Authors (including presenting author) :
So AYC (1), Ng WCW (1), Tsoi KYN (1), Chiu JJH (2), So CT (1)
Affiliation :
(1) Occupational Therapy Department, Princess Margaret Hospital, (2) Department of Medicine and Geriatrics, Princess Margaret Hospital
Introduction :
Post-stroke cognitive impairment is very common (Sun, Tan & Yu, 2014). To assess cognitive performance, Occupational Therapists use various standardized cognitive assessment tools. However, both MMSE and HK-MoCA have their limitations that restrict the clinical application (Chiu et al., 2018). Therefore, the HKBC was developed and validated by CUHK (Chiu et al., 2018) for local patients, especially patients with low educational level.
Objectives :
By using HKBC in this research, it is hoped that the discharge destination of patient with stroke can be predicted in early stage of in-patient rehabilitation. Therefore, the multi-disciplinary team can prioritize patients for early discharge planning according to the cut-off. At the same time, Occupational Therapist can provide specific interventions to facilitate the patient to return home and re-integrate into Community. As HKBC is a relatively new and localized cognitive assessment tool, this is a pioneering study to discriminate home discharge destination by using HKBC after stroke.
Methodology :
This research was approved by Kowloon West Cluster Research Ethics Committee (KWC-REC). HKBC data was collected from patient database retrospectively since January 2020. All patients referred to Occupational Therapy Department with diagnosis of Stroke were included. However, patients who were pre-morbid diagnosed with Dementia or Alzheimer’s disease, or not able to conduct cognitive assessment were excluded in the study. Patients were divided into two groups according to availability of full time caregiver. HKBC was conducted within 7-30 days after stroke. A total of 56 subjects were recruited finally in the study.
Result & Outcome :
For patients with stroke and without full time caregiver, the optimal cut off point of HKBC in discriminating home discharge was 11.0000 with area under curve (AUC) at 0.9907. On the other hand, for patients with stroke and with full time caregiver, the optimal cut off point of HKBC in discriminating home discharge was 5.0000 with AUC at 0.9853.
This study confirmed the highly correlated association of cognitive functioning with discharge destination in patients with stroke, which is consistent with numerous studies conducted previously (Geubbels, Nusselein, VanHeugten, Valentijn & Rasquin, 2015; Van DerZwaluw, Valentijn, Nieuwenhuis-Mark, Rasquin & VanHeugten, 2011). Specifically, it also ascertained that HKBC is a good cognitive assessment tool to discriminate home discharge destinations for patients after stroke.
To conclude, for rehabilitation hospitals, the cut off points resulted from this study can be referenced to facilitate early discharge of patients with stroke by Occupational Therapists and even by multidisciplinary team. In practice, to take it simple and be conservative, despite the availability of full time care giver, HKBC at 11.0 may be referenced as a cut off point in home discharge for patients suffering from stroke.
