Authors (including presenting author) :
POON CK (1), DR LAU MT(2), DR WONG OF(2), DR WONG CH(2), CHEUNG YN(1), PAK AM(1） LEUNG YK (1), LEUNG YYC(1)(3)
Affiliation :
(1)Physiotherapy Department, North Lantau Hospital, (2)Accident & Emergency Department, North Lantau Hospital, (3)Physiotherapy Department, Princess Margaret Hospital
Introduction :
In North Lantau Hospital (NLTH), in the past, acute low back pain (LBP) patients, who were admitted to NLTH AED, with further in-patient monitoring and rehabilitation demands were transferred to Princess Margaret Hospital (PMH) Orthopaedic ward. To provide immediate, holistic care for acute LBP patients in NLTH, the low back pain management program of Emergency Medicine (EM) Ward has been established since February 2021. Suitable patients were referred to this program and patients were assessed, cared, treated and undergo rehabilitation under multi-disciplinary approaches by doctor, physiotherapist and nurse in NLTH. Physiotherapists in NLTH played a significant role in formulating and executing rehabilitation plans for acute LBP patients, by completing thorough assessment, providing timely pain relief interventions, delivering back care related educational talk, performing specific mobilization and stabilization exercises and practicing ambulatory training at acute stage. Based on patients’ condition and rehabilitation needs, the case physiotherapist would suggest and arrange further out-patient sessions with fast track after discussion with doctor.
Objectives :
To enhance the care of patients with acute LBP in EM ward by implementing a multi-disciplinary care program. To facilitate early discharge to the care of patients with acute LBP in EM ward.
Methodology :
This program has been commenced since February 2021. Patients admitted with acute LBP are stratified and recruited by EM ward doctor according to the following criteria: Aged 18-65 years old, acute onset of non-specific LBP/ chronic LBP with symptoms flare up within 1 week and LBP without severe neurological signs. Patients with acute vertebral fractures, suspected or known underlying malignancy (eg bone metastasis) and ankylosing spondylitis were excluded to this program. Case physiotherapist performs initial assessment and delivers treatment every Monday to Saturday. Several outcome measures are obtained for the program. They are 1. Roland- Morris Disability Questionnaire Score (RMDQ), 2. Numerical Pain Rating Scale (NPRS), 3. Numerical Global Rating of Change Scale (NGRCS). Total length of stay is recorded upon patient discharge as well. Patients who joined this program were reviewed as below.
Result & Outcome :
Total 49 patients, 23 males (47%) and 26 females(53%), were recruited with a mean age 46 years old. 57 % of patients were diagnosed with back sprain, 16% with sciatica,12% with non-specific mechanical LBP, 10% with back contusion and 2% with chronic degenerative spine with acute onset of LBP. The average length of stay of patients in this program was 3 days. 47% of patients in the program had physiotherapy outpatient follow-up for further pain management and rehabilitation. One patient was transferred to PMH orthopaedic ward for further investigations. The mean NPRS was improved from 6.7 to 3.8. The mean NGRCS was changed from 0.9 to 5.3. The mean RMDQ was decreased from 15.1 to 11.2 (total score of 24). The data was then analyzed by paired t-test, and all the outcome measures were significant statistically (p value <0.05). The results showed that this LBP program helped the targeted patient in terms of reduction of pain and improvement of functional activities. Nearly 50% improvement was generally reported among patients after the program, which indicated that patients in general ameliorated 50% in average 3 days with this LBP program. To conclude, by implementing this program, the goals of immediate assessment, treatment and delivering post-injury education for acute LBP patients are achieved. With this all-rounded program, it minimized NLTH acute LBP patient transferring to other acute hospital orthopaedic ward, alleviating other acute hospital congestion. Overall, the results of this program revealed that the LBP program was constructive and practical.
