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 II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Tong RKL(1), Au ILY(1), Leung AKP(1), Yip MK(2), Chan HW(2), Chak WL(2), Chan ACM(1)
Affiliation :
(1)Physiotherapy Department, Queen Elizabeth Hospital, (2)Department of Medicine, Queen Elizabeth Hospital
Introduction :
Patients with end-stage renal disease who opted for renal palliative care (RPC) suffered from lower quality of life (QoL). Meanwhile, patients with advanced chronic kidney disease were more susceptible to sarcopenia and renal osteodystrophy, leading to higher risk of fall and subsequent fractures, causing disability, immobility and mortality. These further reduce their QoL, independence and dignity during end-of-life care (EoLC).
Physiotherapist is one of the essential members of the multidisciplinary team of RPC in Queen Elizabeth Hospital (QEH). An enhanced fall prevention program was introduced in January 2023, which consisted of probable sarcopenia screening and fall risk stratification according to physical outcomes. Individualized home exercise programs, caregiver training and home visits for selected cases were provided, to prevent fall and promote independence during EoLC in RPC.
Objectives :
To review the preliminary outcomes of the Enhanced Physiotherapy Fall Prevention Program in RPC in QEH.
Methodology :
A retrospective longitudinal study was conducted. Patients who attended the Enhanced Physiotherapy Fall Prevention Program during RPC clinic follow-up between January and June 2023 were reviewed. Falls, subsequent fractures and mortality within 6 months were retrieved from the Clinical Management System. Physical outcome measures of Handgrip strength (HGS), Five Times Sit-to-Stand Test (5XSST), Gait Speed by 6-Metre Timed Walk (6MTW) and Modified Functional Ambulation Classification (MFAC) were retrieved. Correlations between HGS, 5XSST, 6MTW and falls, subsequent fractures, mortality were evaluated by point biserial correlation analysis. Correlations between MFAC and falls, subsequent fracture, mortality were evaluated by rank biserial correlation analysis.
Result & Outcome :
Twenty-one patients (mean age=82.3±6.9)(15 males, 6 females) were reviewed. Only one patient (4.8%) was recorded for one fall within 6 months without subsequent fractures. Mortality rate within 6 months was 33.3%.
Significant correlation between HGS and mortality was shown in male (rpb=-0.720, p=0.002) but not in female subjects (rpb=-0.164, p=0.756). There was a significant correlation between MFAC and mortality (rrb=-0.611, p=0.003). However, there were no significant correlations found between 5XSST and mortality (rpb=0.225, p=0.531), between 6MTW and mortality (rpb =-0.253, p=0.480) and among physical outcome measures and fall or subsequent fractures.
The Enhanced Physiotherapy Fall Prevention Program in RPC could prevent falls and subsequent fractures. HGS and MFAC are easily administered and could potentially predict mortality and assist in the improvement of EoLC in patients under RPC. Future studies with larger sample sizes and longer period of follow up are required to explore any further potential significance in improvement of care in RPC service.
