Authors (including presenting author) :
CLANCEY JCT (1) , LUI NFJ (1)
Affiliation :
(1) Department of Occupational Therapy, Queen Elizabeth Hospital
Introduction :
In Queen Elizabeth Hospital, conventionally Amyotrophic Lateral Sclerosis (ALS) patients are referred by neurologists to occupational therapists for outpatient services if necessary. However, as most patients are largely in the middle to end stages of disease, they would only benefit in late phase treatments of complication prevention and ordinary aids prescription.
Objectives :
The objective of this project is to provide proactive occupational therapy to ALS patients during Home Mechanical Ventilation (HMV) clinic sessions, so as to intervene timely to maximize patients' independence and improve their quality of life, and to facilitate patient autonomy early in their disease progression.
Methodology :
In December 2021, occupational therapist took the initiation to participate in the HMV clinic, a joint clinic that includes neurology, respiratory and palliative teams, for providing early assessment and intervention. The goals were to: (1) identify patients’ current function and needs; (2) provide immediate interventions if feasible; and (3) arrange appropriate follow-up actions in an out-patient context.
Occupational Therapist (OT) would conduct a needs assessment, functional and cognitive status and social participation with patients and their caregivers. OT would report assessment results and suggest interventions during the joint consultation with patient, caregiver and neurologist. Referrals were directly made on-site. If feasible, immediate interventions were provided for patients, which reduced the time and hassle of travelling to the hospital. Out-patient follow-ups were made or via tele-consultation.
Result & Outcome :
Up till October 2022, 47 patients were seen, including 27 (57.5%) ALS patients. Patients aged from 39-74, with mean age 58.5 ± 12.6 years. 59% were male. In regards to their disease staging, 63% were in the middle stage, while 22.2% and 14.8% were in the early and late stages respectively.
12 (44.4%) patients were recommended for occupational therapy during the clinic, with 8 (66.7%) and 3 (25%) patients in the middle and early stages of the disease. Immediate interventions included prescription of splints and neck collars (17.4%), provision of information on community support (17.4%), energy conservation advice (8.7%) and fall prevention education with home program (4.4%). Other services included home visits (8.7%) and pressure injury prevention (13%) which might require long term follow up. For 3 (11.1%) patients, they were referred to the Community Rehabilitation Service Support Center (CRSSC) for early electronic assistive devices arrangement.
Conclusion: With this proactive and early intervention approach, it is discovered that ALS patients have the opportunity to receive timely treatment in their earlier phase of disease. Though ALS is a rapid degenerative disease, patients have the right to enjoy a better quality of life (QOL) and to live with dignity.
