Authors (including presenting author) :
Lau SYJ (1), Kong CMA(1), Leung ELE(1), Lai CWJ(1)
Affiliation :
(1)Kwai Tsing District Health Centre
Introduction :
Setting up a District Health Centre (DHC) in Kwai Tsing District (K&T) was a government-initiated pilot programme for enhancing medical-social collaboration in primary healthcare services. In managing chronic disease the DHC aims to strengthen medical services in the community through networking local doctors and reduce use of hospital services. Chronic low back pain (LBP) and osteoarthritic knee pain (OAK) are the targeted musculoskeletal disorders. Clinical practice guidelines for both disorders advocate active exercise approach and enhancing self-management as psychological support. This paper reviewed whether pain management programme can be delivered in the primary setting of K&T DHC.
Objectives :
1) to observe the clinical care path established in K&T community for chronic disease management
2) to observe the feasibility of the musculoskeletal pain programme for LBP and OAK in DHC
Methodology :
This was a pre-post- observational study involving clients living in K&T district with chronic LBP and OAK. Private network medical practitioners (NMPs) referred them to DHC for physiotherapy pain management programme. Individual treatment with an active approach was given. Exercise with diary for back and knee was delivered to clients in their respective conditions, covering mobilisation, strengthening and functional training. Education on self-management included knowledge of the condition, benefits of exercise, pacing techniques and goal-setting. Clients could receive a maximum of 8 and 12 government-subsidized treatment sessions for LBP and OAK respectively. Outcomes included STarT Back Screening Tool (SBST), Brief Pain Inventory (BPI), Roland Morris Disability Questionnaire (RMDQ) and Pain Self-efficacy Questionnaire (PSEQ) for LBP while Knee Injury & Osteoarthritis Outcome Score (KOOS), Self-efficacy for Exercise (SEE) and Chair-stand Test in 30 seconds (CST-30s) for OAK. Paired T-test was conducted for analysis.
Result & Outcome :
As of December, 2020, there were 360 clients referred to DHC. Sixty-seven (39%) out of 172 (76% female) clients with LBP completed the programme with the rest on-going. Fifty-two (28%) out of 188 (79% female) OAK clients completed. Their mean age was 70±9.7. The mean attendance for LBP and OAK was 6.9 and 8.9 sessions respectively. Psychosocial risk (SBST) for LBP at baseline, 22(32.4%) clients were high, 27(39.7%) medium, and 18(26.5%) low. Disability (RMDQ) was 11.37±5.23 at baseline (improved by 3.92±4.92 points post-programme, p=.000). Pain (BPI-pain) at baseline was 4.12±1.70 (improved by 1.03±2.55, p=0.046). Self-confidence to manage pain (PSEQ) at baseline was 39.17±11.35 (improved by 4.21±10.46, p=.006). For the OAK programme, KOOS-pain at baseline was 56.80±19.01 (improved by 18.00±18.05, p=.000). Functional levels of KOOS-PS was 64.78±17.00 at baseline (improved by 7.80±15.96, p=.003). KOOS-QoL at baseline was 44.71±18.86 (improved by 12.73±21.70, p=.001). SEE at baseline was 5.52±2.15 (improved by 0.76±2.18, p=0.038). The Chair-stand Test at baseline was 10.2±4.5 (increased by 4.7 times, p=0.000).
The clinical care path of private sector in pain management was established in DHC. Pain programme for chronic musculoskeletal disorders was found to be feasible with preliminary positive results.
