Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Kaur R(1), Kwok WY(1), Wong MF(1), Hui N(1)
Affiliation :
(1) Occupational Therapy Department, United Christian Hospital
Introduction :
In 2019, United Christian Hospital joint arthroplasty clinic adopted Enhanced Recovery After Surgery (ERAS) to enhance post-operative outcome and reduce length of stay (LOS). Occupational Therapy Department developed a prehabilitation program for patients who have to undergo total joint arthroplasty.
Objectives :
The aims of the study are to evaluate the effectiveness of prehabilitation program by occupational therapist in optimizing preoperative functional status and to study the effectiveness in shortening LOS.
Methodology :
Participants were recruited through the arthroplasty clinic and an e-platform. They were required to complete a brief screening questionnaire for risk stratification into low, medium, and high based on their social background, functioning level and home environment. They were arranged to attend a comprehensive assessment to identify potential home hazards and explore the social support after operation. Further an 8-week prehabilitation intervention program was arranged. Hong Kong Knee Osteoarthritis Outcome Scale (HK-KOOS) and average LOS were analyzed as primary outcome measure. Secondary outcome measures include numeric pain rating scale, activity tolerance in standing, walking and stairs climbing, and knee function in range of motion.
Result & Outcome :
A retrospective study was conducted from April 2021 to December 2022 by using the pretest and posttest study design. 208 participants were included in the study. 187 participants completed a screening questionnaire with 86.7% were classified into medium to high-risk group. 167 attended a comprehensive occupational therapy assessment and 136 participants attended the prehabilitation intervention program with an average of 6 sessions. 11% were identified with cognitive impairment based on the result of Hong Kong Montreal Cognitive Assessment 5-minute. Results showed that there was statistically significant improvement in 2 sub-scores of HK-KOOS, including Symptoms (p=0.005) and Pain (p=0.000) upon completion of prehabilitation program. The average LOS was 6.40 days versus 6.17 days, for those unattended versus attended OT prehabilitation program. There was a statistically significant improvement in numerical pain rating scale (p = 0.000), activity tolerance in walking (p = 0.002) and both knee flexion (p = 0.000) and extension (p = 0.000).
The results showed that OT prehabilitation services were effective in improving preoperative functioning of OA knee patients as well as reducing the length of stay.
