Authors (including presenting author) :
Cheung WL, Chan SP, Lam CM, Cheung TY
Affiliation :
Department of Occupational Therapy, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority
Introduction :
COVID-19 is a widespread disease affecting more than 657 million people in the world (WHO Coronavirus Dashboard). For patients admitted to hospitals, Occupational Therapists provided assessments and interventions to prevent complications, enhance functional (Activities of Daily Living (ADL) and cognition) recovery and facilitate early discharge. To maintain social distance, tele-carer training via video calls were combined with our well-established technology assisted care model on pre-discharge home assessment.
Objectives :
To review the change in ADL, cognitive function and living setting of patients after COVID-19 infection in Tuen Mun Hospital.
Methodology :
Occupational therapy discharge summaries of COVID-19 patients were retrieved from CDARS with discharge date between 1/1/2020 and 8/12/2022.
Result & Outcome :
Excluding those with missing data, 394 COVID-19 paired data sets (admission & discharge) for patients received occupational therapy service were available. Significant improvements were observed in ADL (n=179), with Modified Barthel Index (MBI) from 51.26 to 60.47 (p<0.001). Cognitive function also improved with Montreal Cognitive Assessment – Hong Kong Version (MoCA-HK) (n=7) from 8.43 to 12.29 (p=0.22) and AMT (n=16) from 4.06 to 5 (p=0.23). It is reported that 80% of COVID-19 patients demonstrated cognitive deficit in MoCA score one month after discharge (Alemanno et al., 2021). Fifty patients were recruited upon discharge to follow up their cognitive deficit. Sixteen patients exhibited improved MoCA-HK score from 14.79 to 16.50 in community (p=0.08) with mean follow-up of 66.93 days. Despite improvements in MoCA-HK score in two-month follow-up, cognitive impairments were still observed which called for long term review and cognitive rehabilitation for patients recovered from COVID-19. Discharge destinations for 179 patients with pre-post MBI were analyzed. The number of patients premorbid living at home and discharge back to the community decreased from 150 to 117 while those required institutional care increased from 29 to 62 . The p value for McNemar test was <0.001. The change in proportion of OAH resident was significantly different after COVID-19 infection. The functional scores were significantly different (p<0.05) between the community group (mean MBI=78.85, MoCA-HK=14.6) and the institutional care group (mean MBI=37.13, MoCA-HK=8.13). Besides, a higher proportion of patients received carer training during hospital stay could be discharged home. To analyse the results with logistic regression, the adjusted odds ratio of living in the community is 1.18 per 1 unit increase of MoCA score adjusted for the effect of MBI (p=0.049). Utilising MBI and MoCA as predictor of discharge destination with receiver operating characteristic curve, the area under curve is 0.81 (p=0.002).
Notably, more community dwelling adults required institutional care after hospitalization due to COVID-19, and this might lead to social healthcare burden. The early interventions of occupational therapy during hospitalization contributed in complication prevention and functional recovery. The adoption of tele mode for carer training expedited timely and safe discharge and in turn spared the limited healthcare resources to other patients in need.
