Authors (including presenting author) :
Yuen LYC, Chan KC, Ho PY, Lee HS, Hui N
Affiliation :
Occupational Therapy Department, United Christian Hospital
Introduction :
Delirium is a neuropsychiatric syndrome commonly observed in acute hospital settings, which often leading to adverse effects on patients’ cognitive and functional performance. Conventional Occupational Therapy (OT) management for delirium includes interventions such as multisensory stimulation, cognitive stimulation, activities of daily living (ADL) training and other reality-engaging activities. These interventions are proven to be clinically effective, yet they are primarily uni-directional and labor-intensive. In light of technological advancement, OT is beginning to incorporate smart devices into patient care, including smart tablets and interactive robots. These devices provide interactive and patient-centered training, while also improve training efficiency by automating tasks that were previously performed manually.
Objectives :
“Smart OT Delirium Program” aims to investigate the effectiveness of using additional smart and advanced rehabilitation training devices, in conjunction with conventional therapy, on improving the delirium features, cognitive function and ADL function of delirium patients.
Methodology :
The “Smart OT Delirium Program” primarily utilized various technology-assisted rehabilitation and non-immersive Virtual Reality (VR) training devices to provide “smart delirium” management for patients. These devices included smart cognitive training tablets, interactive attention training devices and multisensory stimulation therapeutic robots. This study adopted a pre-post clinical outcome measure design. Patients referred to OT with delirium features and 4 A’s Test (4AT) ≥ 4 or Abbreviated Mental Test (AMT) ≤6 between March and November 2024 were eligible for recruitment. All participants received 3-5 sessions of “Smart OT Delirium Training” with each session lasting around 15 minutes. The 4AT was selected to access delirium features; AMT, digit span forward test and Hong Kong Montreal Cognitive Assessment (HK-MoCA) were selected to evaluate cognitive functions; and the Modified Barthel Index (MBI) was selected to access functional performance. All pre-post outcomes data comparisons were conducted using the Wilcoxon Signed-Rank Test.
Result & Outcome :
A total of 37 patients were recruited for the study, with 21 patients transferred to other hospitals or discharged. 16 patients completed the program, with a mean age of 87.5 years old (SD=7.22), in which 31.3% of these patients had previously been diagnosed with dementia. The average number of sessions attended were 4.13 (SD=0.83). After completing the program, improvement in delirium features and overall cognitive function were noted. A significant improvement in mean 4AT by 2.25 score (Z=2.934, P=0.003) were noted. Improvement in alertness and orientation sub-scales were observed in most of the cases. For cognitive function, a significant improvement in mean digit forward span test by 1.437 score (Z=-2.429 P=0.017) and mean HK-MoCA by 1.875 score (Z=-2.691, P=0.007) were noted. Improvement in sustained attention, language and orientation sub-scales were observed in most of the cases. Improvements were also noted in mean AMT by 1.188 score (Z=-1.867, P=0.066) and mean MBI by 3.125 score (Z=-1.886, P=0.066), they were approaching statistical significance. In conclusion, “Smart OT Delirium Program” has been shown to be clinically beneficial to delirium patients with an enrichment of training varieties, enhancement of patient-centered practice and improvement of rehabilitation efficiency. This approach is expected to be a future trend in OT for delirium care, however, larger scale studies with control groups are recommended for future research.
