THE ROLE OF SLEEP QUALITY IN PHYSIOTHERAPY REHABILITATION OUTCOME-A NARRATIVE REVIEW

Abstract

Background: Sleep is a fundamental biological process that supports neuroplasticity, muscle repair, immune regulation, and pain modulation, all of which are essential for effective physiotherapy rehabilitation. Growing evidence indicates that poor sleep quality negatively affects functional recovery, reduces tolerance to therapeutic exercise, and amplifies pain perception, particularly in individuals with musculoskeletal conditions. Despite this, sleep remains underassessed in routine physiotherapy practice, and most existing evidence is observational, limiting causal inference and clinical translation.

Objective: This review aimed to evaluate sleep-related outcomes in adults receiving physiotherapy and to clarify the bidirectional relationship between sleep quality and pain. Additionally, it sought to inform practical strategies that physiotherapists can adopt to optimize recovery and functional performance by addressing sleep-related factors.

Methods: A rapid review was conducted using PubMed, Google Scholar, MDPI, and Scopus databases. Peer-reviewed studies published between 2015 and 2025 were considered. Eligible studies included longitudinal, quasi-experimental, descriptive, and observational designs involving adults aged ≥18 years undergoing physiotherapy for musculoskeletal or rehabilitation-related conditions. Studies evaluating sleep quality, insomnia severity, pain, functional outcomes, or biological recovery markers were included. Non-English articles, animal studies, pediatric populations, and unpublished data were excluded. Data were narratively synthesized, focusing on clinical and functional outcomes relevant to physiotherapy.

Results: Across included studies, sleep disturbance was consistently associated with poorer rehabilitation outcomes. Patients with insomnia demonstrated higher pain scores, greater functional limitation, and reduced quality of life. In one cohort, only 33% of patients achieved a clinically meaningful improvement in insomnia severity, while 62% shifted to a lower insomnia category by discharge. Poor sleep was linked to increased inflammatory activity and delayed tissue healing, whereas improvements in sleep quality were associated with better pain control, enhanced therapy participation, and superior physical health–related quality of life.

Conclusion: Sleep quality significantly influences physiotherapy rehabilitation outcomes. Integrating routine sleep assessment and basic sleep-focused strategies into physiotherapy practice may improve pain control, functional recovery, and long-term rehabilitation success.