Authors (including presenting author) :
ChowKT(1), WooCW(1), LeeKF(1), ChowSL(1), WongFY(1), ChanKS(1), TamKY(1), WongTF(1), ChengS(1), ChanKT(1), ChauMW(1)
Affiliation :
(1)Physiotherapy Department, Kowloon Hospital
Introduction :
COVID-19 pandemics had significantly revamped the usual practices of existing health care system and utilization of health care resources across multidisciplinary context in Hong Kong, also impacting stroke rehabilitation. COVID-19 associated stroke patients suffered from higher mortality rate, increased severity of disability and global cognitive impairment and eventually a higher odd for institutional care. All these challenges contemporary stroke rehabilitation including 365-day stroke rehabilitation.
Objectives :
This retrospective cohort study aimed at comparing stroke patients with and without comorbid COVID-19 in terms of functional outcome, length of stay (LOS) and discharge destination undergoing 365-day stroke rehabilitation informing clinical practice in meeting patients’ needs.
Methodology :
Stroke patients (ICM-9-CM Principal Diagnosis Code 430-436) with and without comorbid COVID-19 who were admitted for 365-day stroke rehabilitation services from January to August 2022 were included. Outcome measures including Modified Functional Ambulation Classification (MFAC), Modified Rivermead Mobility Index (MRMI), Modified Barthal Index (MBI), LOS and discharge destination upon admission and discharge were analyzed.
Result & Outcome :
26 pairs of age-gender matched stroke patients (COVID-19 and non-COVID-19 control arms) were identified. No significant between-group differences in age, types of strokes, admission MFAC, but significantly lower admission MRMI (11.73±4.99vs16.04±8.71,p=0.035) and MBI (24.73±14.60vs39.50±24.15,p=0.011) were found at baseline in COVID-19 group. Both groups demonstrated significant and comparable within-group improvements (p<0.05) in discharge MFAC, MRMI and MBI, but no significant between-group differences in discharge MFAC (p=0.233), MRMI (20.98vs23.60,p=0.248) and MBI (51.63vs52.99,p=0.737) were found after controlling for covariates of admission MRMI and MBI. Both groups also demonstrated no significant difference in LOS and discharge destination. Results showed that stroke patients with comorbid COVID-19, though more impaired at onset, could benefit from 365-day stroke rehabilitation with comparable functional improvement. The higher complexity in disease nature of stroke patients with comorbid COVID-19 did not depreciate the effective delivery of stroke rehabilitative services as manifested by comparable LOS and discharge pathway. The additional material and human resources for upholding infection control measures and enriched stroke physiotherapy program were justified as effective enablers to alleviate the barrier for access to rehabilitation for the more crippled stroke patients with comorbidity of COVID-19. Study results incentivize active and intensive stroke rehabilitation during the continuing COVID-19 pandemics.
