Promoting Functional Recovery after Knee Replacement — Occupational Therapy Programme in Post-Discharge Program (PDP) of Peri-operative Programme for Total Knee Replacement: Service review

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Authors (including presenting author) :
Ho CY(1), Tang MHD(1), Lau FCA(1)
Affiliation :
(1) Occupational Therapy Department, Pok Oi Hospital
Introduction :
During post-operative in-patient stay after total knee replacement, occupational therapists helped prepare safe home environment and trained up patients’ basic ADL functioning to facilitate them to take care of themselves independently, or with assistance if carer available, before discharging home safely. However, in early phase of post-discharge, patients may still need help in managing their IADL such as meal preparation, housekeeping or community access which demanded higher activity tolerance and physical functioning. Moreover, some of them may even plan to resume work after operation. Thus, further functional training is highly indicated post-discharge.
Objectives :
In the post discharge programme (PDP), occupational therapy aims at maximizing patients’ occupational performance and functional ability in their daily living, i.e. ADL / IADL functioning, community living, return to work etc. through the programme.
Methodology :
128 patients were recruited to PDP from August, 2016 to November, 2018. They were scheduled to attend occupational therapy in afternoon sessions throughout PDP. With reference to pre-operative assessment as baseline, initial assessments were conducted in the first session followed by functional training. Functional training classes focusing on ADL / IADL and community reintegration as well as education/ practice groups were scheduled in the remaining sessions. Round-up and re-assessments were done in the last session of the programme. Outcome measures on functional and psychological assessment included Modified Bathel Index (MBI), Adapted Lawton IADL Scale (Lawton IADL) and Knee Injury and Osteoarthritis Outcome Score- HK version (HK-KOOS).
Result & Outcome :
Among 128 cases, there were 61 male (47.7%) and 67 female (52.3%) age ranged from 37 to 78 year-old. 83 cases (64.8%) with additional pre-operative assessment outcome attained for comparison. Paired sample-T test was used for data analysis. Compared with pre-PDP functioning, results showed that patients have significant improvement in both MBI (p< 0.001) and Lawton IADL score (p< 0.001) after PDP. They also showed significant improvement in all aspects of HK-KOOS including pain (p< 0.001), symptom (p< 0.001), ADL (p< 0.001), sport/recreation (p< 0.001) and QOL (P< 0.001) after completing PDP. Furthermore, patients showed significant gain in MBI (P=0.001) and all aspects of HK-KOOS (p< 0.001) when comparing with pre-operative functioning. There were also mean gain noted in Lawton IADL score when compared with premorbid. Besides, 54 cases (42.1%) were referred to Occupational Therapy Outpatient follow-up upon discharge from PDP for early intervention of hypertrophic scar. 3 cases (0.02%) were referred for further work rehabilitation and other 2 cases (0.02%) were referred for RA management. Conclusion With occupational therapy program in PDP focusing on ADL / IADL and community reintegration, patients showed significant functional gain and improvement in psychological status that reverted back to or even exceeded premorbid functioning after completing PDP. Apart from promoting functional recovery after knee replacement, occupational therapy also contributed to early identification and intervention for post-operative hypertrophic scar management and facilitated early intervention for occupational performance including work rehabilitation.

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