A 3-year Review for Community Physiotherapy Service and Geriatric Day Hospital Service for Total Knee Replacement Patients in Princess Margaret Hospital (PMH)

Abstract Description

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Authors (including presenting author) :

Wong CM(1), Chui KW(1), Kan WL(1), Mok YT(1), Yip SC(1), Wong YB(1), Chan TM(1), Leung YYC(1)

Affiliation :

(1)Physiotherapy Department, Princess Margaret Hospital

Introduction :

Total knee replacement (TKR) is a common orthopedic surgery that requires comprehensive post-operative rehabilitation in geriatric day hospital (GDH). For those frail elderly with poor family support, exercise compliance and having anxiety to have outdoor activities, community physiotherapy (CPT) is provided to help them returning into their community by on-site outdoor activities practice like going to the market, crossing the road and managing escalator.

Objectives :

(1) To evaluate the functional outcome in TKR patients after GDH training. (2) To evaluate any difference in functional improvement between patients who have or have not received CPT.

Methodology :

Patients admitted to PMH for unilateral TKR from Jan 2015 to Sep 2018 and being referred to GDH were identified via Clinical Management System (CMS). The functional outcome including Modified Functional Ambulation Classification (MFAC), Elderly Mobility Scale (EMS) and Time Up and Go (TUG) were collected. Wilcoxon Signed-Rank Test was used as the statistical analysis by SPSS.

Result & Outcome :

89 cases were recruited. 70 (78.6%) of them were female with mean age of 72.5±5.49 years old. The mean duration was 10±4.52 weeks with total 15.4±7.7 physiotherapy sessions provided. Among all, 25 (31.6%) of them received CPT with average 1.3±0.79 sessions per patient. The percentage of patients with MFAC category VII (outdoor walker) significantly increased from 5.6% to 38.2% (p< 0.01) and the EMS score significantly increased from 13.1±3.21 to 16.4±3.12 (p< 0.01). Additionally, there was significant reduction in time of TUG test from 44.8±20.6s to 22.9±12.0s (p< 0.01). For those patients who received CPT, there were greater improvement in TUG test (54% reduction vs 46% reduction, p=0.446) and EMS score (27% increase vs 24% increase, p=0.696). There is significant functional improvement after structured multi-disciplinary rehabilitation training in GDH. A lower fall risk can therefore be predicted particularly when they need to return to the community. The greater improvement found in CPT group is probably due to increased home exercise compliance, stronger patient-therapist rapport built and more real practice in the community after home visit.