Authors (including presenting author) :
Choi YYJ(1), Chui KW(1), Mok YT(1), Leung YYC(1)
Affiliation :
(1)Physiotherapy Department, Princess Margaret Hospital
Introduction :
Parkinson’s disease (PD) is a neurodegenerative disease, leading to increased risk of fall and hospitalization and reduced mobility and autonomy in PD patients. Geriatric Day Hospital (GDH) in Princess Margaret Hospital (PMH) provides multi-disciplinary rehabilitation service while medical treatment can be titrated simultaneously. Physiotherapy (PT) in GDH provides centre-based training as well as community physiotherapy service (CPT) to optimize functional mobility and facilitate reintegration from hospital care to community care.
Objectives :
This review aims to investigate the effectiveness of PT service of GDH rehabilitation on functional mobility in PD patients in PMH.
Methodology :
Forty-five PD patients who had attended GDH rehabilitation from 1st April, 2019 to 1st December, 2020 were recruited. Functional mobility was measured by Timed Up and Go test (TUG), Elderly Mobility Scale (EMS), Modified Rivermead Mobility Index (MRMI) and Modified Functional Ambulatory Category (MFAC). Assessments were performed at first and last GDH sessions. Data was retrospectively retrieved from Clinical Management System. Paired sample T-test was used for result analysis of MRMI and EMS while Wilcoxon Signed-Rank Test was used for results analysis of TUG and MFAC by SPSS.
Result & Outcome :
The mean age of cases recruited was 74.7 ± 8.7. Among the forty-five PD patients, 30 (66.7%) of them were male and 15 (33.3%) of them were female. 31 out of 45 (68.9%) of them has at least one fall episode reported within the past 1 year before the commencement of GDH training. An average of 11.7 ± 7.3 weeks and 15.7 ± 9.1 sessions of approximately 1.5-hour PT training were received by PD patients. 25 sessions of CPT were additionally delivered to 17 indicated PD patients. A significant average improvement of 0.79 was found in EMS (t = -2.54, p = 0.021) with a mean EMS score improved from 9.84 ± 3.63 to 10.63 ± 3.91. For MRMI, an average improvement of 0.20 was observed (t = 0.29, p = 0.80) with a mean MRMI score improved from 26.10 ± 4.84 to 26.30 ± 5.71. The median TUG result remained as 35 seconds (Z = -1.02, p = 0.31) and the median of MFAC remained as class V (Z = -0.28, p = 0.78) at pre- and post-training. Percentage of assisted walker (MFAC class III to V) reduced from 93.3% to 87.2% while that of independent walker (MFAC class VI to VII) increased from 2.2% to 7.7%. This study showed that PT service of GDH rehabilitation in PMH contributed to the improvement and reduction in deterioration in functional mobility in PD patients. Despite an improvement in physical mobility, a potentially higher fall risk in PD cases as indicated by TUG result remained. Thus, reinforcement on fall prevention measures and exercises by CPT is essential. Future study of larger sample size with assessment performed standardized at either on- or off-medication state is warranted.
