Authors (including presenting author) :
Chui PF, Tsoi YN, Law HT, Tang HT, So CT, Wong YC
Affiliation :
Occupational Therapy Department, Princess Margaret Hospital, HKSAR
Introduction :
During pandemic period, rehabilitation for stroke patients living in private residential care settings are tremendously deprived from the existing face-to-face out-patient service model due to organizational infection control policy. Limited post-discharge training may lead to unnecessary re-admission due to deconditioning. A hybrid telecare Occupational Therapy (OT) service was developed as an innovative alternative to carry on rehabilitation right after discharge to Old Aged Home (OAH). A collaboration with Multidisciplinary Outreaching Support Team for the Elderly (MOSTE)-OT was initiated to carry-over the training for an extended period to foster the treatment effectiveness.
Objectives :
• To provide continuation of post-stroke OT in residential care settings due to restriction/ limitation of GDH/ out-patient service. • To prevent clinical deterioration while waiting for day-patient/out-patient rehabilitation service. • To collaborate with MOSTE to provide continuation of rehabilitation service in the residential setting.
Methodology :
To set up a “Hybrid” (Face-to-face + Tele-care) program in bridging up the gap while waiting for MOSTE/ out-patient service. Depending on patient’s ability, the program was scheduled with 8 sessions, in which 40% were face-to-face visits by Occupational Therapists (OTs) and 60% were by Supporting Staff (tele-supervised by therapists in hospital) within 1-month period. The target subjects were stroke patients with Modified Barthel Index (MBI) ≥ 40. The training program included empowerment of patients' ADL, facilitation of upper limb function and education of OAH staff in facilitating patients' ADL performance. Prescription / follow-up on the use of HA-GO training videos were provided, whenever applicable, to facilitate practice of learnt skills.
Result & Outcome :
A total of 8 stroke patients were recruited on discharge from PMH. The mean age was 68. The mean sessions provided was 8 sessions, in which 52% of visits were provided by therapists. The outcome indicated that there was significant improvement in MBI (mean diff,: 10.2, p<0.005), but insignificant improvement in Functional Test of Hemiplegic Upper Extremities (FTHUE) (mean diff,: 0.6, p>0.005). Majority of subjects, 7 out of 8 were handed over to MOSTE OTs to continue training under the Medico-Social Collaboration model. Further connection with MOSTE for evaluation on the progress/maintenance effect by their consecutive involvement is pending. With the stringent infection control measures taken and various restraints, the provision of this innovative program had offered continuous service to those deprived patients in OAH with significant clinical improvement shown. In addition, the design of the therapist-led telecare sessions did not jeopardize the training opportunity. Furthermore, this could save therapists much traveling time for other clinical workload.
