Authors (including presenting author) :
Chan WCD(1), Yuk KLD(2), Lau M(1), Yue SYA(1), Ip WMK(1), Choi KYN(1), Yip CHW(1), Yu HYJ(1)
Affiliation :
(1) Occupational Therapy Department, Shatin Hospital (2) Department of Medicine & Geriatrics, Shatin Hospital
Introduction :
Pulmonary Rehabilitation Program (PRP) is a multidisciplinary program involving Medical Officers, Occupational Therapists, Physiotherapists, Nurses and Medical Social Workers. In Shatin Hospital (SH), all patients with principal diagnosis of Chronic Obstructive Pulmonary Disease (COPD) will join Basic PRP. After initial assessment, if patients satisfy the selection criteria for Enhanced PRP, they will be recruited into Enhanced PRP. Otherwise, they will continue Basic PRP training.
Objectives :
To evaluate the effectiveness of Occupational Therapy interventions in PRP for patients with COPD
Methodology :
In Occupational Therapy (OT) training, patients in both Basic PRP and Enhanced PRP will receive individual training and group education on disease management skills; activities of daily living (ADL) training with pulse oximetry monitoring; caregiver education and training; education on stress management and infection prevention & health promotion. In Enhanced PRP, OT will provide additional mandatory training and services including bathing assessment & training and patients can self-practice bathing in ward. Pre-discharge home visit with patients will be arranged to enhance disease management skills at home; to reinforce patients' compliance and promote integration of long-term oxygen therapy in ADL; and to empower patient reintegrating into community. In addition, Integrated Care and Discharge Support (ICDS) will be referred after discharge for home hygiene, environmental assessment and recommendations; on-site ADL coping skill training and recommendations; and disease coping skills and panic management techniques. From December 2020 to December 2022, patients finished both Basic and Enhanced PRP were recruited. In Enhanced PRP, their functional outcomes and health-related QOL including Modified Barthel Index (MBI); Montreal Cognitive Assessment Hong Kong Version (HK-MoCA) & HK-MoCA 5-min; Modified Medical Research Council Dyspnea Scale (mMRC); Monitored Functional Task Evaluation (MFTE) and Chronic Respiratory Disease Questionnaire were collected. In Basic PRP, only MBI, mMRC and HK-MoCA 5-min were collected. Both PRP group of patients’ data would be compared with themselves on admission and discharge.
Result & Outcome :
In Enhanced PRP, total of 19 patients were recruited. All patients were male with mean age of 77.1 years old and mean length of stay was 17.6 days. Their functional outcomes and health-related QOL showed improvement when compared on admission and discharge [mean difference of MBI change: 84.2 to 93.2; mean difference of HK-MoCA change: 22.5 to 23.9; mean difference of MFTE (Total) change: 13.5 to 15.2; mean difference of mMRC change: 2.6 to 1.9; mean difference in CRDQ (Emotion) change: 4.1 to 5.3; mean difference in CRDQ (Mastery) change: 3.8 to 5.4; mean difference in CRDQ (Dyspnea) change: 3.61 to 5.26; mean difference in CRDQ (Fatigue) change: 3.88 to 5.16). In Basic PRP, total of 61 patients with 59 male and 2 female were recruited. Their mean age was 79.2 years old and mean length of stay was 14.4 days. Their functional outcomes showed improvement when compared on admission and discharge (mean difference of MBI change: from 65.9 to 71.7; mean difference of HK-MoCA 5-min change: 16.3 to 16.8; mean difference of mMRC change: 3.0 to 2.8]. In comparing Basic and Enhanced PRP on MBI, HK-MoCA and mMRC, Enhanced PRP showed greater improvement than that of Basic PRP (mean difference of MBI in Basic & Enhanced PRP is 5.8 & 9.0; mean difference of HK-MoCA 5-min in Basic & Enhanced PRP is 0.6 & 3.2; mean difference of mMRC in Basic & Enhanced PRP is 0.2 & 0.7). Conclusion: Occupational Therapy interventions in PRP can enhance functional outcomes and improve health-related quality of patients with COPD.
