Authors (including presenting author) :
Kwok WH (1), Chan YCD (2), Chung YL (1), Chong CM (1), Kwok YK (2), Lam YSS (2), Wai YYH (2), Leung KLK (2), Cheung HF (1)
Affiliation :
(1) Department of Psychiatry, Kowloon Hospital, (2) Department of Physiotherapy, Kowloon Hospital
Introduction :
Patient falls are often ranked in the top three in the risk registry of the Department of Psychiatry of the Hospital Authority public hospitals. The gait weakness of adults with mental health conditions is partly associated with the adverse effects of psychotropics, psychomotor impairments, and hospitalisation-related functional decline. Only a few clinical improvement projects using an interdisciplinary approach for fall prevention training in the local psychiatric inpatient setting were evaluated and disseminated. Additionally, literature revealed that adequate physical exercise would help to improve the sleep quality of psychiatric service users. Therefore, a ward-based enhanced collaborative limb exercise training programme was implemented to strengthen adult psychiatric inpatients' physical and mental well-being.
Objectives :
To examine the feasibility and effect of a tailor-made fourteen-day enhanced collaborative exercise programme for adults with mental health challenges in the acute psychiatric inpatient setting.
Methodology :
A parallel two-group quasi-experimental pre-and-post feasibility study was conducted in a female adult psychiatric admission ward of Kowloon Hospital from April to June 2024. All newly admitted service users, who aged 18-64 and were at high fall risk upon admission, were screened and allocated to the enhanced collaborative exercise programme (i.e., intervention group) and treatment as usual group (TAU), based on the alternative day of admission. The participants in the intervention group received a consecutive fourteen-day enhanced exercise programme, while the participants in the TAU received usual, unstructured morning exercise. The enhanced collaborative exercise programme consisted of (i) a circuit exercise training, including balance training with Sensbalance board, virtual reality aerobic exergaming with multi sensory interactive components, strengthening exercise with Theraband, and gait training exercise implemented by physiotherapists on weekdays, and (ii) fall prevention group education, a 15-minute limb mobilisation and strengthening exercise with video demonstration implemented by nurses on weekends or public holidays. Overall programme logistics and ward therapeutic and safety settings for the enhanced exercise programme were facilitated and monitored by nurses throughout the whole project. The Wilson-Sims Fall Risk Assessment Tools (WSFRAT), Modified Functional Ambulation Classification (mFAC), Handgrip strength test (HGS), 30 seconds sit-to-stand test (30CST), functional reach test (FRT), 2-minute walk test (2MWT), and Insomnia Severity Index (ISI) were measured at posttreatment to evaluate the immediate treatment effect of the exercise programme. Linear and logistic regression controlling the baseline outcome data were used to analyse the between group treatment effect in the continuous and binary outcome data, respectively. The feasibility of the programme was assessed by the attrition rate and the qualitative feedback from the participants in the intervention group.
Result & Outcome :
In total, twenty-five psychiatric adult inpatients (mean age = 43.90, SD = 12.35) participated in this programme. Nine were allocated to the intervention group, and no dropouts were noted. The exercise programme significantly reduced the gait speed (B = -0.411, p = 0.03), level of insomnia (B = -0.523, p = 0.014), and fall risk by clinical judgement (OR = 0.083, 95% CI = 0.007, 0.950). All participants in the intervention group showed appreciation for the programme and felt satisfied with the programme’s logistics and arrangement.
