Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Kwok SK(1), Law WY(1), Lam SH(1), Chau HK(1), Chan SY(1), Tang WYV(1), Lee KL(1), Wong YCJ(1)
Affiliation :
(1) Occupational Therapy Department, Princess Margaret Hospital
Introduction :
In 2020, Perioperative Management program for total knee replacement (TKR) has been utilized in PMH to shorten length of stay (LOS) and improve functional outcomes. Occupational therapy services incorporated by providing community occupational therapy (COT) and OPD services preoperatively. Preoperative home visit and suitable aids prescription are vital to alleviate environmental barriers, and facilitate streamlined discharge planning.
Objectives :
To study the effectiveness of Perioperative Management program and the role of COT services in reducing LOS and improving post-operative functional performances after TKR surgery.
Methodology :
250 patients who underwent TKR surgery in PMH were divided into conventional group which comprised 141 patients from April 2018 to November 2020, while perioperative group comprised 109 patients from December 2020 to March 2022. All cases received preoperative OT session for assessment and education. Among the 109 patients, 60 received COT preoperatively. LOS, Modified Barthel Index (MBI) and discharge destinations were evaluated.
Result & Outcome :
No significant differences were found in baseline parameters. The mean LOS of conventional and preoperative COT group were 9.1 and 6.05 days and statistical significant effect was found between them (p< 0.05). The proportion of these two group of patients that could be discharged to home on or before postoperative day 6 were 18.3% and 63.3%. A statistically significant correlation was found between these two groups in the proportion of patients that can be discharged to home directly (p< 0.05).
For self-care abilities, the mean functional scoring based on MBI were compared in different phases postoperatively. The immediate postoperative scores of conventional and preoperative COT group were 37.8 and 46.7 (severely dependent) with statistical difference (p=0.009), whereas the scores for patients discharged to home were 70.4 and 74.8 (moderately dependent). The mean scores in preoperative COT group were significantly higher than conventional group (p< 0.05). It showed that patients may discharge with shorter LOS and higher MBI scores combining with preoperative COT and in-patient ADL training.
The preoperative COT program yielded significant improvements in LOS and functional outcomes. Well settled home environment made a strong contribution in multidisciplinary team to facilitate safe and early discharge, reduce anxiety and optimize functional independence. Preliminary home screening by telehealth can be used to decide the needs for on-site visit, and promote the efficiency of resources allocation.
