REST: a preoperative tailored sleep intervention for patients undergoing total knee replacement – feasibility study for a randomised controlled trial

Abstract

ObjectivesTo test the feasibility of a randomised controlled trial (RCT) of a novel preoperative tailored sleep intervention for patients undergoing total knee replacement.DesignFeasibility two-arm two-centre RCT using 1:1 randomisation with an embedded qualitative study.SettingTwo National Health Service (NHS) secondary care hospitals in England and Wales.ParticipantsPreoperative adult patients identified from total knee replacement waiting lists with disturbed sleep, defined as a score of 0–28 on the Sleep Condition Indicator questionnaire.InterventionThe REST intervention is a preoperative tailored sleep assessment and behavioural intervention package delivered by an Extended Scope Practitioner (ESP), with a follow-up phone call 4 weeks postintervention. All participants received usual care as provided by the participating NHS hospitals.Outcome measuresThe primary aim was to assess the feasibility of conducting a full trial. Patient-reported outcomes were assessed at baseline, 1-week presurgery, and 3 months postsurgery. Data collected to determine feasibility included the number of eligible patients, recruitment rates and intervention adherence. Qualitative work explored the acceptability of the study processes and intervention delivery through interviews with ESPs and patients.ResultsScreening packs were posted to 378 patients and 57 patients were randomised. Of those randomised, 20 had surgery within the study timelines. An appointment was attended by 25/28 (89%) of participants randomised to the intervention. Follow-up outcomes measures were completed by 40/57 (70%) of participants presurgery and 15/57 (26%) postsurgery. Where outcome measures were completed, data completion rates were 80% or higher for outcomes at all time points, apart from the painDETECT: 86% complete at baseline, 72% at presurgery and 67% postsurgery. Interviews indicated that most participants found the study processes and intervention acceptable.ConclusionsThis feasibility study has demonstrated that with some amendments to processes and design, an RCT to evaluate the clinical and cost-effectiveness of the REST intervention is feasible.Trial registration numberISRCTN14233189.

An empirical comparison of sleep-specific versus generic quality of life instruments among Australians with sleep disorders

“…An alternative instrument that, to our knowledge, has not been used in sleep economic evaluations is the ICEpop CAPability measure for Adults (ICECAP-A) [15], which focuses on capability-based QoL gains with a broader scope. It is however being used in other non-economic sleep studies [16,17] Additionally, the ICECAP-A is considered a promising tool for future economic evaluations that extend beyond just health benefits [18]. Reimer and Flemons [19] have argued in support of using generic instruments to measure QoL in sleep-disordered populations, with consideration of physical, mental, and social function, symptom burden, and wellbeing.…”