Authors: (including presenting author): :
Tang HTF(1)(2), Au KM(1), Wong YCJ(1)(2), Law WYR(1)(2), Lau MTG(1)(2), Chau HK(1)(2) Au SH(1)(2), Fok TY(1)(2)
Affiliation: :
(1)Integrated Neurological Rehabilitation Centre (INRC), Princess Margaret Hospital, (2)Occupational Department, Princess Margaret Hospital
Keyword 1: :
Integrated Day Stroke Rehabilitation Program / stroke patients
Keyword 2: :
Effects / effectiveness
Keyword 3: :
Activities of Daily Living (ADL)
Keyword 4: :
Instrumental Activities of Daily Living (IADL)
Keyword 5: :
Upper Limb (UL) Functions
Keyword 6: :
Occupational Therapy
Introduction: :
INRC Integrated Day Stroke Rehabilitation Program has been providing a comprehensive neurological rehabilitation to optimize the patients’ recovery and promote community reintegration through a multi-disciplinary team. Occupational Therapy (OT) is a core team member, providing essential services include training in activities of daily living (ADL), instrumental activities of daily living (IADL), and upper limb (UL) & hand functions. Emerging evidence has shown that a comprehensive stroke program leads to improved outcomes for stroke patients, enhancing their ADL & IADL performance as well as their ability to perform UL tasks.
Objectives: :
This study aims to investigate the effectiveness of INRC Day Stroke Rehabilitation Program on improving ADL, IADL and UL functions in people with stroke.
Methodology: :
Initial assessments were conducted prior to the program enrollment, and post-treatment assessment was completed before discharge. Treatment plans were set among therapists, patients and their caregivers. Multidisciplinary team conference was held promptly after the initial assessment to establish goals and develop treatment plans for newly recruited cases, with periodic reviews in subsequent team conferences. Each patient received weekly 45 minute individualized OT stroke session focused on managing post-stroke upper extremity dysfunction/ spasticity, ADL & IADL training, and/ UL robotic training. The training period for majority of patients is approximately 6-9 months. ADL performance was measured using Modified Barthel Index (MBI) while IADL performance was measured using Adapted Lawton IADL (4-point scale). UL function was evaluated through various assessments, including Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Hong Kong version of Functional Test for Hemiplegic Upper Extremity (FTHUE-HK), Nine-Hole Peg Test (NHPT) and Motor Activity Log (MAL) were performed before and after the treatment.
Result & Outcome: :
A total of 93 patients with age ranged from 24 to 79 completed INRC Integrated Day Stroke Rehabilitation Program from 1/1/2022 to 31/12/2025 (4 years). Pre and post standardized ADL, IADL and UL assessments were conducted for all participants. Data were analyzed using paired sample t-test in SPSS version 31. The findings demonstrated a significant enhancement in patients' ADL performance (MBI: p< 0.01) and IADL outcomes (Adapted Lawton IADL: p< 0.01). Additionally, the program markedly improved UL functions, as evidenced by the WMFT (p< 0.01) and the ARAT (p=0.01). The MAL also indicated positive results in both the amount of use (p=0.03) and the quality of movement (p< 0.01). However, the FTHUE and the NHPT exhibited limited significance, likely due to a ceiling effect for FTHUE (p=0.062, p>0.05) and a low floor effect for NHPT (p=0.135, p>0.05). Given these findings, we recommend prioritizing the adoption of more sensitive and responsive measures—such as ARAT, WMFT, and MAL—in future service development to ensure a comprehensive evaluation of upper limb functions within the INRC Day Stroke Rehabilitation Program. In conclusion, the INRC Day Stroke Rehabilitation Program effectively enhances ADL, IADL, and UL functions in stroke patients, particularly through the WMFT, ARAT, and MAL. While tools like the FTHUE and NHPT can offer valuable insights when used selectively, their application should be tailored to individual patients. This strategy helps reduce assessment time and allows for a stronger focus on therapeutic interventions, thereby optimizing clinical workflow and improving the overall efficiency of the INRC Day Stroke Rehabilitation Program.
