Total hip replacement - College of Occupational Therapists

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Guideline recommendations later, and that individuals may be involved in voluntary or other work- related activities, work roles are an area which should not be neglected. “This [work roles] must be considered in the widest sense – some people are no longer in paid work but do voluntary work which is really important to them.” 50+ Forum service user feedback Ideally, work- related issues should be addressed earlier in the care pathway of arthritis to facilitate adaptation to the work environment while the individual is still at work, and not yet listed for surgery. It is important that occupational therapists, where necessary, access guidance and information on work- related assessment and intervention, such as the ‘Work Matters’ resources available from their professional body, the College of Occupational Therapists (COT and National Social Inclusion Programme 2007). 7.3.2 Evidence Four studies provided low-level evidence on the relationship between work and total hip replacement. Nunley et al (2011) explored the area of return to work for younger service users in America through a multi- centre telephone study. The study found that most young active individuals who were employed before their surgery could be expected to return to work (90.4%), and the vast majority returned to their pre- operative occupation. This was similar to results in the smaller retrospective study by Mobasheri et al (2006) who likewise found that nearly all service users who were working pre- operatively returned to their jobs. Nunley’s cohort enabled analysis of 790 responses, but specifically targeted younger adults, with a mean age at time of surgery of 49.5 years, considerably younger than the typical adult receiving a total hip replacement in the UK. Older respondents (although upper age limit in the study was 65 for men and 55 for women) were found to report more restrictions at work and difficulties with particular activities such as squatting, kneeling, driving and climbing. Bohm (2010) in a small cohort study also found that total hip replacement had a positive effect on work capacity for those service users who returned to work. A further qualitative study by Parsons et al (2009) explored the experiences of service users living with severe osteoarthritis while awaiting hip and knee joint replacement surgery and highlighted the difficulty maintaining work or the need to seek premature retirement. The study also made reference to a lack of understanding on the part of the employer. These studies reinforce that closer attention may need to be given to service users who are still in the workforce in terms of discussing their job roles and supporting return to work. In the context of the wider clinical pathway, this could mean occupational therapists providing advice on areas such as energy conservation, joint protection, pacing and possible role/task modification while awaiting hip replacement. Discussion around employment status should form part of the pre- operative assessment, to give the service user a realistic timeframe regarding return to work and allowing them to plan a return to work schedule with their employer. Post- operatively, this should also be addressed, with advice given regarding when the service user can return to completing certain tasks as opposed to others, and giving suggestions about task and 46 Occupational therapy for adults undergoing total hip replacement
Guideline recommendations environmental adaptations to promote a successful transition back to work postoperatively. Where resources are available it may be appropriate to refer onto community services for return to work programme intervention. Acute hospital staff may not always have the opportunity to gain experience in managing issues or questions related to employment. An added concern may be that a service user’s expectations may be raised and then cannot be followed up. The potential lack of community resources to which service users can be referred, where further support or advice is needed in relation to work, may be an additional barrier. 15. It is recommended that work roles are discussed at the earliest opportunity as part of a comprehensive assessment. (Bohm 2010, C; Mobasheri et al 2006, D; Nunley et al 2011, C) 16. It is suggested that for service users who are working, advice is provided relating to maintaining their work role pre- operatively, post- operative expectations and relevant information for employers. (Bohm 2010, C; Mobasheri et al 2006, D; Nunley et al 2011, C; Parsons et al 2009, D) 1 C 2 C A more general focus on resumption of roles and relationships following a total hip replacement was identified as a key theme in a small qualitative study, which investigated the processes of recovery from the service user perspective (Grant et al 2009). The study highlighted that the physical domain was seen as being the main focus of recovery in hospital, but as recovery progressed, psychosocial issues, such as reestablishing roles and relationships, and shifting the focus from pre- surgical disability to post- operative ability, could be challenging. However, reliance on others for assistance with everyday activities decreased, and this facilitated the re- establishment of roles and relationships and the expansion of horizons. Grant explores the re- establishment of relationships, although the focus reported was on activities such as going out, gardening and visiting friends. Sexual activity within relationships was not apparently raised by participants, although this is an area which can be an important aspect of resumption of roles. Service users should be given the opportunity to discuss this issue, although it is suggested this is most likely to be within the context of protocols to avoid the risk of dislocation. The national survey of occupational therapy practice (Drummond et al 2012) identified that the discussion of sexual activities was reported by only 5 out of the 174 respondents within the ‘other ADL’ category. The focus on early discharge may mean that the issues arising in terms of resuming previous roles, and taking on new ones, may not always be apparent, or possible to address during the acute hospital phase. 17. It is recommended that occupational therapists provide advice to facilitate service users to establish previous and new roles and relationships, and shift their focus from disability to ability. (Grant et al 2009, C) 1 C College of Occupational Therapists 47
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Occupational therapy for adults und
Page 3 and 4: Occupational therapy for adults und
Page 5 and 6: Contents Foreword by Professor Avri
Page 7 and 8: Foreword I am delighted to have bee
Page 9 and 10: Key recommendations for implementat
Page 11 and 12: Key recommendations for implementat
Page 13 and 14: 1 Introduction Total hip replacemen
Page 15 and 16: Introduction Health education of pu
Page 17 and 18: Introduction In terms of best pract
Page 19 and 20: Introduction other members of the m
Page 21 and 22: Introduction surgery, the role of t
Page 23 and 24: 3 Guideline scope 3.1 Clinical ques
Page 25 and 26: Guideline scope • There are no re
Page 27 and 28: 4 Guideline development process Det
Page 29 and 30: Guideline development process contr
Page 31 and 32: 5 Guideline methodology 5.1 Guideli
Page 33 and 34: Guideline methodology 5.3 Criteria
Page 35 and 36: Guideline methodology Table 3: Grad
Page 37 and 38: Guideline methodology A recommendat
Page 39 and 40: 6 Background to clinical condition
Page 41 and 42: 7 Guideline recommendations The rec
Page 43 and 44: Guideline recommendations The inter
Page 45 and 46: Guideline recommendations mean leng
Page 47 and 48: Guideline recommendations assessmen
Page 49 and 50: Guideline recommendations suggestio
Page 51 and 52: Guideline recommendations and were
Page 53: Guideline recommendations 11. It is
Page 57 and 58: Guideline recommendations increased
Page 59 and 60: Guideline recommendations contribut
Page 61 and 62: Guideline recommendations an accele
Page 63 and 64: Guideline recommendations In terms
Page 65 and 66: Guideline recommendations spent in
Page 67 and 68: Service user perspectives of the re
Page 69 and 70: 9 Implementation of the guideline T
Page 71 and 72: Implementation of the guideline The
Page 73 and 74: Recommendations for future research
Page 75 and 76: Appendix 1: Guideline development g
Page 77 and 78: Appendix 2: Acknowledgements A2.4 C
Page 79 and 80: Appendix 3: Service user consultati
Page 81 and 82: Appendix 3: Service user consultati
Page 83 and 84: Appendix 4: Literature search strat
Page 85 and 86: Appendix 4: Literature search strat
Page 87 and 88: Appendix 5: Evidence- based review
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Appendix 5: Evidence- based review
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Appendix 6: Glossary and abbreviati
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References Evidence references Bere
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References Lin JJ, Kaplan RJ (2004)
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References Wang W, Morrison TA, Gel
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References Health and Care Professi
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