Authors (including presenting author) :
Yuen WY(1), Cheng CK(1), Wu A(1)
Affiliation :
(1)Occupational Therapy, Caritas Medical Centre
Introduction :
Caritas Medical Centre had launched a total knee replacement (TKR) Fast Track Program since June 2017. It was a multi-disciplinary program with the collaboration from Orthopaedic surgeon, anaesthetist, nurse, physiotherapist and occupational therapist. Early pre-operation assessment in out-patient phase as well as early in-patient and out-patient intervention would be arranged.
Objectives :
This project aimed to review the functional outcomes by comparing patients’ performance in different time period.
Methodology :
For patients being recruited into the program, the Occupational Therapist Department would provide fast track pre-operation assessment, pre-operation education as well as in-patient and out-patient intensive training.
In the pre-operation phase, general physical assessment, cognitive assessment and home exploration would be included. In functional aspect, it was assessed by Modified Barthel Index (MBI) and Lawton Instrumental Activity of Daily living scale (Lawton-IADL ) as well as the Hong Kong Knee Injury Osteoarthritis Outcome score (HK-KOOS).
Patient’s condition was re-assessed in pre-discharge, post-operation 6/52, post-operation 3/12 and post-operation 6/12 respectively. The performances in different time point were compared by paired t-test and Wilcoxon signed ranks test.
Result & Outcome :
From June 2017 to February 2019, 75 cases attended the pre-op assessment. The age ranged from 53 to 81 years old, with a mean age 68 years old. Among all the 75 cases, 22 of themcompleted the whole program. The mean length of stay was 15.6, which was significantly different from the mean before the program (mean length of stay 21 from Jan 2012 to March 2017) (t=5.97, p< 0.001). For functioning aspects, cases achieved the pre-morbid MBI score and Lawton-IADL score in post-operation 6/52 and post-operation 3/12 respectively. When comparing the HK-KOOS score in post-operation 6/12 with pre-operation, it improved in the symptom sub-score (t=5.399, p< 0.001), pain sub-score (Z=4.078, p< 0.000) and ADL sub-score (Z=4.108, p< 0.001) by 40% to 60%, and improved in the sports sub-score (Z=4.020, p< 0.001) and quality of life sub-score (t=6.533, p< 0.001) by over 100%. The results showed that despite a decrease in hospital lenght of stay, the program could proviude an effective functional recovery and enhance patients’ of quality of life.
