Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second 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) :
Liu YT(1), Yuk KL(2), Lau M(1), Chan WC(1), Yue SY(1), Ip WM(1), Leung YS(1), Wong KC(1), Mak HT(1), Yu HY(1) (1) Occupational Therapy Department, Shatin Hospital (2) Department of Medicine & Geriatrics, Shatin Hospital
Affiliation :
Department of Occupational Therapy, Shatin Hospital
Introduction :
In Shatin Hospital (SH), Pulmonary Rehabilitation Program (PRP) has been developed since Dec, 2020. Patients with principal diagnosis of COPD will be recruited into enhanced PRP if they satisfy the selection criteria, including Montreal Cognitive Assessment 5 Minute Protocol (HK-MoCA 5-min) ≥ 7th percentile; Modified Functional Ambulation Classification ≥ Cat 3 and willing to join. In Enhanced PRP, apart from individual activities of daily living (ADL) training and group education on disease management skills: including breathing techniques, energy conservation techniques, stress management, adaptive coping strategies, infection prevention & health promotion; patient also receive bathing assessment & training, carer training and pre-discharge on site home visit with skills practices & environment recommendation to facilitate smooth discharge. They will be prescribed with tele-materials with HA-Go prescription and cue cards for further revision & daily practice in ward and after discharge. In addition, community rehabilitation (geriatric day hospital or Integrated Care Discharge Support services) will be arranged after discharge to ensure good community reintegration and reduce readmission.
Objectives :
To evaluate the effectiveness of Occupational Therapy interventions in enhanced PRP for patients with Chronic Obstructive Pulmonary Disease
Methodology :
A one group pre- and post-test design was employed. From December 2020 to Dec 2023, functional outcomes and health-related QOL data of patients who finished enhanced PRP are collected: including Modified Barthel Index (MBI); Montreal Cognitive Assessment Hong Kong Version (HK-MoCA); Modified Medical Research Council Dyspnea Scale (mMRC); Monitored Functional Task Evaluation (MFTE); PRP Quiz score; Bathing – Rate of Perceived Dyspnea (RPD) & Rate of Perceived Exertion (RPE) and Chronic Respiratory Disease Questionnaire (CRDQ). Qualitative Feedback was also collected from patients with use of questionnaire before discharge. 2 months follow up will be carried out and all data of the above would be collected and compared
Result & Outcome :
(1) A total of 32 patients successfully finished Enhanced PRP. All patients were male with mean age of 75.3 years old and mean length of stay was 15.9 days. (2) Result shows that there is a statistically significant improvement in all measured patients’ functional outcomes and health related QOL including MBI (p<0.001), HK-MoCA (p<0.05), MFTE (p<0.05), MMRC (p<0.05), CRDQ (Dyspnea, Fatigue, Emotions and Mastery) (p<0.001), PRP quiz score (p<0.001), Bathing- RPE (p<0.001) and Bathing- RPD. (3) 12 patients were successfully being followed up. Results shows statistically improvements in MBI (p<0.05), while no statistical difference was found between all functional outcomes and other health related QOL when comparing mean difference between discharge and follow up. Patient’s function and QOL were maintained or even improved in community phase (4) Mean of readmission frequency within 3 months reduced from 1.6 to 0.6 times after enhanced PRP (5) All patients agreed that enhanced PRP would improve both their knowledge, coping skills and competence in disease management. (6) All patients expressed positive feedback and appreciation towards PRP and would recommend the program to future users Occupational Therapy interventions in enhanced PRP can enhance functional outcomes, improve health-related quality of life and reduce readmission rate for patients with COPD. Data collection should be continued for recruiting larger sample size and regularly review for continuous service improvement.
