Authors (including presenting author) :
Li TLC(1), Hung KN(2), Fong NK(3)
Affiliation :
(1)The Occupational Therapy Department, Haven of Hope Hospital, (2)TWGHs Early Child Services/Ma Kung Lin Chi Child Development Center, (3)Rehabilitation & Sciences Department, The Hong Kong Polytechnic University
Introduction :
In Hong Kong, there is an increasing trend of geriatric hip fracture incidence, based on the data from 2000 to 2006. Although, 98% of the geriatric hip fractures are managed in the hospital, less than half of the hip fracture patients will regain the pre-fracture physical and functional ability which encompass the patient’s mobility, activities of daily living performance, and subsequently the potential increasing risk for falls . Tele-rehabilitation (TR) is a branch of telemedicine. Telemedicine incorporates direct clinical, preventive, diagnostic, and therapeutic services and treatment; consultative and follow-up services; remote monitoring of patients; rehabilitative services; and patient education. TR refers to the use of information and communication technology to provide rehabilitation services at a distance . World Federation of Occupational Therapists acknowledges telerehabilitation (TR) is an appropriate service delivery model for occupational therapy services. Participants and caregivers were satisfied and had positive attitudes towards the use of TR in occupational therapy services. Recent reviews found that TR had similar clinical outcomes when compare to face-to-face rehabilitation service in varied pathology and impairment. As a matter of fact, strong to moderate grades of evidence in motor recovery in post orthopaedic surgery in lower limbs after application of TR were found. However, it is not known whether the use of smartphone technology to delivering home programme for patients after hip fracture in combination of out or day patient rehabilitation is feasible due to the intense popularity of smartphone and advancement of mobile technology. Limited literatures studied the effectiveness of TR in occupational therapy. However, there have been no studies assessing the effectiveness of home programme in occupational therapy through tele-rehabilitation for older adults after hip fracture surgery. Therefore, the purpose of this study was to investigate the effectiveness of a home-based programme through a TR intervention using Caspar system as compared to paper instructions for older adults receiving day hospital rehabilitation after hip fracture surgery in Hong Kong. This study hypothesized that using TR for home programme is more effective on enhancing older adults’ motor and functional performances, and daily functioning, as well as their fall efficacy than those receiving home programme via paper-and-pencil instructions in day hospital rehabilitation.
Objectives :
To investigate the effectiveness of a home-based tele-rehabilitation intervention for older adults receiving day hospital rehabilitation after hip fracture surgery in Hong Kong.
Methodology :
This was a feasibility randomized controlled trial with two groups – experimental and comparison groups, in a sample of 31 older adults after hip fracture surgery within 12 weeks attending the Geriatric Day Hospital. Participants were assessed at baseline, post 3-weeks intervention, and 3-weeks follow-up for motor performances, daily activities functioning and fall efficacy. The experimental group received home programme using the Caspar tele-rehabilitation (TR) e-system through the use of mobile apps, while the comparison group received paper-and-pencil instructions for the home programme on weekly basis, for 3 weeks.
Result & Outcome :
Significant improvement in fall efficacy and instrumental activities of daily living (IADL) performance in post-test and follow-up were found in the experimental group than the comparison group. However, inadequate social support was a factor to contribute to better muscle strength testing in both affected and non-affected legs of the comparison group. There were no significant differences in other variables between the two groups. The results of the utility questionnaire showed that 93% of the participants using TR would choose using mobile apps compared to visiting hospital for rehabilitation.
