SleepHab: Effectiveness of Healthy Sleep Habits for Hospitalized Older Adults to Optimize Rehabilitation

项目摘要/摘要 与NINR和NCMRR在康复背景下解决睡眠障碍的优先事项一致，这 一项旨在评估非药物干预对老年患者失眠的疗效的提案 髋关节或膝关节置换术后康复的每年住院的1500万老年患者中几乎有一半 据报道，他们在医院就诊时睡眠受到干扰。在接下来的几个月里，睡眠问题会持续几个月 住院，并与出院期间和出院后的功能损害有关。此外，白天 失眠的后遗症，如注意力/注意力下降和疲劳，可能会破坏和限制 康复的有效性。因此，这项拟议的研究旨在评估急需的安全治疗。 针对失眠(失眠的认知行为疗法)结合医疗康复进行管理 改善失眠症状，促进功能健康。改善睡眠有望通过以下方式促进康复 提高患者参与和遵守康复建议的能力。为了最大限度地扩大公众 影响健康，改善机会，减少治疗障碍(耻辱和交通问题)，我们建议 评价护士和体检人员实施干预的效果和效果 职业治疗师在医院床边和家庭环境中工作。中心假设是量身定制的 在住院期间和住院后给予CBTI将改善老年人的睡眠和功能结果 接受医疗康复，并以以下目标为指导：(1)评估CBTI在 随机、安慰剂对照试验，以及(2)确定CBTI在康复和治疗中的有效性。 健康结果。这项研究的主要结果是，这项研究得到了最佳设计和足够的动力 主观和客观测量的睡眠。次要结果，我们无法估计其威力 是功能性(运动、认知、独立性)的结果。我们还将探讨治疗与治疗的关系 对其他健康后果的反应，包括炎症程度、药物使用、疲劳、疼痛强度和 抑郁症状严重程度。我们的团队在设计和实施行为方面拥有丰富的经验 在医院和以社区为基础的环境中为老年人进行健康临床试验。如果有效的话，睡眠 干预有可能优化康复中的功能收益，减少不良健康 结果，从而提高生活质量，降低社会的巨大成本。

PROJECT SUMMARY/ABSTRACT Consistent with NINR and NCMRR priorities to address sleep disorders in the context of rehabilitation, this proposal aims to evaluate the efficacy of a nonpharmacological intervention for insomnia among older patients recovering from hip or knee arthroplasty. Almost half of the 15 million older patients hospitalized each year report disrupted sleep during their hospital visit. Sleep complaints can persist for several months following hospitalization and are associated with functional impairment during and following discharge. Further, daytime sequela of insomnia, such as diminished attention/concentration and fatigue, may serve to undermine and limit the effectiveness of rehabilitation. Thus, the proposed study aims to evaluate a much-needed safe treatment for insomnia (cognitive behavioral therapy for insomnia) in conjunction with medical rehabilitation to manage insomnia symptoms and promote functional health. Improving sleep is expected to enhance rehabilitation, by increasing patients' abilities to attend and adhere to rehabilitation recommendations. To maximize the public health impact, improve access, and reduce treatment barriers (stigma and transportation issues), we propose to evaluate the efficacy and effectiveness of the intervention delivered by nurses and physical and occupational therapists hospital bedside and in the home environment. The central hypothesis is that tailored CBTI delivered during and following hospitalization will improve sleep and functional outcomes in older adults receiving medical rehabilitation and is guided by the following aims: (1) to evaluate the efficacy of CBTI in a randomized, placebo-controlled trial, and (2) to determine the effectiveness of CBTI on rehabilitation and health outcomes. Primary outcomes, for which the study is optimally designed and sufficiently powered, are subjectively- and objectively-measured sleep. Secondary outcomes, for which we are unable to estimate power are functional (motor, cognition, independence) outcomes. We will also explore the relationship of treatment response to other health outcomes, including level of inflammation, medication use, fatigue, pain intensity, and depressive symptom severity. Our team has extensive experience in designing and implementing behavioral health clinical trials for older adults within hospital and community-based settings. If effective the sleep intervention has the potential to optimize functional gains in rehabilitation and reduce adverse health outcomes, thereby improving quality of life and reducing significant costs to society.