Authors (including presenting author) :
Lam HW(1), Soo KW(1), Lam CM(1), Cheung TY(1)
Affiliation :
(1)Occupational Therapy Department, Tuen Mun Hospital
Introduction :
Conventional Occupational Therapy (OT) stroke rehabilitation training program was provided on weekdays but was limited on weekend and public holidays. In order to provide seamless rehabilitation training and facilitate early and safe discharge of patients. Stroke 365 days program was commenced since October 2019 in Tuen Mun Hospital (TMH). In Stroke 365 days program, additional restorative OT functional training program is provided in rehabilitation wards. With the increase in dosage of rehabilitation training, functional recovery for patients was expected to be enhanced (Lang, Lohse & Birkenmeier, 2015).
Objectives :
To study relationship of stroke 365 days OT training program with activities of daily living (ADL) and upper limb (UL) functional recovery in Rehabilitation Stroke Unit of Tuen Mun Hospital.
Methodology :
Stroke patients admitted to TMH receiving Stroke 365 days OT training program during 1 October 2019 to 30 September 2020 were recruited. Outcome measures included Modified Barthel Index (MBI) and Functional Test for the Hemiplegic Upper Extremity (FTHUE). Data driven included admission to acute stroke unit (ASU) and rehabilitation stroke unit (RSU), and upon discharge. Total number of additional OT services was counted. Spearman’s rho correlation was applied to analyze the correlation of the service provision with change in MBI and FTHUE during hospital stay in rehabilitation wards.
Result & Outcome :
391 patients aged 66.9±37.1 were recruited. 210 of the subjects were male and 181 were female. In ADL functional recovery, the subjects on admission were stratified into 3 subgroups for data analysis. The subgroups are major impairment (MBI score 0-40/100), mild-to-moderate impairment (MBI score 41-85/100), and nil-to-minimal impairment in ADL (MBI score 86-100/100). The additional number of OT training sessions on Saturday, Sunday and public holidays was found significantly correlated with change in MBI in rehabilitation wards for the major impairment group (n=168, rs=0.425, p< 0.001) and mild-to moderate impairment group patient (n=207, rs=0.313, p< 0.001). For the major impairment and mild-to-moderate impairment group, mean number of additional OT training session was 4.83 (SD=4.44) and 4.26 (SD=3.28) respectively. The mean change in MBI score of the subjects during hospital stay were compared with conventional stroke training program during 1/4/2019 to 31/3/2020 in TMH (data obtained from Allied Health Rehabilitation Program Report (AHRPR) on Stroke In-patient Service). In Stroke 365 days program, the mean MBI change for the major impairment and mild-to-moderate impairment group was +27.8 and +13.2 respectively, while those in the conventional stroke training program was +19.2 and +11.5 respectively. The mean MBI change showed a better improvement in ADL function in Stroke 365 days program. In UL functional recovery, the subjects were stratified into 3 subgroups. The subgroups are major impairment (FTHUE level 1-2), moderate impairment (FTHUE level 3-4), and mild impairment in UL function (FTHUE level 5-6). The additional number of OT training sessions on Saturday, Sunday and public holidays was found significantly correlated with change in FTHUE in rehabilitation wards for major impairment group (n=130, rs=0.328, p< 0.001) and mild impairment group (n=57, rs=0.339, p< 0.05). For the major impairment and mild impairment group, mean number of additional OT training session was 5.25 (SD=4.60) and 4.46 (SD=3.49) respectively. The mean change in FTHUE level for the two groups during hospital stay was +1.37 and +0.60 respectively. The results showed the ADL and UL functional recovery of stroke patient increased with OT training intensity, which was the most significant for patient with major impairment (MBI score 0-40 and FTHUE level 1-2). With further continuous monitoring of outcomes, a new service model could be developed to meet the high demand of stroke rehabilitation services and patients’ needs in different functional level during their rehabilitation journey.
