Total hip replacement - College of Occupational Therapists

Introduction
In terms of best practice approaches to intervention, ‘enhanced recovery’ (or rapid
recovery) programmes provide a more ‘front- loaded pathway’ to ensure aspects of
recuperation and social care are addressed pre- operatively to reduce delays postoperatively
(i.e. by pre- operative equipment provision). The goal of these programmes
is to achieve an improved service user experience by virtue of the service user being
more informed. In some localities ‘joint schools’ operate, consisting of a
multidisciplinary education session in which the service user is provided with the
relevant information and encouraged to bring along a ‘coach’ (family member or
friend) to assist and support them (Worrall 2010).
Enhanced recovery programmes can also lead to a more streamlined approach to care
and shorter length of stay (NHS South East Coast 2012). The provision of a seven day
rehabilitation service is also emerging as a part of the approach to improving quality
and providing an equitable service for elective orthopaedic service users (NHS
Improvement 2012).
Empowering the service user with information can be effective in assisting with
motivation and developing appropriate expectations about achievements along the
pathway. The need for effective pre- admission assessment and provisional discharge
planning is, therefore, imperative.
1.3 The occupational therapy role
Occupational therapy involvement with adults undergoing a total hip replacement
takes place in the acute inpatient or pre- operative setting, although not exclusively
(Drummond et al 2012). Given the wider context of the ‘service user flow’ (Figure 1), it
is, therefore, important to draw attention to the person- centred and holistic philosophy
of occupational therapy.
Occupational therapists view people as occupational beings. People are
intrinsically active and creative, needing to engage in a balanced range of
activities in their daily lives in order to maintain health and wellbeing. People
shape, and are shaped by, their experiences and interactions with their
environments. They create identity and meaning through what they do and have
the capacity to transform themselves through premeditated and autonomous
action. The purpose of occupational therapy is to enable people to fulfil, or to
work towards fulfilling, their potential as occupational beings. Occupational
therapists promote function, quality of life and the realisation of potential in
people who are experiencing occupational deprivation, imbalance or alienation.
They believe that activity can be an effective medium for remediating
dysfunction, facilitating adaptation and recreating identity. (COT 2009, p1)
Clinical reasoning must take account of individual preferences and needs, including the
complexities of treating service users with multiple pathologies, or those with cognitive
or emotional dysfunctions, dementia and learning disabilities.
Shorter length of hospital stay has necessitated, in many services, prioritisation of
inpatient therapy to elements such as mobility and self- care that are essential for safe
discharge, rather than adopting a more holistic stance. Occupational therapy recognises
that service users have a wide range and diversity of goals, specific to their own
situation. Part of the remit of the hospital- based occupational therapist, therefore,
includes signposting and referral to community teams, in recognition that not all needs
may be addressed within the hospital environment. This may be due to service user
College of Occupational Therapists
9