Authors (including presenting author) :
Po TF(1), Kwok WY (1)(2), Kaur R(1)(2), Wong KK (1)(2), Wong MF (1)(2)
Affiliation :
Occupational Therapy Department, United Christian Hospital
Introduction :
The first multidisciplinary clinical pathway of knee and hip arthroplasty was established in UCH during the period of 2007-2008. In previous service model, Occupational Therapy (OT) mainly focused on post-operative care which failed in early identification of risk factors for prolonged hospitalization (i.e., poor premorbid functioning, lack of family support and home environmental barriers etc.). Until July 2020, this clinical pathway was further revised after being incorporated as one of the Enhanced Recovery After Surgery (ERAS) program in UCH. Occupational Therapy Prehabilitation (OTP) training program was then developed, aiming at early identification and remediation of risk factors for prolonged hospitalization, as well as functional optimization of the patients before operation for better post-operative outcome.
Objectives :
1. To develop OTP for ERAS program 2. To study the effectiveness of OTP training program in optimizing the preoperative functional status of patients and the length of stay (LOS) for hip and knee arthroplasty
Methodology :
A pretest-posttest study design was adopted. Patients were recruited after completing a brief OT screening 6-9 months before the operation either in the arthroplasty clinic or by patient tracing through a customized electronic dashboard. They will then receive different levels of care according to the risk stratification. For medium-to-high risk patients, they will be triaged for a comprehensive assessment followed by OTP training program for pre-operative rehearsal on adaptive ADL skills and virtual reality-based functional rehabilitation. Some patients will also receive pre-operative community OT for home assessment and modification. Both LOS and the Hong Kong Version of the Knee Injury and Osteoarthritis Outcome Score (HK-KOOS) were chosen as respective service and clinical outcomes.
Result & Outcome :
Of 311 patients with hip or knee arthroplasty between April 2021 and December 2022, 270 patients (86.8%) completed a brief OT screening. 257 patients (95.2%) were classified as medium-to-high risk and were then arranged for a comprehensive OT assessment. 197 patients (63.3%) completed OTP training program with an average attendance of 5.6 sessions. Result showed that there were statistically significant improvement in 3 sub-scores, including Symptoms (p=0.007), Pain (p=0.005) and Sports and Recreation (p=0.017), and overall Total score (p=0.013) of HK-KOOS upon completion of OTP training program. Furthermore, the average LOS of hip and knee arthroplasty patients who have attended OTP program was significantly shorter compared with the unattended group. The average LOS of unattended group vs. attended group in unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients were 2.82 days vs. 1.74 days, 6.38 days vs. 6.07 days, and 7.64 days vs. 6.87 days respectively. Conclusion: This pilot study supported the positive effect of OTP training program under ERAS program in improving overall symptoms and functional status of patients in preoperative phase. Hip and knee arthroplasty patients who have attended OTP training program were observed to have a shorter post-operative LOS than those who were unattended. To maximize the positive effect of the OTP training program, it can be further optimized by increasing the number of training sessions (i.e. from average 5.6 to average 8 sessions) and implementation of Tele-Care in patient education in the future.
