2022 ANZSCoS Grant Winner: Dr Marnie Graco
Evaluating the implementation of a new model for managing sleep disordered breathing in the Spinal Injury Unit at Royal Rehab
Sleep disordered breathing (SDB), which includes sleep apnoea, is extremely common following spinal cord injury (SCI) and has negative effects on daytime functioning and quality of life. Unfortunately, the way in which SDB is managed in people with SCI is highly variable. Few rehabilitation centres routinely screen for SDB symptoms, and when it is suspected, most people are referred to specialist sleep laboratories for testing and treatment. However, these laboratories are typically not designed for people in wheelchairs, and many have long wait lists and can be difficult to access. As such, few people with SCI end up being diagnosed and treated for the disorder.
Dr. Marnie Graco’s PhD research identified three international SCI rehabilitation centres that were independently diagnosing and treating SDB without referring to specialist sleep services. In 2019 and 2020, she worked closely with the clinicians from these centres to understand and describe their models of care. All three centres had small, highly skilled, multidisciplinary teams, responsible for screening and diagnosing people with SDB on the rehabilitation ward and initiating treatment with continuous positive airway pressure (CPAP) when indicated.
Since then, Dr. Graco has partnered with Dr. Gerard Weber and team at Royal Rehab Hospital (Sydney) to adapt and implement a similar “in-house” model for managing SDB. Together with Dr. David Joffe, Respiratory Physician at Royal North Shore Hospital, the team have tailored a model of care to suit the Spinal Injuries Unit at Royal Rehab, which includes clear pathways for clinical practice. The multidisciplinary clinical team have been trained in the assessment and treatment techniques, and the necessary equipment has been acquired. In July 2022, the Royal Rehab team implemented the new model of care, which is being pilot tested for 12 months. Since then, they have assessed 22 people with SCI on the rehabilitation ward and commenced 6 on CPAP treatment.
In 2022, the team successfully applied for the ANZSCoS Small Grant to support a thorough evaluation of this novel model of care. The mixed-methods evaluation is using qualitative and quantitative methods to assess whether the new care model is effective at improving access to care, is acceptable to staff and patients, and feasible for the health service to deliver. The results will inform whether similar models for managing SDB could be implemented in other SCI rehabilitation centres.
The project is overseen by a Clinical Advisory Group which includes researchers, rehabilitation clinicians (doctors, physiotherapists, and nurses), respiratory physicians, and people with the lived experience of SCI and SDB. The 12-month pilot will conclude in June 2023 and the results of the evaluation are expected at the end of 2023.