Authors (including presenting author) :
Ho SWS(1), Tang KL(1), Lui NFJ(1)
Affiliation :
(1) Department of Occupational Therapy, Queen Elizabeth Hospital
Introduction :
Under the policy of “PD first” in Hospital Authority, most of the patients suffering from chronic kidney disease (CKD) require peritoneal dialysis (PD). However, the process of PD is complicated. Only patients with high functional performance in cognition, eye hand coordination and hand dexterity are able to complete the procedure safely without complication. Occupational Therapist plays an important role in assessing patient’s ability in performing PD at home. Comprehensive training and aids prescription are also essential to facilitate independent performance. Since October 2020, a pre-PD assessment program has been launched for patients who are planning for renal replacement therapy, in which Occupational Therapist will provide early evaluation on patients’ ability to perform PD and intervene timely if necessary.
Objectives :
This pilot study aimed to review the validity of Occupational Therapist assessments in pre-PD program in determining patients’ ability to perform PD by themselves at home.
Methodology :
Eligible patients were referred by renal nurses to Occupational Therapy department of Queen Elizabeth Hospital to evaluate ability of independent PD. Assessments conducted included Hong Kong Montreal Cognitive Assessment (HK-MoCA), MNREAD Chinese Reading Chart, Nine-Hole Peg Test, Monofilament Test, and Functional Reach Test. Results were further interpreted to provide an overall readiness scale. Patients with results >16th percentile in HK-MoCA, ≤0.5 in vision acuity, Monofilament sensation level <3.61, and/or performance <1 SD from average in Nine-Hole Peg test were classified as high readiness to self PD. Chi-Square test of Independence was used to examine the correlation between the readiness and successful rate in conducting PD independently. A retrospective study was also carried out to review for the prevalence of complications (e.g., peritonitis) within one year upon home PD.
Result & Outcome :
Between October 2020 to December 2022, 128 patients (44 females, 84 males; Mean age=62.8) were recruited in the pre-PD assessment program. Among these patients, around 56.5%, 22.8% and 20.6% of patients were classified as high, moderate and low readiness respectively according to Occupational Therapist assessments. The subsequent self PD rates in community were 88.5%, 57.1% and 36.8% in each category of readiness. There was a statistically significant relationship between the readiness level and PD succeed rate (Chi-square = 20.277, p <.001). Besides, 22 patients finished a one-year review on complications in home PD. Our recent analysis showed that the incidence of peritonitis within a 12-month period was 14%.
The results showed that Occupational Therapists can effectively screen out those who are ready for self PD at home with low complication rate. Further studies on the correlation among factors contributing to the successful independent PD rate will be conducted in the future.
