Authors (including presenting author) :
Lau TS (1), Chung PH (1), Lau FO (1)
Affiliation :
(1) Tai Po Hospital
Introduction :
Tai Po Hospital (TPH) physiotherapy stroke rehabilitation has adopted an “IT”-enhanced approach since late 2019. Information (I) means using predictive data analytics to predict outcomes for proactive management. Technology (T) means using standardized exercise interventions with modern technologies and evidence-based practice to enhance treatment effectiveness. With the adoption of the “IT”-enhanced approach, clinical outcomes improved despite the decreased training intensity under the impact of COVID19 and staff experience much decreased.
Objectives :
To maximize functional outcomes despite the decreased training intensity under COVID19 and staff experience much decreased.
Methodology :
The predictive model of Modified Rivermead Mobility Index (MRMI) gain (Pearson correlation: 0.386) using the past 8 years, 2011 to 2018 TPH stroke data (N=4136) has been adopted since Oct 2019. The predicted MRMI gain was calculated by inputting patients’ current MRMI score, age and premorbid Modified Functional Ambulation Category (MFAC). Patients would receive a goal-oriented standardized intervention according to the predicted MRMI gain. The standardized interventions were derived using the principles of motor learning based on existing literature: task-specific, repetitive practice, increasing difficulty, goal-oriented practice, optimal dosage together with modern technologies including robotic gait training and Knee-Ankle-Foot Orthosis. Patients then received interventions that covered 5 functional domains (Bed mobility, Sitting, Sit-to-stand, Standing and Walking) according to their current MRMI scores. Stroke treatment library, a standardized exercise prescription manual was developed to facilitate the prescription of standardized interventions and optimize the level of difficulties.
Result & Outcome :
Functional outcomes of stroke patients in TPH during 4Q18-3Q19 (Before COVID19, N=357) and 4Q20-3Q21 (New norm after COVID19 with IT-enhanced approach, N=272) were analyzed. Patients who received the IT-enhanced approach had significant within-group improvement in MRMI, Berg’s Balance Scale (BBS) and MFAC (p< 0.001) and between groups difference in MRMI gain (Before COVID19: 5.3 vs New norm: 6.3, p< 0.040). The mean changes of MRMI, BBS and MFAC were 6.3 (Pre:15.7 vs Post: 22.0), 8.1 (Pre: 13.2 vs Post: 21.3) and 0.8 (Pre: 2.7 vs Post: 3.5) respectively despite the gym training intensity was decreased from 1.5 to 0.95 hours due to the stringent infection control measure under COVID19 and staff experience decreased by 10 years. In 4Q21-3Q22 (N=333), the improvement in functional outcomes was sustainable with MRMI gain was 5.9 while the mean changes of BBS and MFAC were 7.9 and 0.8 respectively. The predictive model of MRMI gain and the standardization of interventions demonstrated its effectiveness with an improvement on functional outcomes despite the decreased training intensity under COVID19 and staff experience much decreased.
