Authors (including presenting author) :
IP YC(1), Au TK(1), Cheng CW(1), Cheung WYW(2), Fung YK(1), Leung YF(2), Tam CL(1), Tang CY(1)
Affiliation :
(1) Physiotherapy Department, TKOH (2) Department of Orthopaedics and Traumatology, TKOH
Introduction :
Escalating service demand for total knee replacement(TKR) after establishment of KEC Joint Centre at TKOH necessitated measures for enhancing patient recovery and empowerment to facilitate safe discharge. Elderly undergoing TKR usually experience difficulties understanding home exercise when reading traditional pamphlets, leading to suboptimal post-operative outcomes. Traditional patient education involves printed material and videos presented separately without clear linkage. Compilation of a brand-new physiotherapy education pamphlet with utilization-monitoring QR-codes linking to different tailor-made exercise and demonstration videos was therefore proposed and implemented in 10/2018.
Objectives :
To assess the effectiveness of QR-coded pamphlet in improving exercise compliance of TKR patients and facilitating post-operative functional recovery
Methodology :
Eighteen audio-visual-supported therapeutic exercise demonstration videos were produced by the joint effort of Physiotherapy Department and Department of Orthopaedics and Traumatology of TKOH. Link-management-enabled-QR-codes were linked to these videos, by which education material utilization could be monitored. This pamphlet was distributed to patients in TKR-prehabilitation workshop from 10/2018 onwards. Patients were encouraged to review and practice selected exercises anytime, anywhere pre-operatively, during in-patient stay and during out-patient phase through their smartphones. Pain(NPRS), knee range-of-motion(knee-ROM) and function measured by timed-up-and-go test(TUG) and 30-second-chair-stand test(30scST) upon discharge from physiotherapy were compared between cohorts in pre-implementation(10/2017-9/2018) and post-implementation(10/2018-11/2019) of pamphlet. Length-of-stay(LOS) was reviewed. Patient satisfaction survey was conducted. Total “click” rate of all videos(CR) was also monitored for the smart pamphlet utilization.
Result & Outcome :
A total of 153 patients(114 post-implementation-group vs 39 pre-implementation-group) completed physiotherapy training at post-op 3-4months. There was no significant difference(p>0.05) in pain(NPRS 1.7 vs 2.8), knee-ROM(100.2deg vs 105.0deg) and functional performance(TUG 13.2sec vs 12.5sec; 30sCST 9.3times vs 9.5times) between post-implementation and pre-implementation groups. Average LOS at 3Q2019 was shorter than 3Q2017(7.14days vs 9.89days). More than 90% of patients satisfied with this pamphlet for the reason of its user-friendliness which could motivate them to perform prescribed exercises by referring to those QR-codes on pamphlet. The fact of patient satisfaction was also supported by the total CR of >1700 between 11/2018 and 11/2019. This service enhancement through compilation of a QR-coded pamphlet was an innovative way to facilitate safe discharge from in-patient and out-patient care despite increasing service demand. This new patient education model could effectively enhance patients’ understanding of TKR rehabilitation journey and improve exercise compliance.
