Total hip replacement - College of Occupational Therapists

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
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