Page 61 - Hospital Authority Convention 2017

Corporate Scholarship Presentations

C3.3 Allied Health and Pharmacy 14:30 Room 428

Bridging the Service Gap of Stroke Care – Formal Vision Screening by Orthoptists
Tam WH
Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong HOSPITAL AUTHORITY CONVENTION 2017
According to the statistical report of Hospital Authority (HA) in 2014-2015, there were about 3,000 stroke inpatients under
care in HA hospitals. Extensive international studies have shown that ocular and visual problems are common in post-stroke
patients. In UK, 70% to 80% patients suffer from visual difficulties following stroke. There is no data of the prevalence of
visual problems among stroke survivors in Hong Kong as many post-stroke patients had undetected or undiagnosed ocular
and visual problems. Formal visual evaluation is not included in current stroke care pathway.
Most of the visual problems are not detected by simply observing the individual. It requires questioning and assessment
to detect and subsequently make an accurate diagnosis. Thus, visual impairment following stroke may be missed or
misdiagnosed. Visual symptoms can be poorly defined by patients and particularly when individuals have co-existing
communication problems and cognitive impairments.
Orthoptists are allied health profession in the field of ophthalmology who work closely with ophthalmologists. They specialise
in the assessment of visual function and monitoring of visual development. They also assess, investigate and treat ocular
muscle defects. Many tests used by the orthoptist are non-verbal and therefore responses can still be obtained even
communication problem exists after stroke.

In UK, orthoptists are essential in the care and management of stroke patients by contributing their specialist knowledge
and skills as part of the stroke multi-disciplinary team. The role of orthoptic service is highly recommended and recognised
in stroke rehabilitation. Through the collaboration with multi-disciplinary team, early orthoptic assessment can be provided.
Realistic goals can be set and therapy can be adapted to suit the needs of the patients. It is hoped that through the precious
experiences in UK, further improvement in the management of stroke patients could be achieved.

C3.4 Allied Health and Pharmacy 14:30 Room 428

STarT Back – a Biopsychosocial Approach in the Management of Low Back Pain
Lam P
Physiotherapy Department, Queen Mary Hospital, Hong Kong

STarT Back Approach is a stratified care approach used in UK. The approach comprises of the STarT Back Screening Tool
and the matched treatment pathway. The STarT Back Screening Tool is a simple prognostic questionnaire based on the
identified and modifiable risk factors (biomedical, psychological and social) of poor clinical outcome or poor prognosis in
persistent disability due to back pain. The questionnaire allocates non-specific back pain patients into high, medium or low
risk group of chronicity. Each risk group is matched to corresponding treatment pathway.
Back pain patients of low risk group are provided with advice, information and reassurance of self-management. Back pain Wednesday, 17 May
patients of medium risk group mainly have physical obstacles to recovery, and are provided with good quality physiotherapy
treatment. Back pain patients of high risk group have additional psychological obstacles to recovery, and are given enhanced
package of care with psychologically informed physiotherapy.

The treatment approach emphasises the good use of communication skills. Therapist guides the patient with non-directional
questioning together with an active listening approach that facilitates self-disclosure on the patient side with an aim to
understand how they feel and think about their pain. Explaining pain in neuroscience evidence, they encourage patients to
accept it rather than control it. Through motivational skills, they are guided to build a meaningful life based on their chosen
values. This biopsychosocial model allows the physiotherapist to have a better understanding of the patients’ behaviour in
relation to their pain journey and would therefore be able to develop a treatment programme that suits the patient’s pace and
encourages success in different stages of the rehabilitation process.
The STarT Back Screening Tool and the matched treatment pathway in UK demonstrated to be clinically and cost effective for
patients with back pain in primary care management.

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