Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Yim ST(1), Chan WC(1), Ho HW(1), Ng CL(1), Cheng WLO(1), Woo CWY(1), Lam S(1)
Affiliation :
(1)Physiotherapy Department, Haven of Hope Hospital
Introduction :
Lower limb robotic is introduced in HA hospitals to facilitate stroke rehabilitation. The weight supported system and orthosis guided gait training provide high intensity, high frequency and functional walking exercise to stroke patients. However, high skin abrasion incidence was observed in the first 6 months from the service commencement. This led to high injury risk, poor therapy compliance and high drop-out rate.
Objectives :
Extra measures for skin protection were introduced to the lower limb robotic training after 6 months of service commencement. This project aims to estimate the effectiveness of the newly implemented safety measures for reducing skin abrasion and improving training compliance.
Methodology :
Safety interventions included: (1) extra padding and towels were applied to pressure points including inner thigh, groin and lumbar area. (2) A specially designed cycling pants was designed for lower limb robotic training. A usual cycling padding material was sewed into the cotton pants in an inverted way. (3) Skin condition of high-risk area was checked after each training session. (4) Patient discomfort was checked regularly during training. Outcome measures included: (1) the incident rate of skin abrasion injury before and after safety measurement was compared. (2) The drop-out rate due to skin pressure discomfort was also compared. (3) Patient self-reported discomfort level during training was evaluated by Numerical Rating Scale (NRS).
Result & Outcome :
Results 32 stroke patients were recruited for lower limb robotic training in 2023 including 13 patients in the first half year and 19 patients in the second half year. The skin injury rate reduced significantly from 29.4% (January to June, 2023) to 0% (July to December, 2023) after the safety interventions implemented. The drop-out rate due to setup discomfort also decreased significantly from 41.2% to 4.8%. The patient self-reported discomfort level reduced significantly from NRS 6/10 to 2.5/10. Conclusion The newly designed cycling pants and other safety measures were effective for skin injury reduction during the lower limb robotic training. The drop-out rate and patient discomfort level were also reduced, thus enhancing overall treatment compliance. The experience of new padding measures was shared to physiotherapy department in other hospitals. Also, suggestions were reflected to the manufacturer to improve the design of equipment and safety accessories.
