Authors (including presenting author) :
Wong SM (1), Chung PH (1), Ng CM (1), Wong HL (1), Lo TM (SPT TPH), Lau FO (1)
Affiliation :
(1)Physiotherapy Department, Tai Po Hospital
Introduction :
Walking is one of the most essential functional tasks to determine whether stroke patient can be discharged home safely. Improving walking ability is one of the main rehabilitation goals after stroke. However, the in-patient rehabilitation is limited due to short length of stay. Furthermore, owing to different clinical experience and knowledge, even the practice in ambulation training among physiotherapists may have large variation which may hinder rehab progress.
Objectives :
1. To standardize physiotherapist’s practice of early ambulation for stroke patient in TPH. 2. To enhance patient’s mobility by early standing and walking training during in-patient phase.
Methodology :
The program was implemented in 3 phases. Preparation phase was to develop a standardized stroke rehab program aiming at facilitating early standing and walking training for stroke patients in in-patient rehab setting. It includes: 1) To develop “Stroke Exercise Prescription Manual” based on 5 major domains in functional mobility after literature review by experience physiotherapists; 2) To Standardize “Ambulation Training Regime” (proportion of standing/walking training among all training provided at different stages of functional mobility) and 3) To enrich new standing and walking equipment to facilitate early ambulation. Implementation phase was to commence ASAP program in April 2019. Training session was provided to all clinical staff before program commencement. Evaluation phase was to audit 1) The first standing day of patients after hospital admission; 2) The compliance on ambulation training regime and 3) Functional mobility of patients.
Result & Outcome :
Results 1. A standardized in-patient stroke rehab program “Accelerated Stroke Ambulation Program” (ASAP) was developed in March 2019 2. The mean of first standing day of stroke patients advanced from 3.5 days (April –May 2018 before ASAP) to 2.1 days (April - May 2019 after ASAP) 3. Regarding the compliance of proportion of standing/walking training of stroke patients, physiotherapists of medical team achieved 89.9% compliance to pre-set standard. 4. Regarding functional outcome of stroke patients, the mean Modified Rivermead Mobility Index (MRMI) changed from 3.8 (April to May 2018 before ASAP) to 5.7 (April to May 2019 after ASAP). Conclusion and Recommendation: Preliminary result showed that with the establishment of “Accelerated Stroke Ambulation Program” (ASAP) , early ambulation training could be enhanced and this standardization of practice among physiotherapists will benefit stroke rehab in the in-patient hospitalization stage. The outcome was collected for two months only. Longer period of data collection is recommended to analyze the effect of the program especially on the walking ability of stroke patients.
