Authors (including presenting author) :
Lee JKY(1), Chow ESL(1), Au JYT(1), Chan DYC(1), Woo CW(1), Lam ICY(2), Leung KKL(1), Chan ACM(2)
Affiliation :
(1) Physiotherapy Department, Kowloon Hospital
(2) Physiotherapy Department, Queen Elizabeth Hospital
Introduction :
With rehabilitation from day one, restoring functional mobility is one of the ultimate goals for patients after stroke. Yet, little is known about the rehabilitation outcome across different rehabilitation settings. This work explores the mobility outcome along the patient journey, from acute hospital to extended rehabilitation hospital and ambulatory setting, to understand patients’ outcomes and hence, provide insights on resources utilization.
Objectives :
To evaluate the mobility outcome along the patient journey for stroke patients.
Methodology :
Patients admitted to QEH with diagnosis of stroke(ICD9:430-436), who were transferred to KH, and completed trainings from KH day rehabilitation from April 2023 to September 2024 were included for analyses. Modified Functional Ambulatory Category(MFAC) were evaluated for mobility outcome.
Result & Outcome :
Ninety-five patients with mean-age of 66.6±14.0 year-old were identified. There were significant improvements in MFAC score across different settings(all p<0.001), with median progression score gain of 2 in KH and 3 after completion of day rehabilitation. Upon discharged from QEH, 51.6% of patients were non-ambulatory(MFAC1-2), 46.4% required one assistant in walking(MFAC3-5). On discharge from KH, 18.9% remained non-ambulatory(MFAC1-2); 65.2% required one assistant(MFAC3-5), 15.8% became independent(MFAC6-7). After completion of day rehabilitation, 2.1% remained non-ambulatory(MFAC1-2), 61.1% required one assistant(MFAC3-5) and 36.8% became independent(MFAC6-7).
Thirty-two patients with mean-age of 61.7±14.9 year-old progressed from non-ambulatory to assisted walker during hospital-stay. 37.5% of them were young stroke(onset <60 year-old). 28.1% of them became independent(MFAC6-7) after completion of day rehabilitation. Those with younger age tend to have greater overall score gain in MFAC(ρ =-0.47, p<0.05) and longer LOS(r=-0.40, p<0.05).
The key message is two sides of the same coin. Promising improvements in mobility with rehabilitation from acute to ambulatory care were demonstrated. While regaining walking ability was possible for patients who were non-ambulatory at admission, this is a good motivation to patients and carers. The relative proportion of young stroke with tendency of longer LOS causes burden on public health care system. Given the support of ambulatory setting with satisfactory outcome, hospital-stay for rehabilitation can be shortened. Early identification and communication with patients and carers with timely and appropriate social support can facilitate safe and early discharge. Strengthening collaboration between ambulatory care and community resources such as District Health Center, can reduce bottleneck in ambulatory care.
