Facilitators and Barriers to Integrating Sleep Recommendations for Counselling Patients with Arthritis: A Survey of Physiotherapists and Students in Canada

Purpose: Individuals with arthritis face challenges in balancing activity, rest, and sleep. While physiotherapists address activity, sleep considerations are often overlooked, despite evidence suggesting better sleep improves treatment outcomes. The purpose of this study was to describe facilitators and barriers for physiotherapists and students incorporating sleep in practice. Methods: We conducted a self-administered electronic survey among physiotherapists and students in Canada. The survey included 28 items (7-point Likert scale) mapped on the Capability-Opportunity-Motivation-Behaviour system and Theoretical Domains Framework. We report means (95% confidence interval) and identified facilitators (mean >5/7) and barriers (mean <4/7) by item. Results: Between January and November 2023, 216 responded and 191 (88%) completed the survey (149 physiotherapists; 42 students). Mean age (±SD) was 35 (±11) years. Most delivered in-person care (67%) in urban settings (67%). Facilitators (mean >5/7) included the belief that sleep health is within practice scope, optimism about its benefits, awareness of sleep's importance in managing arthritis, learning about movement guidelines, and plans to integrate sleep education into arthritis treatment. Barriers (mean <4/7) included being unaware of where to find sleep resources (mean = 3.63 [95% CI: 3.39, 3.89]) and lacking knowledge about sleep guidelines (mean = 3.78 [95% CI: 3.46, 4.10]) and lack of confidence in guiding sleep for patients (mean = 3.38 [95% CI: 3.10, 3.69]). Few reported providing sleep education for patients with arthritis (mean = 3.52 [95% CI: 3.27, 3.77]), or observing similar behaviours from colleagues (mean = 3.60 [95% CI: 3.40, 3.80]). Conclusions: While physiotherapists and students show positive perceptions about sleep health in practice, challenges remain for effective implementation. These findings can inform the development of theory-informed behaviour-change interventions to engage physiotherapists in greater sleep integration in practice.