Authors (including presenting author) :
Chan JSP, Chow ESL, Lee SKF, Wong TFW, Chan MYL, Lam KHM, Lee JKY, Chow KKT, Chan SH, Chak NNT, Chan MMY, Chau RMW
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
A weekend physiotherapy service for patient with stroke has been introduced for two-month at Kowloon Hospital(KH) since October 2019.
Objectives :
The aim of the present study was to investigate a change in restorative physiotherapy provision from a non-365-day to 365-day service on both functional mobility, activity and hospital length of stay(LOS) for stroke in KH.
Methodology :
Patients with stroke receiving weekday-rehabilitation (period 1:1/10/2018-31/3/2019) and 365-day rehabilitation (period 2:1/10/2019-30/11/2019) admitted to rehabilitation-ward of KH were recruited. Subjects was included if they had principal-diagnosis of stroke ICD9 code ranged from 430-436 and excluded if out-of-range.
The score of Modified-Functional-Ambulation-Classification(MFAC), Modified Barthel Index(MBI), Modified Rivermead Mobility Index(MRMI) were rated by in-charge Physiotherapist on-admission and at-discharge. The total LOS in KH was assessed. SPSS23.0 was used to evaluate the outcomes measures.
Result & Outcome :
Data of 157 patients with stroke aged 68.6±13.73years were analyzed. 41.4%(N=65) was female and 59.2%(N=93) diagnosis from cerebral-infarction.
Results of Wilcoxon-Signed-Ranks test revealed that all outcomes improved at discharged including gain-score from MBI 23.91±16.97(N=157, p< 0.05), MRMI 9.61±6.66(N=157, p< 0.05) and MFAC demonstrated a median progression of 2(N=157, p< 0.05). Majority (82.17%,N=129) of discharge destination were home.
The results of Mann-Whitney test revealed no difference of the change score of MBI among two groups(p≥0.05). At discharge, MBI in non 365-day was 73.19±25.60(moderate dependency) and in 365-day rehabilitation was 68.03±28.93(moderate dependency). There was no difference of the change score of MRMI among two groups(p≥0.05). At-discharge, MRMI in non-365-day was 30.64±8.77 and in 365-day rehabilitation was 26.97±10.70. There was no difference of the change score of MFAC among two groups(p≥0.05). At discharge, MFAC median-score of both groups was category 5. There was a 6-day reduction for the 365-day-group(29.84±13.19 for non-365-day;23.77±9.14 for 365-day;P< 0.05) in hospital LOS.
Provision of intensive 365-day rehabilitation service for stroke resulted in earlier achievement of functional mobility and activities gain within shorter LOS. The 365-day Physiotherapy rehabilitation achieved anticipated benefits of enhanced patient flow along clinical pathway with continuity and minimized patient idle time.
