Feasibility of Sleep Treatment Education in stroke Rehabilitation Settings (FOSTERS)

Stroke is a leading cause of disability with over 1 million people in the UK living with the effects of stroke. Sleep is a fundamental requirement for health, but there is growing evidence that sleep is disrupted after stroke, impacting negatively on rehabilitation outcomes and quality of life. Stroke survivors have highlighted to us that it is difficult to sleep in the hospital after a stroke, and that they feel that sleep isn t perceived as high priority despite clear importance for next day function and healing. We have worked with people with lived experience of stroke, clinical staff, and charity representatives, to identify areas of hospital care where sleep factors could be improved. Our patient co-applicant and other public contributors will be involved throughout the project to make sure our approach is suitable for people recovering from stroke. This project will develop and test a sleep education package for clinical staff and stroke survivors in the rehabilitation hospital. Specifically we aim to 1) develop an educational training programme (for staff) and toolkit of resources (for staff, patients and carers) addressing sleep disturbance following stroke, 2) use qualitative interviews and surveys of staff and patients to assess acceptability of the training and toolkit of resources, and 3) assess feasibility of implementation of the sleep education package and data collection (e.g. sleep measures) in an additional site that was not involved in the initial development. During Work Package 1 (WP1) we will adapt materials and learning modules that have been developed for other conditions. We will obtain feedback from people with lived experience of stroke and clinical staff. Following refinement, WP2 will recruit 10-15 neurorehabilitation unit staff and 10-15 stroke patients to receive the training (staff) and the toolkit of resources (staff and patients). Using questionnaires and interviews we will ascertain opinions about the sleep education package, about the changes that are made to support better sleep and any additional factors that need to be addressed. Following further refinement, WP3 will test the feasibility of delivery of the sleep education package and collection of sleep outcome measures in an additional stroke rehabilitation unit. All staff who have access to the package will be sent surveys following training and 2-3 months later to obtain their perceptions. Sleep data will be collected using self-report (Sleep Condition Indicator) and a wrist-worn actigraphy monitor (1 week) from a sample of stroke patients who are in the hospital over the 4 months before the sleep education package is delivered, and another sample over the 4 months following delivery of the package. We will quantify recruitment rates at the patient participant level and assess rate of completion of outcome measures. We will assess variability in outcome measures and provide proof-of-concept information. The results of this project will enable us to design a future multi-centre trial to test the uptake and effectiveness of the sleep education package.