Authors (including presenting author) :
Mok YT(1), Sham PK (1), Chui KW(1), Leung YYC(1), Wong TWL(2)(3)
Affiliation :
(1) Physiotherapy Department, Princess Margaret Hospital (2) Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University (3) School of Public Health, LKS Faculty of Medicine, The University of Hong Kong
Introduction :
Physiotherapy is an essential part of rehabilitation after stroke, which promotes motor control, functional mobility, and community reintegration. A 365-day physiotherapy service for subacute stroke patients in the extended rehabilitation wards of Lai King Building (LKB) of Princess Margaret Hospital (PMH) was launched in October 2019 which aimed to promote the continuity of physical training on weekends and public holidays, also facilitate patients for an earlier discharge. Additionally, education and skill transfer to care-giver were delivered utilizing tele-communication with post-discharge home visit as indicated during the COVID-19 pandemic.
Objectives :
To evaluate the effectiveness of the 365-day physiotherapy stroke rehabilitation program.
Methodology :
Patients who were diagnosed with stroke (ICD 430-436.99) and received 365-day physiotherapy in LKB of PMH from 1 October 2019 to 30 September 2020 were identified retrospectively via Clinical Management System as the 365-day physiotherapy group. They were compared with patients who attended usual physiotherapy from 1 October 2018 to 30 September 2019 as control group. Clinical outcomes measures including Modified Functional Ambulation Classification (MFAC), Modified Rivermead Mobility Index (MRMI), grip strength, and Timed Up and Go test (TUG) were collected. Total length of stay (LOS) in PMH was retrieved. Besides, a patient’s satisfaction survey was conducted and analyzed upon discharge for patients receiving physiotherapy during weekends and public holidays.
Result & Outcome :
A total of 231 patients received 365-day physiotherapy service with 55% were male (mean age 72.0 ± 0.88). 359 patients were identified in the control group in which 55% were male (mean age 72.7 ± 0.70). There was a statistically significant improvement (p< 0.05) of the MFAC, MRMI, grip strength and TUG with paired sample t-test in both groups. In the 365-day physiotherapy group, the percentage of initial MFAC 3-5 and 6-7 were 39% and 0.9% respectively, and were increased to 55.4% and 6% post-intervention. Scores of the MRMI also improved for 5.66 (p< 0.05). The change indicated an improvement of functional mobility for stroke patients. The grip strength improved for 0.51 kg (p< 0.05) as well. However, there was no statistically significant improvement of clinical outcomes in comparing both groups. Concerning the LOS, it was shorter in the 365-day physiotherapy group (40.9 days) compared with the control group (42.1 days), but no statistical significance could be revealed. There were 20 patients who completed the satisfaction survey and rated 28.5 out of 30. Majority of the patients reflected that 365-day physiotherapy service enhanced their recovery and promoted their confidence to cope with the activities post-discharge. In conclusion, physiotherapy improved the motor performance and shortened the LOS of subacute stroke patients. Moreover, patients showed encouraging satisfaction with the program. Future studies are required to examine the sustainability of functional recovery post-discharge further.
