Community Rehabilitation for Stroke & Chronic Pain. Haven of Hope Community Rehabilitation Day Centre Mary Yu

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1 Community Rehabilitation for Stroke & Chronic Pain Haven of Hope Community Rehabilitation Day Centre Mary Yu

2 Acknowledgement 1. Hong Kong Family Welfare Society 2. Hong Kong Society for the Aged 3. Methodist Centre 4. The Hong Kong Society for Rehabilitation 5. Tung Wah Group of Hospitals

3 1. Stroke Client: Content a) Advantages of Community Rehab b) Services in HKE 2. Clients with Chronic Pain: a) Advantages of Community Rehab b) Services in HKE 3. Difficulties Encountered by Rehabilitation Providers in HKE Cluster

4 Stroke Clients

5 Documented Advantages of Community Rehabilitation reduced the odds of deterioration in personal activities of daily living (odds ratio 0 72 [95% CI ], p=0 009) increased ability of patients to do personal activities of daily living (standardised mean difference 0 14 [95% CI ], p=0 02). (1617 patients). (Lancet 2004; 363: )

6 Community based rehabilitation help stroke patients to improve their neurological function : Clinical Neurological Function Deficit Scale scores (p<0.01) (Yu JJ et. al The effects of community based rehabilitation on stroke patients in China: a single blind, randomized controlled multicentre trial. Clinical Rehabilitation 2009; 23: )

7 Participation in outpatient, home health, and day rehabilitation programs is strongly associated with improved functional outcome after stroke. (David X. Cifu, Deborah G. Stewart, Factors Affecting Functional Outcome After Stroke: A Critical Review of Rehabilitation Interventions. Arch Phys Med Rehabil 1999; 80: 35 39)

8 Stroke people who receive a more intensive community based multidisciplinary rehabilitation service at three months may experience short term benefit in social participation and some aspects of healthrelated quality of life.[therapy Outcome Measure Handicap (median difference 0.5 (P< 0.05))and EQ 5D (median difference0.17 (P< 0.05)]and in change at three months [TherapyOutcomeMeasure (mean difference 0.52 (SD0.85) 95% Cl(0.16,0.8) and EQ5D (mean difference 0.15(SD0.25) 95% Cl(0.05,0.26)]. (Ryan T. et. al. Clinical Rehabilitation 2006; 20: )

9 Community Services in HKE Cluster

10 Hong Kong East Cluster Community Maintenance Rehabilitation Service Referral Form 港 島 東 醫 院 聯 網 社 區 復 康 延 展 計 劃 轉 介 表 From: RHTSK Geriatric/ Date: To: PT/OT Tel: Fax: SAGE Chai Wan Centre TWGHs FSCSSB PYNEH GDH TWEH RDH Tel: Fax: Tel: Fax: Methodist Kin Lok Centre Others: Tel: Fax: SAGE North Point Centre HOH DC cum Rehab Centre (HKE) HKFWS Health Care Centre Tel: Fax: Wan Chai Methodist Centre Tel: Fax: TWGHs KWMCMHHC Tel: Fax: HOH Rehabilitation Day Centre Tel: Fax: HOH TotalCare Tel: Fax: Others: Tel: Fax: Tel: Fax: Tel: Fax: Tel: Fax: Tel: Fax: Tel: Fax: Name 姓 名 : ( 中 ) ( 英 ) ID No. 身 份 證 號 碼 : Sex 性 別 /Age 年 齡 : / Tel. 電 話 : With Financial Difficulty Diagnosis 診 斷 : Remarks 備 註 : MO Signature:

11 Reply for PYNEH GDH / TWEH RDH only 1.Assessment Date: Time: Location: Clerk Signature: 1. Commencement Date: Clerk Signature: 1. Comment: Expected Treatment End Date: PT: BBS: /56 PT Signature: OT: BI: /100; MMSE: /30; Lawton IADL: /27 OT Signature: 1. Day Hospital Follow-Up Date: Day Hospital Nurse Signature: 病 人 同 意 書 本 人 / 家 屬 同 意 上 述 醫 院 將 本 人 個 人 資 料 ( 姓 名 年 齡 性 別 及 電 話 資 料 ) 轉 介 往 上 述 指 定 復 康 機 構 或 病 人 組 織 作 跟 進, 參 加 活 動 與 否 最 終 由 病 人 決 定 簽 署 : 日 期 : 病 人 / 家 屬 已 口 頭 上 答 應 將 個 人 資 料 ( 姓 名 年 齡 性 別 及 電 話 資 料 ) 由 本 院 轉 介 往 上 述 指 定 復 康 機 構 或 病 人 組 織 作 跟 進, 參 加 活 動 與 否 最 終 由 病 人 決 定 只 限 東 區 醫 院 專 科 門 診 病 人 可 將 轉 介 表 交 往 病 人 支 援 站 [ 大 樓 地 庫 一 樓 東 翼 ( 近 抽 血 站 旁 )] 病 人 支 援 站 職 員 或 義 工 填 寫 : 簽 署 : 遞 交 日 期 :

12 *** 稍 後 將 由 有 關 機 構 之 職 員 聯 絡 你 ***

13

14 Subvented service: physical rehab: group treatment

15 Subvented service: individual/group treatment $60/100 per session

16 Self financed financed physical rehabilitation

17 Individual training $80/session For client > age 50

18 Individual training - $65/session for member - $75/session for nonmember

19 Individual home based or centre based Physiotherapy : $40 membership fee 1 st -4 th session: $80 5 th onwards: $180- $250 Home visit: $400 Rehab home training: $900/10sessions

20 Individual or group treatment Individual Rx >age 60 $140/session <age 60 $170/session Group Rx >age 60 $120/session <age 60 $140/session

21 Individual & group(has hydrotherapy)

22 Individual, domicillary, day care

23 Psychosocial Rehabilitation

24

25

26 Clients with Chronic Pain

27 Documented Advantages of Community Rehabilitation Pain rehabilitation programs are significantly cost effective (Dennis C. Turk The Clinical Journal of Pain 2002; 18: ) Meta analysis shown that multidisciplinary treatments for chronic pain are superior to..single discipline treatments (Flor H et. al Pain 1992; 49: )

28 Multidisciplinary rehabilitation is promising to improve health related quality of life for patients with chronic back pain in the community (Eberhard Langa et. al. The Spine Journal 2003; 3: )

29 Community Services in HKE Cluster

30

31

32

33

34 Psychosocial Rehab

35

36

37 Difficulties encountered by rehabilitation providers in HKE A) Center Perspective referral manpower resources (both for subvented & selffinanced services) transportation chronicity of client

38 b) Client Perspective community resources: what? where? get referral transportation motivation in psychosocial rehab finance

39 (chronic pain clients) psychiatric illness IOD; in litigation physical? psyhosocial? physical tolerance pain related fear High correlations were found among the pain related fear measures and measures of self reported disability and behavioral performance. (Crombez C. et. al Pain 1999; 80 : )

40 c) Perspective of outlet/integration to community long term maintenance (young client) return to work barrier free environment social integration volunteer to help those who live alone

41 Future planning and development to fill the gap To be discussed in floor discussion time & round table discussion time

42 Two are better than one; because they have a good reward for their labour. Bible

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