ha convention 2017 - hospital authority · ha convention 2017 ... ba duan jin ( revision routine...

HA Convention 2017 Clinical Safety & Quality Service I

Vera Chan sui-mei Occupational Therapy

16.5.2017

1

Title of Pilot Study

To investigate the effect of group-

based activity program on health

related quality of life ( HR-QOL ) for

patients with musculoskeletal injuries

in work rehabilitation program

2

Background

Musculoskeletal disorders ( MSKD ) are one of the largest work

related problems being encountered in work rehabilitation program

( Antonio, 2013 )

Patients displayed significant pain & functional limits mentally &

physically especially for lower back & lower limbs injuries

Activity program are frequently advocated for the management of

musculoskeletal disorders & improved QOL ( Antonia, 2013 )

3

Background 3 Interventions Improving Patients’ QOL

4

Stretching Exercise can increase the range of joint movement & encourage circulation & oxygenation of joints, muscles & tendon units ( Sihawong, 2014 ). It was associated with improved QOL for many chronic conditions with sedentary lifestyle ( Corby, 2009 )

Progressive Muscle Relaxation is a mind-body technique involves alternately tensing & relaxing muscle groups in sequence throughout the body. It is a well established psychological therapy for alleviating psychological distress in patients with chronic illnesses & improving QOL ( Tahereh, 2007 )

Ba Duan Jin ( Chinese Ba Duan Jin Qigong ) is a long term component of Chinese medicine, which demonstrated the effectiveness for relieving pain & improving quality of life ( Wang, 2014 )

Study Design : Randomized Control Trial

Control Group

The subjects in the control group received the conventional

work hardening program

Intervention Group

The subjects in the intervention group received the

conventional work hardening program & join the group-

based activity program

5

Study Design : Subjects Recruitment

Inclusion Criteria

- Both gender referring for work hardening program

- Manual workers

- Duration of injury on duty (IOD) > 6 months

- Suffering from either low back pain or lower limbs injury

Exclusive Criteria

- Received Rx including physiotherapy, psychiatry intervention

or other medical Rx outside ( i.e. acupuncture )

- CTD, burns, cardiac, medical or neurological diseases 6

Intervention : Content of Group-based Activity Program

1. Stretching exercises ( neck, shoulder, elbow,

wrist, fingers, trunk, hip, knee & ankle )

2. Progressive muscle relaxation

3. Ba Duan Jin ( Ready position, Routine 1-3 )

4. Ba Duan Jin ( Revision Routine 1-3, Routine 4-5 )

5. Ba Duan Jin ( Revision Routine 4-5, Routine 6-8 )

6. Ba Duan Jin ( Revision Routine 1-8 ) 7

Group-based activity program is :

: A closed group with 4 - 6 patients

: Included 6 sessions

: Carried out by trained PCA in 6 week

Outcome Measurement (1)

8

Each subject completed a self-report survey by using Chinese version of SF-36 with 8 domains of health at baseline ( Week 1 ) & post intervention ( Week 6 ) as the primary outcome measure of health status

8 Domains

1. Physical functioning 5. Emotional well being

2. Role limitations due to physical problems 6. Social Functioning

3. Role limitations due to emotional problems 7. Bodily Pain

4. Vitality 8. General health

Outcome Measurement (2) Group-based Activity Program Evaluation Form

11 items with 5- point scale (strongly satisfied to strongly dissatisfied )

& 5 open questions

9

Statistical Analysis

Descriptive characteristics of baseline

subjects ( continuous & categorical variables )

Gender ( male & female )

Age

Injury site ( low back pain - LBP & lower limbs

injury - LL )

10

Statistical Analysis Mann-Whitney U test ( Independent sample t-test )

Compare the pretest & posttest mean scores of 8 domains in SF-36 between

the control & intervention group, gender & injury group

Wilcoxon Sign Rank test ( Paired sample t-test )

Compare the pretest & posttest mean scores of 8 domains in SF-36 of

control, intervention, male, female, low back pain & lower limbs injury group

All statistical test were one-sided with significance level P value <

0.05

All analyses were conducted with Mac SPSS version 20

11

Results : The Flow of Subjects

12

Randomized Sampling

Intervention Group ( n=11 )

Control Group ( n=11 )

Complete SF-36 questionnaire at week 1 & week 6

Data Analyzed

Complete SF-36 questionnaire at week 1 & week 6

Total 22 subjects had recruited & completed initial work capacity evaluation ( LBP & LL )

even no. odd no.

Results – Baseline Demographics

Recruitment Period : Jan, 2015 – Aug, 2015

Intervention Group ( n=11)

Control Group (n=11)

P - value

Occupation Manual worker

Age range ( years ) Mean SD

25 - 59 44.36 13.0

36 - 62 52.36 7.54

0.428

Gender

Male 13 (59%) 6 7 1.0

Female 9 (41%) 5 4

Injury site

LBP 16 (73%) 7 9 0.635

LL 6 (27%) 4 2

13

Baseline characteristics of subjects were homogenous in the group-based activity program ( intervention group ) & conventional work hardening program ( control group )

Results – Intervention Vs Control Group Scale Week Intervention Group Control Group P - value

Physical Functioning W1 W6

12 12.68

11 10.32

0.716 0.387

Role Limitation due to Physical Health

W1

W6 13 13.82

10 9.18

0.069

0.041*

Role Limitation due to Emotional Problems W1 W6

12.68 13.23

10.32 9.77

0.274 0.167

Vitality W1 W6

11.50 14.09

11.50 8.91

1.000 0.057

Emotional Well Being W1 W6

13.82 13.86

9.18 9.14

0.090 0.082

Social Functioning W1 W6

13.45 14.00

9.55 9.00

0.148 0.065

Bodily Pain W1

W6 14.23 14.91

8.77 8.09

0.043

0.012* General Health W1

W6 11.64 13.00

11.36 10.00

0.920 0.276

14

• There are statistically difference in role physical health ( p=0.041) & bodily pain (p=0.012) between intervention & control group after 6-week program

Results – LBP Vs LL Scale Week Low back pain Lower limbs

injury P - value


9.84 10.31

15.92 14.67

0.049* 0.156

Role Limitation due to Physical Health

W1

W6 12.06 10.06

10.00 15.33

0.256

0.039*


10.38 10.44

14.50 14.33

0.089 0.165

Vitality W1

W6 10.72 9.03

13.58 18.08

0.353

0.003* Emotional Well Being W1

W6 10.44 10.25

14.33 14.83

0.205 0.084


10.94 9.63

13.00 14.83

0.497 0.132

Bodily Pain W1

W6 9.75 9.63

16.17 16.50

0.034*

0.023*

General Health W1

W6 10.56 9.44

14.00 17.00

0.257

0.014*

15

• There are statistically difference in role physical health (p=0.039), vitality (p=0.003), bodily pain ( p=0.023) & general health (0.014) between LBP & LL group after 6-week program

Results – Male Vs Female Scale Week Male Female P - value


12.73 13.42

9.72 8.72

0.282 0.091

Role Limitation due to Physical Health W1 W6

12.54 12.85

10.00 9.56

0.130 0.154


11.81 12.04

11.06 10.72

0.732 0.605

Vitality W1 W6

11.23 12.15

11.89 10.56

0.814 0.564

Emotional Well Being W1 W6

10.73 10.92

12.61 12.33

0.499 0.609


14.42 11.81

10.17 11.06

0.412 0.785

Bodily Pain W1 W6

13.65 12.15

8.39 10.56

0.055 0.561

General Health W1 W6

9.77 11.73

14.00 11.17

0.123 0.840

16

• There are NO statistically difference between male & female group after 6-week program

Results – Intervention Group Scale W1 W6 Mean

difference P - value

Physical Functioning 52.73 63.64 10.91 0.16

Role Limitation due to Physical Health 6.82 20.45 13.63 0.157

Role Limitation due to Emotional Problems 24.24 30.30 6.06 0.577

Vitality 43.18 48.64 5.46 0.095

Emotional Well Being 54.91 57.45 2.54 0.242

Social Functioning 47.82 56.77 8.95 0.123

Bodily Pain 41.45 45.91 4.46 0.594

General Health 40.91 48.64 7.73 0.048*

17

• There are statistically difference in general health (p=0.048) in intervention group after 6-week program

Results – Control Group Scale W1 W6 Mean





Vitality 38.64 36.36 - 2.28 0.474

Emotional Well Being 42.18 45.82 3.64 0.014*


Bodily Pain 29.82 30.09 0.27 0.928

General Health 36.64 37.45 0.81 0.583

18

• There are statistically difference in emotional well being (p=0.014) in control group after 6-week program

Results – Male Group Scale W1 W6 Mean


Physical Functioning 55.77 65.38 9.61 0.03*



Vitality 37.69 40.77 3.08 0.390



Bodily Pain 40.92 39.46 - 1.46 0.551

General Health 34.46 42.08 7.62 0.023*

19

• There are statistically difference in physical functioning (p=0.03) & general health (p=0.023) in male group after 6-week program

Results – Female Group

Scale W1 W6 Mean difference

P - value




Vitality 45.56 45 - 0.56 0.888


Social Functioning 36.22 48.61 12.39 0.017*

Bodily Pain 28 35.89 7.89 0.075

General Health 45 44.44 - 0.56 0.931

20

• There are statistically difference in social functioning (p=0.017) in female group after 6-week program

Results – LBP Group Scale W1 W6 Mean


Physical Functioning 48.13 57.19 9.06 0.003*



Vitality 37.81 37.19 - 0.62 0.727

Emotional Well Being 44.50 47.25 2.75 0.017*


Bodily Pain 31.88 32.56 0.68 0.874

General Health 35.31 37.50 2.19 0.374

21

• There are statistically difference in physical functioning (p=0.003) & emotional well being (p=0.017) in LBP group after 6-week program

Results – LL Group Scale W1 W6 Mean



Role Limitation due to Physical Health 0.00 29.17 29.17 0.039*


Vitality 49.17 56.67 7.50 0.003*



Bodily Pain 45.67 52.50 6.83 0.023*

General Health 48.00 57.83 9.83 0.014*

22

• There are statistically difference in role physical health (p=0.039), vitality (p=0.003) & bodily pain (p=0.023) in lower limbs injury group after 6-week program

Results – Patients Feedback

23

3

8

0

5

10

Very satisfied Satisfied

Group was encouraging &

interactive

02468

10

Very satisfied Satisfied

1

10

Group objectives

2

7

2

Group content

Very satisfied Satisfied Neutral

0 5 10

Very satisfiedSatisfiedNeutral

Verysatisfied Satisfied Neutral

Giveninformation was

useful3 6 2

Useful information

Results – Patients Feedback

24

Verysatisfied

Satisfied

Group tutorhad adequate

knowledge5 6

Group tutor had adequate knowledge

4.55

5.56

Verysatisfied

Satisfied

Group tutor hadadequate

preparation6 5

Group tutor had adequate preparation

Patients Feedback in Open Questions

• Patients expected more training space & increased training

time or Rx sessions for them to practice

• Patients had positive feedback towards the group

Discussion 1) Intervention Group showed significant improvement in

role physical health & bodily pain than control group

2) Male had improvement in physical functioning

3) Female had improvement in social functioning

4) LBP Group had significant improvement only in physical

functioning & emotional well being

5) LL Group had 3 aspects of improvement including role

physical health, vitality & bodily pain 25

Limitation of Study

Small Sample Size ( n=22 ) in this pilot study. Larger sample size are

recommended to confirm the findings

Short Study Duration with 6 week & only twice time for data collection,

carry-over effect had not explored & observation period was too brief

Researcher Was Not Blinded that there will be a bias on planning the

content of conventional work hardening program between control or intervention group

It may be Too Subjective to use single SF-36 as an evaluative & outcome

measure. Further studies should aim to utilize more objective measure for assessing

dysfunction in individuals with low back pain & lower limbs injury

26

Conclusion & Clinical Application This pilot study suggested that a group-based activity program had

significant & positive effect in physical functioning than

emotional well being in HR-QOL among different groups

Evidence-based effect & patients were satisfied with favorable feedback about the combination of stretching exercises, progressive muscle relaxation & Ba Duan Jin practice

Explore the group Rx as the routine or early intervention program for work rehabilitation patients suffering from low back pain & lower limbs injury

27

ha convention 2017 - hospital authority · ha convention 2017 ... ba duan jin ( revision routine...

Documents