Authors (including presenting author) :
Cheung PCT(1), Lam CY(2), Suen MYA(1), Law YTE(3)
Affiliation :
(1)Department of Physiotherapy, Tin Shui Wai Hospital, (2) Department of
Orthopaedics & Traumatology, Tuen Mun Hospital, (3) Department of Physiotherapy, Pok Oi Hospital
Introduction :
Mechanical spinal pain and trigger finger account for significant number of cases waiting for Orthopaedics & Traumatology (O&T) consultation in NTWC. Long waiting time may lead to chronicity of disease which increases the burden on health care system in the long run. Moreover, these cases may be beneficial from early physiotherapy intervention through patient empowerment, remedial exercises and different physiotherapy approaches. Therefore, a pilot run of joint clinic of Orthopaedics & Traumatology and physiotherapy was commenced in Tin Shui Wai Hospital (TSWH) in 2017 to enhanced efficiency and quality in managing mechanical spinal pain and trigger finger.
Objectives :
(1) to triage cases who would be beneficial from early physiotherapy consultation; (2) to minimize disease chronicity and demand on health care through earlier intervention; (3) to space out Orthopaedics & Traumatology follow up consultation.
Methodology :
New spinal and trigger finger cases who booked for TSWH O&T consultation since July 2017 were included. Cases who were on sick leave due to injury on duty and have chronic pain were excluded. Physiotherapist collected the TSWH O&T new case list from TSWH HIRO weekly, screened and selected suitable cases through CMS. Physiotherapist phone contact suitable patients and invite them to join the program by attending physical triage and joint clinic. Physiotherapist did physical triage followed by the joint clinic session hold by O&T doctor and physiotherapist. Suitable cases will be referred for physiotherapy for 6-8 weeks training. Patients will be discharged if satisfactory improvement is achieved after training. Patients’ joint clinic appointment will be advanced for identification of red flag sign, sudden deterioration or poor progress during physiotherapy training. Outcome measures included: (1) Numerical Global Rating of Change Scale (NGRCS); (2) Numerical Pain Rating Scale (NPRS); (3) Roland Morris Disability Questionnaire (RMDQ); (4) Northwick Neck Pain Questionnaire (NPQ); (5) discharge destination; and (6) patient satisfaction level. Paired t-test was used to analyze the data.
Result & Outcome :
From 27th July 2017 to 13th September 2018, 28 sessions of joint clinic were held with 101 patients booked. The attendance rate of joint clinic was 92%. 83% (77 patients) of the attended cases referred for physiotherapy (53 male and 24 female; mean age of 56.08±9.82 years old). 42 patients finished physiotherapy treatment and 49% of patients do not need further O&T follow-up. 29% of patients had chief complaint of spinal pain whereas 70% of patients had chief complaint of trigger finger, the remaining 1 % was others. Among the 42 patients, the average number of physiotherapy sessions attended was 6. NPRS (4.6 to 2.22), RMDQ (7.67 to 7.27) and NPQ (34.5% to 26.6%) were significantly improved (p <0.05) after physiotherapy training. Subjective improvement as measured by NGRCS was 75%. Moreover, patients satisfied with the service with mean satisfaction level of 5.55 out of 6. Conclusions:
Joint clinic of Orthopaedics & Traumatology and physiotherapy enhanced efficiency and quality in managing mechanical spinal pain and trigger finger through patient empowerment, remedial exercises and different physiotherapy approaches.
Co-location with:
