Authors (including presenting author) :
Hau CY(1), Cheung PY(1), Ng MW(1), Mo KC(1), Poon KH(1), Tsang HC(1), To YL(1)
Affiliation :
Physiotherapy Department, North District Hospital
Keyword 1: :
Rehabilitation
Keyword 2: :
Physiotherapy
Keyword 3: :
Geriatric medicine
Keyword 4: :
Community care
Introduction :
The Planning Department of the Hong Kong SAR estimates a 41% increase in elderly population in the North District, from 309,600 in 2021 to 435,600 in 2031. To reduce pressure on inpatient services and promote long-term healthcare sustainability, strengthening community-based rehabilitation and reorienting existing service models are essential. In response, North District Hospital (NDH) launched a structured post-discharge outreach physiotherapy initiative, “Rehab@Home,” in October 2023 to support physically deconditioned geriatric patients following hospitalization. The program provides 4—8 weeks home-based physiotherapy with personalized mobility and self-management training within three days after discharge.
Objectives :
To evaluate the clinical effectiveness of the “Rehab@Home” program in NDH.
Methodology :
A retrospective pre-post analysis was conducted on patients who received the “Rehab@Home” program from October 2023 to October 2025.
Result & Outcome :
A total of 427 patients (mean age: 76.9±12.4, 49.9% male) participated the program. Major diagnosis included chronic cardiovascular and respiratory conditions (44.5%), neurological disorders (15.7%) and fall (10.5%). The mean length of stay was 16.7±19.3 days, with 75.8% discharged from acute wards. Patients started the program 2.67±1.74 days post-discharge and participated in 3.31±2.95 sessions. Significant improvements were observed in functional mobility and ambulatory status. The mean Elderly Mobility Scale (EMS) score increased from 10.5±5.52 to 12.0±5.65 (p< 0.001), with a 16% increase in patients achieving independent functional mobility (from 34.1% to 50.1%). The Modified Functional Ambulatory Category (MFAC) also improved significantly (p< 0.001), with a 16.9% increase in unassisted walkers (26.2% to 43.1%), 46.0% of the patients regained the premorbid ambulatory status. The majority of patients (82.9%) remained stable in the community within 28-day post-discharge. Multiple linear regression revealed that the number of home visits (p< 0.001) and earlier commencement of program (p=0.009) were significant predictors of EMS improvement, accounting for 11.9% of the variance (multiple R=0.345, p< 0.001). Each additional physiotherapist visit was associated with a 0.293-point EMS gain, while each day delay reduced the EMS by 0.133-point. Logistic regression revealed that patients living at home with carer had 2.19 times higher odds of regaining pre-morbidity (OR=2.19, 95% CI[1.20, 4.00], p=0.011). The "Rehab@Home" program effectively enhances mobility and walking independence among post-hospitalized geriatric patients. These findings support the implementation of early home-based physiotherapy programs to optimize patient outcomes and reduce healthcare utilization. Carer involvement provides essential support in physical improvement, while patients without carer support may benefit from intensive home visit.
