Changes in Sleep Quality and Treatment Outcomes in Patients with Musculoskeletal Pain Managed in Primary Care Physiotherapy.

Purpose: To investigate the association between change in sleep quality over a 3-month period and the overall perceived effect of treatment, pain intensity, and health-related quality of life up to 12-month follow-up. Patients and methods: This longitudinal study included 997 individuals (mean age 49.7 years, 72.1% women) with musculoskeletal pain who sought care from a physiotherapist in primary health care in Norway. Postoperative patients were excluded. We used a Generalized Estimating Equation (GEE) model to calculate adjusted risk ratios (RRs) for the probability of a positive treatment outcome at 6 and 12 months, associated with categories of good and poor sleep reported at first encounter and after three months. Results: Compared with those who reported poor sleep quality over the first three months, those who reported improved sleep quality had a greater probability for a positive perceived effect of treatment (relative risk 1.66; 95% confidence interval [CI]:1.37-2.00), low pain intensity (RR:1.71; 95% CI:1.34-2.19), and high health-related quality of life (RR:2.06; 95% CI:1.55-2.75) at 12 months. Those who reported good sleep quality over the 3-month period had similar probabilities of positive treatment outcomes as those who reported improved sleep quality. Conclusion: Individuals who reported improved sleep quality during the first three months after the first consultation with a physiotherapist in primary care had a substantially higher probability of positive treatment outcomes up to 12 months, compared with those who had poor sleep.