Authors: (including presenting author): :
Chan NHT(1), Chan C(2), Chan CY(3), Ko KL(4), Kwok WY(4), Kwok M(5), Li SS(4), Li Jimmy(2), Leung E(5), To R(2), Wong CL(1), Wong C(5)
Affiliation: :
(1)Department of Medicine & Geriatrics, Pok Oi Hospital and Tin Shui Wai Hospital, (2)Physiotherapy Department, Pok Oi Hospital, (3)Community Care Division, Pok Oi Hospital, (4)Community Care Division, Tuen Mun Hospital, (5)Occupational Therapy Department, Pok Oi Hospital
Keyword 1: :
Smart Geriatric Day Hospital
Keyword 3: :
Hybrid hospital–home rehabilitation
Keyword 4: :
Digital health innovation
Keyword 5: :
Exergame‑assisted training
Keyword 6: :
Geriatric day hospital
Introduction: :
Traditional geriatric day hospital (GDH) services are under growing pressure as community‑dwelling older adults increasingly present with multiple comorbidities and frailty, driving complex rehabilitation needs. Conventional GDH models provide limited centre‑based sessions and do not systematically capture home exercise performance, leading to gaps in continuity of care, suboptimal monitoring, and frequent disruption from transport difficulties, weather and outbreaks that particularly disadvantage frail patients. At Pok Oi Hospital, these constraints are compounded by fixed physical space and long waiting times, limiting the number of patients who can access structured rehabilitation despite clear functional needs. The Smart Geriatric Day Hospital project was established to address these challenges by transforming elderly rehabilitation through innovation and technology. The model introduces a technology‑enabled hybrid approach that combines streamlined in‑hospital training with structured, data‑driven home exercise supported by gerontechnology. Key digital components include a tablet‑based exergame platform (eTRAIN@Home) using motion capture for performance data collection, together with an electronic logging system that uploads exercise data via mobile networks for remote clinical review. Within this framework, frail and multimorbid patients receive individualized programs that extend beyond the physical day hospital, while clinicians can adjust training intensity and content based on objective home‑performance data. By redesigning how rehabilitation is delivered rather than expanding bricks‑and‑mortar capacity, the Smart Geriatric Day Hospital aims to relieve space constraints, enhance continuity of care, and improve access and engagement for older adults with high comorbidity and frailty burden.
Objectives: :
To demonstrate that the Smart Geriatric Day Hospital, using a technology‑enabled hybrid hospital–home rehabilitation model, can increase service capacity for elderly patients without expanding physical GDH space or proportionally increasing on‑site attendance, while maintaining satisfactory functional rehabilitation quality.
Methodology: :
This was a real‑world implementation study in the Pok Oi Hospital Geriatric Day Hospital for community‑dwelling patients aged ≥60 with impaired mobility and comorbidities such as post‑hospital deconditioning, stroke, femoral fracture, fall or dementia. Patients were excluded from the hybrid training mode if they had severe cognitive impairment, poor vision or hearing, or inadequate carer support at home. In the conventional group, patients attended the GDH for 2 centre‑based rehabilitation sessions per week for 8 weeks (total 16 sessions), with no structured digital home programme. In the hybrid Smart Geriatric Day Hospital group, patients attended 2 GDH sessions per week from week 1 to week 4, then 1 GDH session per week from week 5 to week 8 (total 12 sessions), and performed prescribed daily home exercise using the eTRAIN@Home platform from week 2 to week 7. Personalised exergame‑based home programmes were uploaded to the tablet‑based system, and patients trained at the prescribed frequency and intensity between GDH visits. Exercise performance was automatically transmitted via mobile network to a electronic platform and dashboard, where therapists reviewed adherence and progress and modified programmes during subsequent visits or telephone follow‑up. Service‑level metrics included annual new GDH cases, total GDH attendances and the number of patients enrolled to the hybrid training mode. Functional outcomes were assessed at week 1 (baseline), week 4 and week 8 using standardised tools such as Timed Up and Go Test, Modified Barthel Index and Abbreviated Mental Test.
Result & Outcome: :
Implementation of the Smart Geriatric Day Hospital hybrid model was associated with increased service capacity with only a modest rise in on‑site utilisation. Counting annual new GDH cases from July 2024 to June 2025, new case recruitment rose from 563 to 689, a 22.4% relative increase, while total yearly GDH attendances increased by only 5.9%. Between February 2024 and December 2025, 325 patients were enrolled into the hybrid hospital–home training mode, demonstrating feasibility and uptake in routine service. Preliminary functional outcome data from patients managed with the home–hospital hybrid rehabilitation model demonstrated statistically and clinically relevant improvement over 8 weeks. In one cohort (n≈80), 6‑meter walk speed increased from 0.51±0.23 m/s to 0.63±0.23 m/s (p=0.002), Timed Up and Go decreased from 26.44±14.20 s to 21.63±12.65 s (p=0.030), and Functional Reach improved from 15.0±6.67 cm to 18.0±7.25 cm (p=0.002). Compared with a larger conventional GDH cohort (n≈176–183), the “comprehensive rehabilitation rate” (improvement in multiple mobility domains) was 33.33% in the hybrid group versus 17.27% in the traditional group, indicating an almost 1.9‑fold higher probability of multidomain functional gain with the hybrid approach. Early occupational therapy data from a hybrid group versus conventional group further support the potential of technology‑enabled models. In that analysis (69 patients per group), the hybrid group showed significant and more consistent improvements in self‑care (Modified Barthel Index, Lawton Instrumental Activities of Daily Living Scale) and cognition (Abbreviated Mental Test) across both 1–4‑week and 5–8‑week intervals, whereas the conventional group demonstrated smaller or later‑onset gains. Although detailed numeric values and full multivariable analyses are still being compiled, these preliminary findings suggest that the hybrid and telehealth‑supported rehabilitation models can expand capacity while maintaining, and potentially enhancing, functional and cognitive outcomes for multimorbid older adults.
