Authors (including presenting author) :
Man YL (1), Leung KH (1), Pang NY (1), Lee T (1), Lau S (1)
Affiliation :
(1) Occupational Therapy Department, Pok Oi Hospital
Introduction :
Postural hypotension, characterized by significant blood pressure drops upon standing, can severely affect a patient's functional independence and quality of life. A pilot multidisciplinary program was developed to improve the management of this condition, enhancing patient independence and safety during daily activities. The program includes various therapeutic interventions, with occupational therapists providing ADL and IADL education, aids prescription such as pressure stockings and abdominal binder, and recommending special seating arrangements, home and lifestyle modifications.
Objectives :
The aim of this service review is to evaluate the effectiveness of the program in managing postural hypotension and improving patients' functional abilities.
Methodology :
Pre- and post-intervention data were collected on a range of outcome measures, including the Modified Barthel Index (MBI) score, Abbreviated Mental Test (AMT) score, discharge location, blood pressure changes, sitting tolerance, and the presence of symptoms related to postural hypotension.
Result & Outcome :
16 participants were recruited from a medical convalescence ward at Pok Oi Hospital and completed the program between November 2023 and December 2024. They consist of 87.5% males and 12.5% females, with a mean age of 80.9-year-old. Half of the subjects had vascular conditions (50%), followed by neurological issues (25%). Pre-post comparison showed minimal changes in mental test scores (p=0.333, mean increase of 0.125), suggesting stable cognitive function. Paired-t tests were used for pre-post data analysis. A marked reduction was observed in mean systolic (from 23.27 to 10.06 mmHg, p=0.0283) and diastolic (from 10.40 to 6.81 mmHg, p=0.3441) blood pressure drops during postural changes, indicating better orthostatic tolerance following the intervention. Additionally, interventions such as pressure stockings (mean drop from 16mmHg to 9.21mmHg) and abdominal binder (mean drop from 10.43mmHg to 7.5mmHg) showed to have stronger effect on systolic blood pressure regulation compared to those without. The improved blood pressure responses facilitated participants' ability to perform daily tasks. Compared with pre-program functioning, 68.75% of patients demonstrated symptoms improvement after the program. There was a significant improvement in sitting tolerance (Wilcoxon signed-rank test p-value=0.026, Z=-2.232). Pre-intervention showed more varied outcomes with 31.25% patients failing or having less than 15 minutes sitting tolerance (mean level=3.13). Comparatively, post-intervention distribution showed marked improvement with 87.5% patients achieving at least 45 minutes tolerance (mean level=3.81). Besides, significant improvement was noted in MBI score (p=0.0035, mean improvement of 10.94) after intervention, suggesting enhanced functional independence among patients. Most of the patients (81%) were discharged to home setting. In conclusion, this pilot program demonstrates promising outcomes in managing postural hypotension. Occupational therapy interventions not only alleviate symptoms but also enhance functional independence of the affected individuals. Future research with larger sample size is needed to investigate long term clinical outcomes.
