Authors (including presenting author) :
Tse YK(1), Chung PH(1), Lau FO(1)
Affiliation :
(1)Physiotherapy Department, Tai Po Hospital, Hong Kong
Introduction :
A clinical decision support system is effective in enhancing appropriate treatment ordering or prescribing. Since 2019, Accelerated Stroke Ambulation Program (ASAP) was developed in Physiotherapy Department of TPH. Stroke Registry, a longitudinal stroke database, with a clinical prediction model of Modified Rivermead Mobility Index (MRMI) gain, proactively monitors stroke patients progress in TPH. Meanwhile, working experience of Senior Physiotherapist and Physiotherapist I in stroke team reduced 9.45 years and that of Physiotherapist II reduced 1.32 years from 2019 to 2020. Stroke Treatment Library, a standardized exercise prescription manual based on 5 main functional domains for ambulation, started to develop from 4Q 2020. It facilitates timely support to junior physiotherapists when prescribing stroke intervention for ambulation and promotes goal-oriented approach with Stroke Registry.
Objectives :
To facilitate junior physiotherapists to design optimal standardized intervention to stroke patients for ambulation. To facilitate standardization of treatment setup and conduction by visualization.
Methodology :
1. Evidence-based functional tasks-specific training in 5 main functional domains (bed mobility, sitting, sit to stand, standing and walking) for ambulation of stroke patients were sorted into a standardized exercise prescription manual. Treatments were then categorized based on MRMI score (inversely proportional to level of assistance). 2. Stroke Treatment Library was developed and integrated into Stroke Registry for instant reference before prescription. 3. Visualization of Stroke Treatment Library was done with the production of 87 exercise videos. 4. Medical PT II should read the suggested treatments in Stroke Treatment Library according to corresponding MRMI sub-scores before prescribing treatments to stroke patients. 5. To enhance accessibility, mobile version of stroke treatment library was developed. Treatments were also further stratified for gait facilitation. 6. Feedback analysis and compliance audit were done.
Result & Outcome :
Results: All medical PT II (number of staff= 7) agreed that Stroke Treatment Library in Stroke Registry is simple and convenient to operate. Its content is easy to understand and covers essential training areas for ambulation of stroke patients. Stroke Treatment Library facilitates them to prescribe standardized interventions to stroke patients for ambulation. Treatment prescription compliance increased from 52.9% to 82.3% after implementation of Stroke Treatment Library. Conclusion: Stroke Treatment Library facilitates standardization of stroke intervention prescription for ambulation despite staff experience much decreased. It supports junior physiotherapists by data driven prescription of stroke intervention for ambulation with modern technologies and evidence-based practice.
