Authors (including presenting author) :
Leung KKL, Lau MHL, Lam CPY, Chau RMW
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
COVID-19 pandemic has been posing unprecedented challenge to ambulatory healthcare services including physiotherapy since patients with musculoskeletal conditions might refrain from hospital visits amid pandemic leading to delayed intervention(Hsieh et al.,2021). In tackling abrupt huge surge in inpatient service demand, healthcare systems worldwide are obliged to reallocate resources channeling from non-essential and non-emergent services,e.g. musculoskeletal services, towards COVID-19 services(Phillips et al.,2020;Lai et al.,2021;Wong et al.,2020). Service monitoring is pivotal in ensuring accountable scaled down ambulatory service with minimal patient’s impact.
Objectives :
To investigate the impact of COVID-19 on rehabilitation outcomes of scaled ambulatory musculoskeletal PT service for service monitoring and reorientation.
Methodology :
A three-year longitudinal analysis was conducted to evaluate the impact of COVID-19 on pain reduction and self-reported recovery of musculoskeletal patients discharged from Outpatient Physiotherapy Department of Kowloon Hospital. Data set of target patients with discharge during pandemic(1.1.20 to 31.12.21) were compared with pre-pandemic baseline(1.1.19 to 31.12.19). Process data of post-referral patient booking, PT waiting time and total attendances were captured.
Result & Outcome :
Data of 13,599 discharged patients(pre-pandemic-6,891versus6,708pandemic) were included. Interval of referral to patient’s booking were increased for all three patient categories(urgent,semi-urgent and stable cases). The waiting time for stable cases was stretched due to scaled service. During pandemic, the waiting time for all urgent cases were maintained. All patients achieved statistically significant and clinically meaningful pain reduction after physiotherapy(p<0.001) with bigger pain reduction during pandemic time. Nonetheless, self-reported recovery was impacted(78.91±11.46% in pre-pandemic versus77.12±11.47% during pandemic). The average Outpatient attendances increased by ~1 session in non-urgent categories(p<0.001) during pandemic. Our findings revealed that the pandemic deterred musculoskeletal patients in seeking physiotherapy. Pandemic measures in ambulatory service scaling down impacted stable patients in access to PT intervention with increased waiting time and total attendances required to achieve desired outcomes. With dynamic service monitoring & reorientation, comparable significant treatment outcomes in pain reduction was assured during pandemic. The finding of decreased self-reported recovery despite increased pain relief in patients during pandemic flagged concerns as reported in medical literatures, on other non-physical domains, such as psychological and social factors, for holistic total patient care in musculoskeletal condition management(Choi et al.,2020;Oi et al.,2020) while contextual environmental and psycho-social factors were not conducive for recovery. Multidimensional self-management programme, encompassing home exercise, healthy lifestyle, and patient empowerment adopting digital technology to safeguard social distancing with reduced infection risk, were feasible adjunct for musculoskeletal rehabilitation during this ongoing COVID-19 pandemic(Rawlinson et al.,2021; El-Tallawy et al,2020).
