Authors (including presenting author) :
Yeung PY (1), Cheung Y (1), Wu SF (1), Ma KW (1)
Affiliation :
(1) Rehabilitation Day Hospital, Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital
Introduction :
The COVID-19 pandemic has affected health service utilization among older people with chronic health condition, who are particularly vulnerable. They are afraid to attend medical appointments or centre training. In addition, older patients discharged from hospitals are also affected.
To tackle the health threat of COVID-19, telemedicine services have become an alternative. Telemedicine including consultation, education and rehabilitation becomes feasible and effective through videoconferencing. However, not every patient benefits from online learning or tele-rehab. Older people, living alone or with little family support, without a smart phone, iPAD or computer cannot participate in online rehab. In fact, they may not have an internet connection at home. Also, there is no technical support to alert or help them assess tele-rehab. In addition, centre-based training provides physical assessment and treatment, pain relief by therapists. It has different modalities and equipment to assist training. It also facilitates speedy optimization of recovery, regain independence and return to pre-morbidity sooner.
While understanding the importance of face-to-face training, Rehabilitation Day Hospital (RDH) has implemented multiple precautionary measures to minimize the risk of contracting and spreading COVID-19 after resuming training. This procedure helps create a safe environment for older patients and patients with chronic health condition to undergo rehabilitation. Furthermore, day hospital rehabilitation could also facilitate early discharge.
Objectives :
- To evaluate the feasibility and effectiveness of training conducted by RDH with adoption of multiple preventive strategies.
- To assess patients’ willingness to participate in center-based training under mandatory strict infection prevention measures for COVID-19.
Methodology :
Infection prevention strategies
Actions to safeguard access to rehabilitation, social distancing and training flow have been assessed and re-established. Initially, RDH was designed to provide post-discharge support to patients who need and benefit the most. Until COVID-19 cases declined under infection prevention policies and FDA-authorized COVID-19 vaccines were available, our centre started to train home care elderly.
Statistics
The medical records of RDH participants from May 1, 2020, to March 31, 2021, were collected and evaluated. Patients’ demographics and the number of training sessions were collected. The Barthel Index for activities of daily living (BI), Elderly Mobility Scale (EMS), Six-Minute Walk Test (6MWT), Berg Balance Scale (BBS) and Montreal Cognitive Assessment, Hong Kong version (HK-MoCA) were measured at admission and discharge to assess physical and cognitive functions.
Result & Outcome :
From May 2020 to March 2021, RDH successfully provided safe and effective training to 154 elderly patients with 10 training sessions on average. Patients’ average age was 81.4, among them 64% were female. More than 80% of patients were post-discharge support cases and half of them suffered from fragility fracture. Gratefully, almost 100 percent of referred patients attended our rehabilitation training. About 12 percent of attendants declined further training after first few sessions due to tiredness or transport issue which was like without COVID-19.
On admission, the mean scores of BI, EMS, 6MWT, BBS, and HK-MoCA were 65.4, 11.81, 82.3m, 24.0, and 15.6, respectively. Most patients showed improvement in physical and cognitive function after RDH rehabilitation (mean score increased on discharge; P < .000). Among them, fragility fracture group has remarkable functional improvement with BI average score increased by 10.0, EMS increased by 4.1, 6MWT increased by 129.4m and BBS increased by 11.1.
Conclusion
This study demonstrated that older adults with hip fractures definitely can benefit from day rehabilitation service in terms of functional and cognitive outcomes. As COVID-19 is expected to continue to pose a health threat for some time while Tele-rehab is not suitable for everyone and has its own limitations, RDH was crucial in providing interdisciplinary rehabilitation to elderly with fragility fracture, physical decline after hospitalization and those stay at home with functional limitations and fall risk. Through consistent and multiple preventive measures, RDH can provide safe, face-to-face interdisciplinary training to patients in need.
