Authors: (including presenting author): :
Wong SY (1), Yu KP (1), Chan KL (1), Ma WL (1)
Affiliation: :
(1) Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital
Keyword 1: :
End-Stage Renal Failure
Keyword 2: :
Systemic Lupus Erythematosus
Keyword 3: :
Continuous Ambulatory Peritoneal Dialysis
Keyword 4: :
Assistive Technology
Keyword 5: :
Occupational Therapy
Introduction: :
A 29-year-old female with Systemic Lupus Erythematosus (SLE) and End-Stage Renal Failure (ESRF) faced a critical barrier to hospital discharge. While medically stable, her inability to independently perform Continuous Ambulatory Peritoneal Dialysis (CAPD) led to prolonged hospitalization and occupational deprivation. SLE-related impairments—specifically reduced hand dexterity, diminished proximal upper limb strength, and impaired standing balance—prevented her from performing the "overhead hang" of dialysate bags. Living alone without daytime support, she was functionally unable to return home safely, highlighting the frequent disconnect between medical stability and functional autonomy in complex chronic care.
Objectives: :
The objective was to design a bespoke assistive device through a collaborative clinical-engineering approach to overcome the physical barriers of the CAPD process, thereby facilitating a safe discharge and restoring the patient’s independence in life-sustaining self-care.
Methodology: :
The intervention involved a structured collaboration between an Occupational Therapist (OT) and a Rehabilitation Engineer. The OT conducted a comprehensive task analysis of the CAPD cycle and an ergonomic assessment of the patient’s postural stability. These clinical findings were translated into mechanical specifications for a tailor-made electric dialysis stand. The device utilizes a motorized linear actuator, allowing the patient to secure the dialysate bag at a stable sitting height before mechanically raising it to the required overhead position for gravity-fed dialysis.
Post-intervention evaluation utilized four standardized tools:
1. System Usability Scale (SUS) for technical interface assessment.
2. Chinese version of the Quebec User Evaluation of Satisfaction with Assistive Technology (C-QUEST)(Device Domain).
3. Psychosocial Impact of Assistive Devices Scale (PIADS) to measure quality of life and competence.
4. Goal Attainment Scale (GAS) to quantify functional progress from a baseline of -2.
Result & Outcome: :
The patient achieved successful discharge and complete independence in her medical routine. The SUS score was 100 and the C-QUEST score was 5/5, validating the device's usability. PIADS results demonstrated significant improvements in the patient’s sense of control, happiness, self-esteem, and quality of life. Notably, the GAS score improved from -2 to +2, indicating the patient exceeded expected outcomes by managing the process solo.
This case underscores the vital synergy between OT and Rehabilitation Engineering. When physical impairments cannot be remediated, bespoke assistive technology (AT) serves as the primary catalyst for independence. Clinically, this demonstrates that AT directly impacts hospital bed management by reducing the length of stay for "medically fit but functionally dependent" patients, while profoundly enhancing the psychosocial well-being of young patients managing chronic conditions.
