patients about their sleep habits and quality of sleep and routinely administers a sleep questionnaire. However, it is concerning that only 16% of these individuals routinely refer patients to a sleep specialist. This could be that indeed, only a few number of individuals have a sleep issue that warrants a referral to a sleep specialist. However, considering that 25% of the population has a sleep issue or disorder43, it is more likely that despite assessing for sleep issues, sleep issues are being missed by PTs or are identified but not being refered to a specialist for treatment. It is encouraging that many PTs are assessing sleep, but future education is likely needed to ensure accurate assessment of sleep issues and basic identification of possible sleep disorders that would require a referral to a sleep specialist. Also despite a lack of formal education on sleep topics, many PTs are providing education to their patients about the importance of sleep, about the health benefits of quality sleep, how to improve their sleep quality, and positioning strategies to achieve quality sleep. Of PTs who
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do routinely provide education about sleep to their patients, on overwhelming 87% believe education provided to patients to improve their sleep quality impacts their outcomes. Studies are needed to determine if providing sleep education to patients does in fact improve their outcomes, hasten recovery rate, decrease cost of providing care, and decrease length of care. Education provided to patients about sleep and sleep hygiene could potentially be a low-cost means to improve outcomes.
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From the logistic regression analyses, the routine assessment of patients’ sleep is impacted by the PTs age and the numbers of years since graduation, although neither of these factors were statistically significant. This may be due to PTs who graduated more recently from entry-level physical therapy education (and are likely younger) are more likely to have been educated about the emerging evidence indicating the impact of sleep quality on body function. Also, PTs are more likely to assess sleep if they typically treat patients who are older than 65 (although not statistically significant) because sleep parameters and sleep quality change with age44,45 so the prevalence of reported sleep issues occur more often in older adults.46,47 The routine education of patients regarding sleep is impacted (although not statistically significant) by the age of patients the PT primarily treats. PTs who primarily treat patients who are 21 to 65 years old are most likely to educate their patients about sleep followed by those who primarily treat patients who are older than 65 years. This is also likely due to the higher incidence of reported sleep issues that occur with age as well as the change in sleep parameters and quality that occurs with age.48,49
Conclusion
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This is the first survey to assess PTs perception and attitude about the need to assess the sleep of their patients and educate their patients about sleep. This is also the first survey to assess the amount of education PTs receive about sleep and the perceived need to be educated about sleep. This survey provides information about education on sleep PTs received during entry-level physical therapy education which informs the need to include education about sleep into entry-level PT curriculum. Furthermore, results of this survey provide insight into PT’s perceived need to receive education about sleep which indicates a need to develop continuing education courses for currently practicing PTs. Also, PTs listed people with LBP, neck pain, and Fibromyalgia and those post-op as commonly presenting with sleep issues. Thus, the assessment and treatment of sleep disturbances of patients with these should be particularly considered. Considering the impact of sleep on rehab and recovery, the attitude and perception of other health care professionals also warrants investigation.
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Acknowledgments The authors acknowledge: the contribution of Kendra Gagnon, Carla Sabus, Steven Jernigan, Rupali Singh, and Julie Hereford to the development of the survey, feedback provided by Sandra Billinger and Carla Sabus to earlier versions of the manuscript, Tennille Fincham in Teaching & Learning Technologies at KUMC for developing the online survey format, Michael Sateia, MD, for granting permission to use portions of the Dartmouth Sleep Knowledge and Attitude Survey, Klara Papp, PhD, for granting permission to use portions of their survey, and Thomas Heffron from the American Academy of Sleep Medicine for granting permission to use questions from the ASKME survey. This work was partially supported by Frontiers; The Heartland Institute for Clinical and Translational Research (University of Kansas Medical Center’s CTSA; KL2 TR000119-02 & UL1 TR000001-02) to NKS.
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44. Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004 Nov 1; 27(7):1255–1273. [PubMed: 15586779] 45. Scholle S, Scholle HC, Kemper A, et al. First night effect in children and adolescents undergoing polysomnography for sleep-disordered breathing. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2003 Nov; 114(11):2138–2145. [PubMed: 14580612] 46. Misra S, Malow BA. Evaluation of sleep disturbances in older adults. Clinics in geriatric medicine. 2008; 24(1):15–26. [PubMed: 18035228] 47. Neikrug AB, Ancoli-Israel S. Sleep disorders in the older adult–a mini-review. Gerontology. 2009; 56(2):181–189. [PubMed: 19738366] 48. Crowley K. Sleep and sleep disorders in older adults. Neuropsychology review. 2011; 21(1):41–53. [PubMed: 21225347] 49. Espiritu JRD. Aging-related sleep changes. Clinics in geriatric medicine. 2008; 24(1):1–14. [PubMed: 18035227]
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Author Manuscript Author Manuscript Figure 1.
Percent of respondents who think various sleep topics should be taught in PT school, as continuing education, or should not be taught.
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Figure 2.
In the clinical experience of respondents who do routinely assess their patient’s sleep habits or quality (N=43 or 57% of respondents), the number of respondents who think individuals with various diagnoses typically have sleep issues.
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63(83) 13(17)
N (%)
F M
41.99 (10.94) n=76
Age (years)
27(36) 26(34) 23(30)
Bachelor Master Doctorate
N (%)
What degree did you receive in PT school?
15(23) 10(15) 13(2) 10(15) 10(15) 7(11) 11
1–5 6–10 11–15 16–20 21–25 26–30 >30
N (%)
How many years ago did you graduate from PT school?
64(84) 10(13) 1(1) 1(1)
Full time Part time Prn not providing direct patient care
N (%)
What is your current employment status as a PT providing direct patient care?
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Sex
1 1 1 44 17 2 3 1 2 1 5 1 1
Alaska Colorado Florida Kansas Missouri Nebraska Nevada Ohio Oklahoma Pennsylvania Texas Utah Washington
N
What state(s) are you currently practicing?
9 13 31 57 45
Birth to 3yrs 3yrs to schoolage Schoolage to 21 21–65yrs 65 yrs or older
N
What age range(s) of patients do you primarily treat?
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Demographics.
30 14 1 41 5 2 0 1 0 0 1 0 0 8 7
Acute care/hospital Rehabilitation unit/facility Sub-acute rehab Outpatient clinic School setting Wellness/prevention/sports/fitness Extended care facility/nursing home/SNF Industrial/Workplace/Occupational Environments Hospice Local, State, and Federal Government Research Center Faculty in PT/PTA program Not currently practicing as a clinician Supervisor or administrator Other
N
What type of setting best describes your current primary work setting?
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Table 1 Siengsukon et al. Page 14
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Author Manuscript 74 75 76 76 76
In general, people get enough sleep
Poor sleep is associated with impaired function
Most people don’t pay much attention to sleep
Excessive sleepiness is a public health problem
Insomnia is a common health problem
16 (21) 7 (9)
76 75 75 76 76 76 76 76 75 76 76
Most people seek medical help for their sleep disorders
Sleeping medication is over-prescribed
Sleep apnea is underdiagnosed
Daytime sleepiness is an important medical symptom
Sleep disorders may contribute to medical problems
Sleepinesss is an important factor in many motor vehicle accidents
Consultation with a sleep medicine specialist is useful for patients with sleep problems
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Overnight sleep studies provide useful diagnostic information
Most sleep disorders are treatable
CPAP is an effective treatment for sleep apnea
Primary care doctors should counsel patients regarding sleep hygiene
23 (30)
13 (17)
22 (29)
19 (25)
30 (39)
14 (18)
8 (11)
2 (3)
0 (0)
76
28 (37)
10 (13)
6 (8)
4 (5)
42 (56)
3 (4)
70 (92)
N (%) Strongly Agree
I should routinely ask patients about sleep problems
What I think about sleep as a professional
76
Sleep is important to people’s health
What I think about other people’s sleep habits
N
47 (62)
47 (62)
50 (67)
52 (68)
45 (59)
47 (62)
44 (58)
51 (67)
45 (60)
36 (48)
5 (7)
38 (50)
44 (58)
42 (55)
54 (71)
28 (37)
6 (8)
3 (4)
N (%) Agree
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Physical Therapists’ Attitude Regarding Sleep
1 (1)
6 (8)
8 (11)
3 (4)
5 (7)
5 (7)
1 (1)
8 (11)
11 (15)
20 (27)
7 (9)
3 (4)
16 (21)
18 (24)
6 (8)
1(1)
3 (4)
1 (1)
N (%) Neither
0 (0)
2 (3)
0 (0)
0 (0)
1 (1)
0 (0)
0 (0)
1 (1)
3 (4)
6 (8)
60 (79)
7 (9)
2 (3)
6 (8)
10 (13)
3 (4)
54 (73)
0 (0)
N (%) Disagree
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
3 (4)
0 (0)
0 (0)
1 (1)
0 (0)
1 (1)
8 (11)
2 (3)
N (%) Strongly Disagree
5 (7)
8 (1)
10 (13)
5 (7)
3 (4)
5 (7)
1 (1)
2 (3)
8 (11)
11 (15)
1 (1)
0 (0)
4 (5)
3 (4)
2 (3)
0 (0)
0 (0)
0 (0)
N (%) Unsure
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Physical Therapists’ Attitude Regarding Sleep.
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Table 2 Siengsukon et al. Page 15
Author Manuscript 0 (0) 0 (0) 23 (30) 6 (8)
15 (20) 20 (26) 22 (30) 27 (36)
76 76 76
76 76 76 75
Most sleep problems are psychiatric PT’s should ask their patients’ about their sleep habits and sleep quality PT’s should perform objective assessments (such as use questionnaires) to assess their clients’ sleep habits and sleep quality PT’s should counsel patients regarding methods to improve sleep quality PT’s should counsel patients on positioning to improve sleep Assessing my patients’ sleep habits and quality is important Addressing sleep issues may impact physical therapy outcomes
N (%) Strongly Agree
76
Sleep disorders are less important than other medical disorders
N
44 (59)
44 (58)
53 (70)
41 (54)
33 (43)
47 (62)
2 (3)
4 (5)
N (%) Agree
2 (3)
7 (9)
3 (4)
10 (13)
23 (30)
3 (4)
11 (14)
11 (14)
N (%) Neither
2 (3)
3 (4)
0 (0)
7 (9)
10 (13)
3 (4)
47 (62)
49 (64)
N (%) Disagree
0 (0)
0 (0)
0 (0)
0 (0)
1 (1)
0 (0)
10 (13)
10 (13)
N (%) Strongly Disagree
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Physical Therapists’ Attitude Regarding Sleep
0 (0)
0 (0)
0 (0)
3 (4)
3 (4)
0 (0)
6 (8)
2 (3)
N (%) Unsure
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Author Manuscript
Author Manuscript 57 (75) 19 (25)
65 (86) 11 (14)
Have you had education about sleep anywhere other than PT school (such as continuing education, advanced degree, etc.)
Did you receive education in PT school about sleep?
N (%)
PT Education on Sleep
No Yes
No Yes
9 6 2 2 11 0 11 2 10 2 1 0 1 6 8 2 0 0 1 10 13
If Yes, which topics about sleep did you receive education in PT school?
2 4 1 4 1
If Yes, how much education about sleep did you receive in PT school?
If Yes, what type of education did you receive?
Basic physiology of sleep Advanced physiology of sleep Common causes of sleep issues Epidemiology and causes of common sleep disorders Common medical treatments of sleep disorders Prevention of common sleep disorders Assessment of sleep quality Assessment of sleepiness Screening for potential sleep disorders Interventions to address patients’ sleep issues Promotion of healthy sleep habits and quality of sleep Impact of sleep on cardiovascular disease Impact of sleep on diabetes Impact of sleep on dementia Impact of sleep on stroke risk Impact of sleep on cognitive function Impact of sleep on learning
Mentioned during PT school One lecture A series of lectures Unsure
Continuing education or CCU Personal research or reading On the job Inservice or seminar from sleep professional/MD Family member with sleep apnea
Education about sleep PTs have received. One individual specified education was received about sleep in two manners, so each response was calculated resulting in 12 responses total.
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Table 3 Siengsukon et al. Page 17
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Table 4
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PT Assessment of Patients’ Sleep PT Assessment of Patients’ Sleep
N (%)
Do you routinely assess your patient's sleep habits or quality of sleep?
33 (43) 43 (57)
No Yes
N (%)
Of those who answered “yes” to “Do you routinely assess your patient's sleep habits or quality of sleep? Do you routinely ask subjective information about your patient's sleep habits or quality of sleep?
3 (7) 40 (93)
No Yes
Do you routinely administer a sleep questionnaire?
1 (2) 42 (98)
No Yes
Do you use other methods to assess your patients' sleep not already listed or described in the survey?
41 (95) 2 (5)
No Yes
Do you routinely refer your patients to a sleep specialist for additional assessment?
36 (84) 7 (16)
No Yes
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Of those who answered “no” to “Do you routinely assess your patient's sleep habits or quality of sleep? Why do you not routinely assess your patient's sleep habits or quality of sleep?
N
I do not have time
7
I do not know how to assess sleep habits or sleep quality
25
I do not think sleep is important to assess
2
I think assessing sleep is beyond a PT's scope of practice
6
Other
8
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Table 5
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PT Patient Education About Sleep. PT Patient Education
N (%)
Do you routinely educate your patients about the importance of sleep?
34(45) 41 (55)
No Yes
Do you routinely educate your patients about the health benefits of quality sleep?
42 (57) 32 (43)
No Yes
Do you routinely educate your patients how to improve their sleep quality?
41 (55) 33 (45)
No Yes
(If answered “yes” to any of questions above) Do you think educating your patients to improve their sleep quality impacts their outcomes?
6 (13) 40 (87)
No Yes
Do you routinely educate your patients on positioning strategies to achieve quality sleep?
27 (36) 47 (64)
No Yes
If you do not routinely educate your patients about sleep, why do you not?
N
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I do not have time
15
I do not know how to educate patients about sleep or sleep hygiene techniques
23
I do not think it is important to educate my patients about sleep
1
I do not think most patients need sleep education
1
I think providing education about sleep or sleep hygiene is beyond a PT's scope of practice
6
Other
9
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Table 6
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a. The predictor variables for the model “Do you routinely assess your patient’s sleep habits or quality of sleep?” Predictor variables
B
Sig.
Exp(B)
Age
−.139
.075
.870
Gender
−.333
.805
.717
Degree earned
.046
.937
1.047
Years since graduation
.541
.255
1.718
Patient age (birth to 3 years)
.686
.798
1.985
Patient age (3 years to school age)
1.420
.577
4.138
Patient age (21 to 65 years)
−.327
.777
.721
−1.002
.344
.367
Patient age (more than 65 years)
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b. The predictor variables for the model “Do you routinely educate your patients about the importance of sleep?” Predictor variables
B
Sig.
Exp(B)
Age
.020
.856
1.021
Gender
.551
.602
1.739
−.122
.839
.894
.033
.955
1.034
Patient age (birth to 3 years)
17.506
.999
40057627.838
Patient age (3 years to school age)
19.844
.999
415189247.566
1.329
.190
3.776
.553
.495
1.738
Degree earned Years since graduation
Patient age (21 to 65 years) Patient age (more than 65 years)
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