Seamless rehabilitation training program for young stroke patients in Pilot Day Rehabilitation Management Program of Tuen Mun Hospital

Abstract Description

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Authors (including presenting author) :

Fan MK (1), Lam CM (1), Cheung TY (1), Chow ESL (2), Chu ACK (2), Lee S (2), Yick HY (2), Cheung YL (2)

Affiliation :

(1)Occupational Therapy Department, Tuen Mun Hospital (2)Division of Rehabilitation, Department of Medicine and Geriatrics, Tuen Mun Hospital

Introduction :

Cerebrovascular disease is the second commonest cause of death and disease burden for people worldwide. In Hong Kong, it is one of the three commonest causes of hospital admissions accounting for the largest number of hospital bed days, and is the commonest condition warranting long-term residential care. All these give rise to a considerable disease and disability burden (Woo, Ho, Goggins, Chau, & Lo, 2014). Although stroke is often considered as an older person’s disease; specifically, a considerable proportion of around 30% of stroke patients in Hospital Authority are below the age of 65, while around 20% are under 60 years old (Strategic Services Framework for Rehabilitation Services, Hospital Authority, 2014). Stroke in a young person can be devastating in terms of productive years lost and impact on possibility to resume previous work task. Therefore special work rehabilitation needs especially for young stroke patients should be addressed in our clinical practice.

Objectives :

To address the ambulatory service may not be readily available to support patients who are ready for discharge but in need of special rehabilitation training. A pilot day rehabilitation program was commenced from Dec 2016 in Tuen Mun Hospital. This program mainly facilitates timely discharge and provides a seamless rehabilitation training in bridging the gap between discharged from in-patient and waiting time of out-patient rehabilitation training.

Methodology :

Conventionally, patients need to wait around 8 to 10 weeks before receiving Out-Patient Rehabilitation initial assessment and training after discharged from hospital. During the waiting time, patients are only able to continue home program which was prescribed at in-patient phase. When patients are recruited in our Day Rehabilitation Program, patients can continue receiving training once they are discharged from hospital. In Day Rehabilitation Program, occupational therapists play an important role to facilitate young stroke patients in early return to work. Functional capacity evaluation would be conducted. In order to compare patients’ current capacity to job requirement regarded to their workplace; a comprehensive interview, a series of functional assessments, simulated work tasks assessments and workplace environmental analysis were included. According to the results of job analysis and assessments, functional and simulated work tasks trainings were delivered by Occupational Therapists. Job tasks modification and recommendation were suggested.

Result & Outcome :

There were twelve young stroke patients with needs of return to work were admitted in our Pilot Day rehabilitation program from Feb 2017 to Dec 2018. Multi-disciplinary meeting was conducted weekly and individual treatment goals were designed for them. Afterwards, occupational therapist had provided simulated work tasks training program to patients. Finally there were five patients able to resume modified or part-time work duties after Day Rehabilitation Training. Seven patients continued receiving Day Rehabilitation Training until work rehabilitation out-patient service initial assessment appointment was offered. Six patients could return to original job or undergo job resettlement within three months of work hardening in out-patient department. Pilot Day Rehabilitation Program mainly facilitates timely discharge and provides a seamless rehabilitation training in bridging the gap between discharged from in-patient and waiting time of out-patient rehabilitation training. This seamless rehabilitation training can optimize patients’ functional capacity and enhance young stroke patients’ flow of care during their rehabilitation pathway.