Authors (including presenting author) :
Cheung KY(1), Cheung TY(1),Lam CM(1), Lam HW(1), Cheng YC(1)
Affiliation :
(1)Occupational Therapy Department, Tuen Mun Hospital
Introduction :
Stroke is a major cause of morbidity and mortality in Hong Kong (NCDW CHP, 2021). Studies showed that more intensive rehabilitation promotes functional recovery of stroke patient (Winstein, 2016). However, conventional home-based rehabilitation programs are associated with low compliance and high dropout rates (Zondervan, 2016). As tele-communication devices are becoming more popular worldwide, many countries use this technology as media for rehabilitation (Sarfo, 2018). Facing COVID-19 pandemic in Hospital Authority, enhancement on monitoring and compliance of home program have been accelerated recently. Therefore, this study aims to evaluate the effectiveness of home-based tele-care rehabilitation for stroke out-patients’ functional recovery.
Objectives :
1) To improve stroke patient’s functional recovery; 2) to reduce patient and carer’s stress by adopting tele-rehabilitation in home program training
Methodology :
A single-blind RCT design was adopted to compare the outcome measures of Tele-Rehab group (experimental group) with Conventional group. Subjects were recruited from Occupational Therapy Out-patient clinic for stroke rehabilitation in Tuen Mun Hospital. All subjects were conducted initial assessment on 2nd week of the study. For Tele-Rehab group , home program for upper limbs functional training and ADL were prescribed via HA GO Apps and /or printed handout, then 12-week weekly home-based tele-rehabilitation were arranged. Whereas Conventional group started regular out-patient training from 8th week of the study.
The outcome measures were obtained at three timepoints for all subjects (1st, 6th and 12th week), including 1) primary outcomes: Modified Barthel Index, Functional Test for the Hemiplegic Upper Extremity and Action Research Arm Test; 2) secondary outcomes: Patient Psychological State and Carer Stress.
Result & Outcome :
From July 2020 to July 2022, 25 stroke patients were recruited. 48% of them were males. 13 subjects dropped out due to disease recovery or default follow-up. In tele-rehab group, there was significant improvement in MBI (Chi-square = 9.294, p = 0.010) and ARAT-Pinch score (Chi-square = 9.238, p = 0.010) at 6th and 12th week. The mean changes for MBI were +4.4 and +6.3, and that for ARAT-pinch score were +2.0 and +2.6 at 6th and 12th week. In conventional group, no significant improvement in any outcome measures was found. The mean changes for MBI were +1.2 and +2.8, and that for ARAT-pinch scores were +2.0 and +2.4 at 6th and 12th week. Conclusion : Utilization of tele-rehabilitation for OT stroke rehabilitation home program effectively improves patient’s ADL and fine hand function when compared with conventional home program. Tele-rehabilitation could be an adjunctive intervention to connect patient in community with hospital care and empower patient for self-management care.
