Authors (including presenting author) :
WOO CW(1), LEE SKF(1), CHOW ESL(1), WONG TFY(1), LEE JKY(1), CHOW KKT(1), CHAK NNT(1), YU ENL(1), CHAU RMW(1)
Affiliation :
(1) Physiotherapy Department, Kowloon Hospital
Introduction :
Provision of effective levels of rehabilitation is recommended for stroke patients. Rehabilitation with 365-day per year coverage for stroke was introduced in Kowloon Hospital from 1 October 2019.
Objectives :
This retrospective cohort study reports the clinical outcome effectiveness and healthcare utilization of the program.
Methodology :
Data of stroke patients with principle diagnosis of stroke (ICD9 code: 430-436) discharged from 1 October 2019 to 30 September 2021 was drawn from Clinical Data Analysis and Report System (CDARS). Patients who received 365-day rehabilitation (365 group) was compare to those with weekday rehabilitation (weekday group).
For clinical outcomes, changes of scores of Modified-Functional-Ambulation-Classification (MFAC), Modified Barthel Index (MBI), Modified Rivermead Mobility Index (MRMI) were rated by in-charge Physiotherapist on admission and at discharge. Number of physiotherapy attendance and hospital length of stay were used as measures of healthcare utilization.
Result & Outcome :
From 1 October 2019 to 30 September 2020 (2019/20 period), there were 631 stroke patients (N=356 in 365 group). From 1 October 2020 to 30 Sep 2021 (2020/21 period), there were 721 stroke patients (N=350 in 365 group). Patients in 365 group were younger than the weekday group for both periods (2019/20: 68.44±15.09 vs 72.38±14.35, p<0.05, 2020/21: 68.46±13.69 vs 75.34±12.92, p<0.05). There was no significant difference in gender between 365 group and weekday group for both periods (p > 0.05).
For clinical outcomes, patients in 365 group compare to weekday group, have greater changes in scores of MFAC (2019/20: 1.52±1.18 vs 0.82±1.06, p<0.05, 2020/21: 1.35±1.24 vs 0.68±0.93, p<0.05), MBI (2019/20: 26.20±15.45 vs 16.65±13.82, p<0.05, 2020/21: 21.41±16.81 vs 14.56±14.77, p<0.05) and MRMI (2019/20: 10.84±6.78 vs 7.23±6.39, p<0.05, 2020/21: 8.76±6.90 vs 5.10±5.58, p<0.05) even with age as a covariant for both periods.
For healthcare utilization, patients in 365 group received more but not statistically significant sessions of physiotherapy compare to weekday group for both periods (2019/20: 29.00±16.35 vs 26.43±28.10, p=0.18, 2020/21: 27.02±14.93 vs 25.05±27.09, p = 0.22). For length of stay, comparing patients in 365 group to weekday group, with age as a covariant, it was significantly shorter for 2019/20 period (34.42±25.01 vs 39.34±43.16, p < 0.05) and for 2020/21 period (31.35±22.33 vs 36.32±37.77, p < 0.05).
Implementation of 365-day rehabilitation leads to improvement in clinical outcomes and reduce healthcare utilization and suggested for rehabilitation settings.
