Authors (including presenting author) :
Tam RWL
Affiliation :
Medical and Geriatrics Department, Tuen Mun Hospital
Introduction :
Stroke is the second most common cause of death, leading to the death of about 5.5
million every year. Stroke is also the second most common cause of disability
worldwide. To achieve a better functional outcome for stroke survivors, early and
intensive stroke rehabilitation was strongly recommended during acute and subacute phases. COVID-19 coronavirus infection was first discovered in late 2019. Within a short period of time, the number of infected patients rose rapidly across worldwide, resulting in a COVID-19 pandemic. The outbreak of COVID-19 has had an enormous impact on public health and healthcare systems globally, including stroke rehabilitation.
In view of strict infection control measures and manpower shift during COVID-19 period, both inpatient and outpatient stroke rehabilitation services, regarded as less essential services, were being trimmed down or even closed. The provision of inpatient stroke rehabilitation has also been adversely affected by stringent protocols such as limited patient intake, restricted access to gym facilities, and prohibition on visitation.
Additionally, hospital-based-outpatient services have been compelled to shut down to prevent the spread of COVID-19 between hospitals and the wider community. Stroke rehabilitation during the pandemic has been a global challenge and has been shown to be negatively impacted by COVID-19 pandemic in different parts of the world. As a result, the rehabilitation of stroke patients were being compromised and hampered optimal recovery.
Objectives :
The purpose of this study was to examine the impact of COVID-19 pandemic on stroke rehabilitation outcome in a local rehabilitation centre in Hong Kong. Sharing and documenting these experiences and problems faced during the pandemic may hopefully
help in guiding the development of strategies to meet the need of stroke rehabilitation service during challenging times such as another infection outbreak, therefore to ensure that stroke survivors receive the care they need to achieve optimal recovery.
Methodology :
This is a retrospective case-control cohort study to evaluate the rehabilitation outcomes for first ever stroke patients who were able to perform BADL independently before stroke and were admitted to Acute Stroke Unit (ASU) then transferred to RSU of Tuen Mun Hospital (TMH) in Hong Kong during early COVID-19 pandemic in March to August 2020 (first and second wave of COVID-19 pandemic in Hong Kong).
The list of stroke patients was retrieved from a local public healthcare system database - Clinical Data Analysis and Reporting System (CDARS) according to inclusion and exclusion criteria.
A cohort of first ever stroke patients with
independent daily living who transferred to Rehabilitation stroke Unit (RSU) during the pandemic were recruited and compared with stroke patients who were admitted in pre-COVID period in 1:1 ratio. The data on baseline characteristics and rehabilitation outcome was collected and compared.
Result & Outcome :
A total of 160 stroke patients were recruited with 80 patients in pandemic group and 80 patients in pre-COVID group (control group).
There was no significant difference in baseline characteristics between two groups.
Family engagement in rehabilitation before and during pandemic was also compared. Before the COVID pandemics, families of stroke patients were engaged as a team member in our rehabilitation programme. They were allowed for frequent visitations and would be provided with training for caregivers organized by physiotherapists and occupational therapists. In this study, families in the pre-COVID group were observed to be engaged in carer-skill training 6 days earlier than that during the COVID-19 pandemic. The mean
time from RSU admission to the first date of carer training was 18.40 ± 17.50 days and 12.12 ± 7.26 days in the pandemic and pre-COVID group respectively (p=0.036). In addition, the pre-COVID group caregivers were associated with higher number of carer training sessions received during the RSU stay (p=0.035). One fifth of pre-COVID cohort caregivers had >2 sessions of carer training compared to only 6.3% in the pandemic cohort group. More caregivers in pandemic cohort received 1 to 2 sessions of carer training as compared with the pre-COVID cohort (63.8% vs 52.5%). Significant delay and fewer training sessions to caregivers was observed during the pandemic.
For the results, first MBI score measured in RSU was similar in both groups with significant lower MBI score in pandemic group upon discharge (p=0.023). Pandemic group was associated with significant reduced effectiveness (Difference of MBI on transferal to RSU and on discharge) (p=0.006), with
5 fewer points gained in MBI. Efficiency (effectiveness divided by length of stay (LOS) in RSU) was not significantly different between two groups. For stroke rehablitation after discharge, more patients ultilised non-hospital setting and single disciplinary rehabilitation services in pandemic group. Significantly fewer patients achieved mRS ≤2 in pandemic group at 6 months follow-up (p=0.028).
