Authors (including presenting author) :
TSUI TS(1), LAM WT(1), MAN YC(1), WONG HY(1), WAN KH(2), LAM YT(3), LAU WLC(1), CHAN YL(1)
Affiliation :
(1) Occupational Therapy Department, Kowloon Hospital (2) Occupational Therapy Department, Wong Tai Sin Hospital (3) Occupational Therapy Department, Queen Elizabeth Hospital
Introduction :
Hospital Authority launched ICDS 2.0 program in October 2023, expanding services to include stroke and hip fracture patients. This initiative aims to enhance discharge support and provide home-based rehabilitation for frail elderly individuals, empowering caregivers and improving their quality of life during rehabilitation.
Objectives :
1. To investigate post-discharge challenges faced by stroke and hip fracture patients and interventions provided by OT case managers. 2. To evaluate the outcomes of OT management for these patients.
Methodology :
Patients with stroke and hip fractures under OT case management from 01/10/2023 to 30/09/2024 were recruited. Pre- and post-standardized assessments for stroke patients include Modified Barthel Index (MBI), Functional Independence Measure (FIM), Lawton Instrumental Activities of Daily Living Scale (Lawton IADL), Montreal Cognitive Assessment (HK-MoCA), Functional Test for the Hemiplegic Upper Extremity (FTHUE), and three-month readmission rates. For hip fracture patients, MBI, FIM, Lawton IADL, Abbreviated Mental Test (AMT), Fall Efficacy Scale (FES), and three-month readmission rates were studied. Paired T-tests were used to evaluate the outcomes effectiveness.
Result & Outcome :
70 stroke patients and 74 hip fracture patients were recruited. Among stroke patients, 90% experienced declines in activities of daily living (ADL), 67% reported limb weakness, 51% indicated memory deficits, 36% faced upper limb functional impairment, and 24% reported hemiplegic shoulder problems. For hip fracture patients, 99% experienced declines in ADL with drop in lower limb strength. 30% reported cognitive declines. Common OT interventions included fall prevention (98%), ADL training (91%), functional balance training (90%), home modification and/or aids prescription (78%), caregiver education (56%) and cognitive training (40%). Specific interventions for stroke patients included upper limb functional training (70%), normal movement pattern training (27%) and hemiplegic shoulder management (23%), while hip fracture patients received hip precaution education (74%) and scar management (11%). All outcome measures showed statistically significant improvements with p value from 0.000 to 0.002. 74% of stroke patients and 81% of hip fracture patients were not readmitted within three months post-discharged from ICDS. ICDS 2.0 program significantly improved rehabilitation outcomes for stroke and fracture hip patients. The readmission reason should be further explored to develop strategies in reducing any avoidable readmission.
