Authors (including presenting author) :
Yuk KL(1), Ho CYS(1), Kung CC(1), Ma CKM(1), Wu YP(1), Chen WPW(2), Wong KC(2), Mak JHT(2), Tai WY(2), Chan DWC(2), Ip KWM(2), Yue ASY(2), Wong LSY(3), Li CSK(3), Chan CCC(3), Chan PFL(3), Lam SSL(3), Cheung SY(1), Lau M(2), Chiang WKH(3), Tang MWS(1)
Affiliation :
(1) Department of Medicine and Geriatrics, Shatin Hospital (SH), (2) Occupational Therapy Department, SH, (3) Physiotherapy Department, SH
Introduction :
At Shatin Hospital, the multi-disciplinary PRPs have been developed since December 2020. Patients with principal diagnosis of acute exacerbation of COPD were triaged to the designated PRP wards where they would receive a multi-disciplinary programme (Basic PRP) and undergo symptom control and rehabilitation trainings. A continuity-of-care concept was implemented throughout the patient journey, from in-patient (ward-based) to intermediate training through Geriatric Day Hospital (GDH), and finally back to their living environment (community-based). Our PRPs aim to reduce unplanned readmissions and empower patient self-management.
Objectives :
To review the effectiveness of the multi-disciplinary Basic and Enhanced PRPs for patients with COPD admitted to a convalescent and rehabilitation hospital
Methodology :
A retrospective review of PRP rehabilitation outcomes and services data was performed for the period of January 2023 to October 2024. For patients satisfying selection criteria of MoCA -5 ≥7th percentile, MFAC ≥Cat 3, quitted smoking and ready to make changes in their lifestyle, they would be recruited under the multi-disciplinary self-management group (Enhanced PRP). Patients in Enhanced PRP group would on top of Basic PRP group learn more about self-management, coping techniques in daily self-care and lifestyle changes, as well as incorporating exercise habits in their daily lives. Two-way repeated measure ANOVA was used to examine the effectiveness of the two PRP groups. Paired t-tests were used to evaluate physical and functional outcomes.
Result & Outcome :
A total of 164 and 25 patients with mean age of 79±8.5 years and 73±8.9 years were recruited under the Basic and Enhanced PRP respectively. Results showed that the ALOS of both Basic (14.2 days) and Enhanced (12.7 days) groups were less than that before program establishment (14.7 days). 28-day unplanned readmission rates of Basic and Enhanced groups were 29.7% and 0% respectively, which was lower than that before program establishment (38.4%). Two-way repeated measure ANOVA suggested that patients under both Basic and Enhanced PRPs had improvement in Modified Barthel Index (p=0.002), and Modified Medical Research Council Dyspnea Scale (p <0.05) with interaction effect, suggesting Enhanced group had a greater improvement than the Basic group. A pre- and post-test design was further applied to investigate programme effectiveness. Significant improvements were found in both physical and daily functional abilities in Monitored Functional Task Evaluation (p <0.001), rate of perceived dyspnea (p <0.001) in bathing. Physical functions including Modified Functional Ambulatory Category, 6 Minute Walk Test, Elderly Mobility Scale, 30 Second Chair Stand Test and hand grip strength all showed significant improvements with p <0.001. Moreover, significant improvements were also found in disease specific health-related quality of life (COPD Assessment Test, p=0.001, CRDQ, p=0.009-0.029) and knowledge (p <0.001). Conclusion - With the concerted effort of our multi-disciplinary team, we demonstrated benefits to COPD patients under both Basic and Enhanced PRP groups. Our PRPs could improve patients’ physical function, health-related quality of life and disease knowledge. Our PRPs have potential to further reduce patients’ ALOS and 28-day unplanned readmissions.
