Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Cheung CFM(1), Ku WNH(1), Kong SB(1), Lam TP(2)
Affiliation :
(1)Department of Occupational Therapy, Yan Chai Hospital, (2) Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong
Introduction :
Lumbar degenerative spine disease (DSD) has growing prevalence with 3.63% in worldwide due to increased life expectancy (Ravindra et al., 2018). It is one of the leading causes of global disability. Lumbar spinal surgery was considered if conservative treatment failed with disabling pain or progressive neurological deficit (Gometz et al., 2018). Patients after spinal surgery require a period of rehabilitation in hospital. But patient with prolonged length of stay may be at risk of postoperative complication. It can increase the hospitalization cost and burden in hospital. Previous research showed that patient with early discharge after lumbar spinal fusion can lower the readmission rate (Zhan et al., 2019). Thus, it is important to explore effective measures in reducing length of stay and functional outcome for patient after lumbar spinal surgery.
The Enhanced Recovery After Surgery (ERAS) program has been initiated since April 2020 in Kowloon West Cluster (KWC) of the Hospital Authority. It aims to enhance the perioperative care of patients who are going to have spinal surgery with a multidisciplinary approach, which shorten the hospital stay, reduce complications and readmission rate, and improve surgical outcomes. The triage criteria in ERAS program are shown as the below (Appendix I). Recent research has developed comprehensive consensus review of perioperative care for patients with lumbar fusion in ERAS program (Debono et al., 2021). Occupational Therapy is one of the allied health professionals that improves functional outcomes and ADL independence of patients. It also provides home assessment and modification, adaptive aids recommendation to facilitate self-care of patients before and after the spinal surgery.
The prehabilitation is to promote functional capacity of patient before operation and return of ADL function after operation (Debono et al., 2021). Pre-operative education in prehabilitation can provide useful health-related information and resources to facilitate patient being better prepared prior to operation. Eastwood et al. (2019) has studied that a multidisciplinary education session in the pre-operative stage has shown more meeting the patient’s expectation, reducing disability and pain after spinal surgery. However, there is limited and fair-quality research to support the inclusion of pre-operative education as an essential intervention for improving functions, disability, and pain (Burgess et al., 2019). Meanwhile, limited studies focus on Occupational Therapy prehabilitation alone and its effects on length of stay and functional outcome.
Objectives :
This study is to evaluate the effectiveness of Occupational Therapy pre-operative education on length of stay, pain level, and functional outcome of patients after lumbar spinal fusion in the ERAS program. This can provide insight for developing a guideline for prehabilitation in patients with lumbar spinal surgery.
Methodology :
The research is a retrospective cohort study which investigate the progress of patients who have undergone lumbar spinal fusion in Yan Chai Hospital (YCH) from 2022 to 2023. The data collection process can refer to the flowchart (Appendix II). The data will be retrieved from the dataset stored in the intranet of YCH Occupational Therapy department. The eligible patients will be enrolled and allocated into the intervention group and control group with criteria. The estimated total sample size which calculated by G*Power 3.1 program will be 76 in two groups, 38 in intervention group and 38 in control group at a 5% significance level, 0.25 effect size and the power of the study with 80%.
