Page 139 - HA Convention 2015

Symposiums

S6.1 New Advances in Rehabilitation 10:45 Convention Hall B

Singapore’s Tele-rehabilitation Experience: Preliminary Results and Steps Forward Tuesday, 19 May
Koh GCH
Saw Swee Hock School of Public Health, National University of Singapore, Singapore

A tele-rehabilitation system was developed by National University of Singapore. The wearable sensors used in the system
to capture range of motion at all joints of upper and lower limbs were validated against a goniometer in both healthy and
disabled adults, and were found to be accurate. The tele-rehabilitation system is currently being evaluated in a randomised
controlled trial where the intervention group receiving tele-rehabilitation for three months will be compared to the control
group receiving usual care. The target sample size is 50 acute stroke subjects in each group and the primary outcome
measure is functional status at three months. The trial is targeted to be completed in June 2016.

An interim analysis of the first 30 subjects recruited in the study (16 intervention and 14 control subjects) will be presented
(Note: These results did not achieve statistical significance because target sample size has not been reached). The
preliminary results found that at three months, the functional status of tele-rehabilitation group improved by 9.07 Barthel
Index (BI) points while the usual care declined by 0.75 BI points. The tele-rehabilitation group continued to improve between
three and six months, even after tele-rehabilitation ended at three months. After recruitment, 41.7% of controls were going
for day rehabilitation but only 14.3% of tele-rehabilitation subjects were going for day rehabilitation which is expected as the
tele-rehabilitation group were already receiving tele-rehabilitation. In contrast, after three months, fewer (33.3%) controls
were going for day rehabilitation but more (64.3%) tele-rehabilitation subjects continued rehabilitation (after tele-rehabilitation
stopped) by going for day rehabilitation. The results of an ongoing time motion study assessing the efficiency of tele-
rehabilitation compared to centre-based and home rehabilitation will also be presented. The presentation will conclude with
how Singapore intends to implement tele-rehabilitation within its national health information technology framework.

S6.2 New Advances in Rehabilitation 10:45 Convention Hall B

Integrated Care and Discharge Support (ICDS) for Older Patients — from Hospital to Community in Hong Kong HOSPITAL AUTHORITY CONVENTION 2015
West Cluster
Chan FHW 137
Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong

Introduction

Community geriatric assessment service (CGAS) in Hong Kong was introduced 20 years ago, serving clients living in
Residential Care Homes for the Elderly (RCHEs). In January 2012, an Integrated Care and Discharge Support (ICDS)
programme was launched, targeting at home-dwelling elderly with high risk of hospital readmissions.

Objective

(1) To examine the effectiveness of ICDS on Accident and Emergency Department (AED) attendance, acute hospital
admission, hospital bed days and institutionalisation; and (2) to investigate risk factors influencing AED attendance within six
months.

Method

Home-dwelling older patients recruited from four Hong Kong West Cluster hospitals were studied prospectively. AED
attendance, acute hospital admission and hospital bed days (acute and convalescence) six months before and after ICDS
were compared.

Results

Among 1,184 older patients enrolled, 1,090 (92%) were analysed. The average age was 80.4 ± 7 (mean ± SD), and 557 (51%)
were women. 339 (31.2%) were recruited from the computer-generated Hospital Admission Risk Reduction Programme for
the Elderly (HARRPE) scores ≥ 0.2. The rest were by clinical referrals and link-nurse screening in the Emergency Room and
Medical Wards. 475 (43.6%) older patients were followed-up by case managers, while 615 (56.4%) were referred to the Home
Support Team of Aberdeen Kai Fong Association. The average duration of service was 75.8 ± 35.4 days. ICDS was effective
in reducing post-six months AED attendance by 40% (p<0.001), acute hospital admission by 47% (p<0.001), hospital
bed days by 31% (p<0.001). Only 26 older patients (2.4%) were institutionalised in RCHEs after six months. Functional
improvement was evident by an increase in Barthel Index (17.6 ± 4.1 vs 16.5 ± 4.1, p<0.001) and Modified Functional
Ambulation Category scores (6.3 ± 2.2 vs 5.7 ± 1.6, p<0.001). Among the 599 (55%) patients who had at least one post-six
months AED attendance, logistic regression showed age (odds 1.02, 95% CI 1.0 to 1.03, p=0.006), and Charlson Comorbidity
Index (CCI) (odds 1.18, 95% CI 1.11 to 1.25, p=0.001) were positive predictive factors for readmission. Moreover, a simple cost
analysis showed that ICDS could potentially result in an annual saving of 22.5 million HK dollars.

Conclusion

ICDS was not only effective in reducing AED attendance, acute hospital admission and hospital bed days, it was associated
with improved functional and mobility states among older patients, and had met the government’s policy objective of ageing-
in-place.