Room 421 May 15, 2019 oral abstract
Service Enhancement Presentation 10:45 - 12:00

Healthcare Advances, Research and Innovations

Can the Pioneer Multidisciplinary 365-days Rehabilitation Program for Stroke Patients in a Convalescence Hospital Improve Functional Recovery and Patients’ Satisfaction? A Retrospective Cohort Review
10:45 - 10:55

Introduction

Rehabilitation therapy is of paramount importance to help individuals recovering from illnesses and rebuild their lives in returning to the community. Increased rehabilitation intensity (including weekend therapy) has improved outcomes in different patient populations. A multidisciplinary rehabilitation program involving Physiotherapists, Occupational therapists, Nurses, Medical social worker and community NGO was launched on weekends and public holidays for stroke patients in Shatin hospital (SH) since 1 October 2017.

Objectives

To evaluate the benefit of the new multidisciplinary 365-days stroke rehabilitation service model

Methodology

Stroke patients admitted to SH from 1 October 2017 to 30 September 2018 receiving daily rehabilitation services were recruited (365 group). Their clinical and service outcomes including Modified Functional Ambulation Classification (MFAC), Modified Rivermead Mobility Index (MRMI), Bergs Balance Scale (BBS), Modified Barthel Index (MBI) and Functional Test for the Hemiplegic Upper Extremity (FTHUE) for functional independence; Montreal Cognitive Assessment Hong Kong Version (HK-MoCA); Response Time of initial assessment and treatment (RT); Length of Stay (LOS) and Patients & Caregivers Satisfaction Survey were collected and compared with the data of patients with the same diagnostic group captured in 1 October 2016 to 30 September 2017 (non-365 group).

Results & Outcome

Total of 185 patients were recruited in the 365 group. 87% was infarct type of stroke and 13 % was hemorrhagic. 95 of patients were male and 90 were female with mean age of 74.37 +/- 11.23 years old. Their functional and cognitive outcomes were all significantly improved (p< 0.05) in the 365 group compared with those of non-365 group (mean difference of MFAC change: from 0.65 to 1.09; mean difference of MRMI change: 4.46 to 7.99; mean difference in BBS change: 7.07 to 11.49; mean difference in MBI change: 7.89 to 12.11; mean difference in FTHUE change: 0.61 to 0.84; mean difference in HK-MoCA change: 0.84 to 1.34) with comparable LOS (20.732 +/- 8.77 days to 20.730 +/- 8.49 days). The RT was 53% faster than the non-365 group. For the Patients and Caregivers Satisfaction Survey, higher satisfactory scores were obtained in terms of treatment frequency, treatment intensity, response time, patients’ confident upon discharge, caregiver participation and overall service provision in 365 group compared with the non-365 group of patients. In conclusion, the newly-launched 365-days multidisciplinary service model in stroke rehabilitation achieved better functional and cognitive recoveries, higher patients and caregiver satisfaction to service with comparable hospital stay. Data collection should be continued and regularly review for continuous service improvement.

 

 

Pre-operative Intravenous Steroid Improves Pain and Joint Mobility after Total Knee Arthroplasty in Chinese Population, a Double-Blind Randomized Controlled Trial
10:56 - 11:05
Presented by : Dr. L Y CHENG

Introduction

Compared to conservative management alone, patients with moderate-to-severe knee osteoarthritis treated with total knee arthroplasty showed a better pain relief and functional outcome. However, post-operative pain relief remains an important challenge. Considering steroid as an adjunct to the multimodal analgesic regime, it can reduce post-operative inflammation and surgical stress response. However, the effect of systemic steroids on post-operative pain control for total knee arthroplasty in Chinese population has yet been studied. Majority of the randomized-controlled trials focused on post-operative control of pain, nausea and vomiting, the data for improvement in range of movement in total knee arthroplasty was scarce. No studies investigated on patient’s satisfaction towards post-operative pain control with intravenous steroids in total knee arthroplasty.

Objectives

The aim of this study was to investigate the effect of pre-operative high dose methylprednisolone on pain relief and recovery after total knee arthroplasty in Chinese population.

Methodology

This is a prospective, randomized, double-blinded, placebo controlled single-centre trial. 60 patients undergoing elective primary unilateral total knee arthroplasty during June 2017 to March 2018 were randomized into intervention and control group. The pre-operative, intra-operative and post-operative anesthetic and analgesic regimes were standardized. The intervention group received an additional of 125mg methylprednisolone intravenously on induction of anesthesia. Subjects were assessed at 24, 30, 48 hours after surgery and upon discharge by physiotherapists. In each assessment, rest pain and pain on movement from operated knee were assessed with 100mm visual analogue scale. Range of movement from operated knee was also charted. Patient's satisfaction were documented. C-reactive protein level before and after operation was calculated. Adverse reactions were documented. Subjects were followed up at 6 weeks and 4 months.

Results & Outcome

Rest pain and pain on movement, including straight knee raise, maximal knee flexion and walking with frame for 5 metres, were significantly reduced in the methylprednisolone group at 24 and 30 hours after surgery then the placebo group (ANOVA p=0.030, p=0.003, p=0.032, p=0.010 respectively). The methylprednisolone group demonstrated a greater range of movement from the operated knee at 24-hour and 30-hour post-operative assessment (ANOVA p=0.031). Post-operative C-reactive protein level was significantly less in the methylprednisolone group (p< 0.001). Patient's satisfaction was higher in methylprednisolone group(p< 0.001). Incidences of hypokalaemia, hyperglycaemia and sleep disturbance were not statistically significant. No wound complications were noted at 6-week and 4-month follow-up. Pre-operative intravenous methylpredinsone can improve post-operative pain and range of movement after total knee arthroplasty. It can act as an effective adjunct in the multi-modal analgesic regime.

 

 

Physical Training Program to Improve Exercise Capacity of Children with Chronic Kidney Disease
11:06 - 11:15
Presented by : Ms. Mei Wun Cheung

Introduction

Children with Chronic Kidney Disease (CKD) were reported to have reduced exercise capacity, including muscle strength and aerobic fitness. This may reduce their functional ability. Physical training may help improve their exercise capacity.

Objectives

To study the efficacy of the physical training program in improving the exercise capacity of local children with CKD.

Methodology

A four-week exercise training program with two sessions each week was conveyed to local children with CKD. The training program consisted of education on proper exercising, cardiopulmonary training, muscle strengthening, and establishment of exercise habit. Inclusion criteria of subjects were (1) age 11 to 18, (2) medically stable for exercise, (3) volitional participation. Outcome measures were (1) muscle strength: right and left handgrip (HGR, HGL), shoulder abductors (ShA), elbow flexors (ElbF), hip flexors (HipF), knee extensors (KnE), knee flexors (KnF); and (2) aerobic fitness: distance walked in 6-minute-walk-test (6MWD) and Fitkids Treadmill Test Endurance Time (FTTET). All outcomes were measured at baseline (within four weeks pre-program) and after intervention (one week post-program). Non-parametric Wilcoxon Signed Ranks Test was used to assess pre- and post-program differences because of the small subject number (< 30).

Results & Outcome

Fifteen subjects, with age 13 to 18 (15.36±1.8), were recruited. Eleven of them (72.2%) completed the training program and evaluations. Muscle strength (HGR, HGL, ShA, KnF), and aerobic fitness (6MWD, FTTET) were significantly improved post-program. (1) Muscle strength: HGR improved from 30.5±20.3lbs to 49.07±17.6lbs (p=0.004), HGL from 24.82±20.53lbs to 46.52±16.46lbs (p=0.004), ShA from19.86±5.24lbs to 24.5±6.3lbs (p=0.013), KnF from 24.88±8.05lbs to 30.14±6.73lbs (p=0.016); (2) Aerobic fitness: 6MWD improved from 442.45±69.14m to 518.72±61.78m (p=0.003), FTTET from 7.55±2.86min to 9.84±1.8min (p=0.004). Conclusion: The exercise capacity of local children with CKD can be improved by a four-week program of physical training, especially in the aspect of aerobic fitness. The long-term effect of the program should be further investigated.

 

 

The Effectiveness and Outcome of Ultrasound Therapy for Lactating Mothers with Blocked Mammary Ducts
11:16 - 11:25
Presented by : L F HO

Introduction

The 2016 statistics from Department of Health indicated that 86.8% of mothers breastfed their babies at discharge, but the breastfeeding rate dropped to 55.5% at 4 months after delivery. Of the many reasons that mothers stopped breastfeeding, painful blocked ducts leading to reduction of milk production is a known cause of premature cessation of breastfeeding. Although there several studies have assessed the effectiveness of using therapeutic ultrasound to clear ductal blockage, there is only limited information on the pain reduction for these mothers.

Objectives

A Lactation Consultant Clinic was set up in Dec 2017 in collaboration with Physiotherapist to provide ultrasound therapy for mothers with the problem of blocked ducts.

Methodology

Lactating mothers with blocked ducts would be referred to the Physiotherapist for ultrasound therapy. The study period was from December 2017 to November 2018. The pain score pre- and post- ultrasound therapy was assessed by Numeric Pain Rating Scale (NRPS); and milking and hand expression was performed by Lactation Consultant immediately after the treatment. Phone follow-up was done to evaluate the effectiveness and the feeding pattern after 4 months.

Results & Outcome

91 mothers who attended the Lactation Consultant Clinic had USG therapy performed for blocked ducts within the study period. 18.7% (17/91) and 38.5% (35/91) of them expressed breast refusal or were separated with their babies after delivery. The percentage of pain reduction during the first USG therapy were 54.0 ± 28.3 and 55.0 ± 28.8 from the right breast and left breast respectively. The percentage of pain reduction during the second USG therapy were 45.8 ± 29.0 and 49.7 ± 26.0 from the right breast and left breast respectively. 80 mothers were successfully contacted at 4 months after the treatment. 16.3% (13/80) of mothers had exclusively breastfed their babies, 35.0% (28/80) of mothers gave breast milk by direct latch on or expressed breast milk. 25.0% (20/80) of mother gave expressed breast milk and formula, while 23.8% (19/80) of mothers had stopped breastfeeding. In order to assist mothers to solve the problem of blocked ducts, massaging and expression by hands is a vital, but very painful procedure. Nevertheless, ultrasound therapy could help in reduction of pain and increased the milk flow. This would be a therapeutic option for the Lactation Consultant to manage blocked mammary ducts and preventing the occurrence of mastitis.

 

 

Adoption and implementation of a culturally adapted evidence-based integrated self-management and exercise programme for knee osteoarthritis in a local physiotherapy clinic
11:26 - 11:35
Presented by : Jamie Sau Ying LAU

Introduction

Chronic knee pain affects 31% of elderly in Hong Kong (HK). The waiting list for total knee replacement (TKR) was doubled dramatically from 2014 to 2018. Guidelines recommend exercise and self-management education as core management for knee osteoarthritis (OAK). The National Health Service of the United Kingdom adopted an evidence-based ESCAPE-knee pain programme, mandatory before TKR. Cultural adaptation of this programme was undertaken for HK Chinese –Integrated Exercise and Self-management Programme (IPES-knee) – and found to be feasible in clinical application and acceptable to patients. Potential improvement in exercise adherence and health care utilisation was found at one-year follow-up compared with usual physiotherapy. The next step was adoption and implementation of IPES-knee in local clinical setting while maintaining fidelity for effectiveness.

Objectives

1) To adopt IPES-knee for implementation of local OAK management 2) To observe retention rate and clinical benefits of IPES-knee in a physiotherapy out-patient clinic (PT clinic); 3) To compare outcomes of the shortened IPES with the original ESCAPE-knee pain HK.

Methodology

The original 10-sessions programme was modified and shortened to match with local demand and current manpower situation. A physiotherapist led discussion on self-management and exercise in all six-weekly sessions, 75-minutes each. Topics included exercise benefits, goal-setting, flare-management and others. One-day staff training was conducted to update evidence on OAK, management strategies, ESCAPE-knee pain and motivational skills. IPES-knee was provided to OAK patients referred to the PT clinic. Patient demographics and attendance were recorded. Outcome measures included Knee injury and Osteoarthritis Outcome Score (KOOS), Patient-specific Functional Score (PSFS), Self-efficacy for Exercise (SEE-C), walk-speed and chair-stand tests, numeric pain (NPR) and global improvement (GIR). Descriptive statistics was analysed for completers and defaulters of the programme.

Results & Outcome

In 2018, 464 OAK patients received IPES-knee. A total of 323 (69.6%) patients completed the final visit (mean 5.91 sessions), with 68.1% female, mean age 66.0(SD 8.5), body-weight index 26.6, and pain for 4 years. Those defaulted (2.4 sessions) were excluded from the analysis and did not differ from completers in their baseline characteristics except 2 years younger. All outcome measures showed significant improvement (p=.000): KOOS-pain 8.13(15.12)/100, physical function 7.15(15.39)/100, quality-of-life (QoL) 7.67(18.88)/100 points; PSFS 1.67(1.66)/10; SEE-C 1.52(2.24)/10; walk-speed 0.19(0.63) m/s, chair-stand 2 times and GIR 5.52/10 points. The Cohen'sd for pain, PS and QoL were 0.48, 0.41 and 0.40 respectively. Compared with the original study, the shortened IPES-knee showed 50% as good in pain and QoL, 70% in reported functions and 100% in physical testing. IPES-knee is recommended as territory-wide implementation for OAK management under constraints.

 

 

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