Total hip replacement - College of Occupational Therapists

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Guideline recommendations subsequently organising a group would be complex and resource heavy. In the absence of specific evidence regarding carers groups in this clinical context, there is no indication that they would necessarily be any more effective than the involvement of informal carers individually in the pre- operative assessment/education and post- operative intervention. While there may be a barrier for occupational therapists to provide carers groups, they can ensure family members/carers are informed of support services in the local area that may be able to offer advice and support, and told of their right to a carer assessment. More formal opportunities for occupational therapy advice and contribution to carer education and support may be extremely pertinent earlier in the overall care pathway for arthritis. 23. It is suggested that there are potential benefits in including informal carers in pre- operative assessment/education, and post- operative intervention, to maximise service user independence and reduce carer stress. (Chow 2001, C) 2 C 7.7 Reintegration into the community 7.7.1 Introduction Facilitating longer term reintegration into community activities is not an area where occupational therapy intervention is routinely implemented following a hip replacement. Specific indications for post- operative rehabilitation are more likely to be indicated following a hip fracture, or when there are complex needs following elective surgery. It is important, however, that the service user is encouraged to consider activities they wish to engage in subsequent to the immediate post- operative period, and to discuss how they may re- engage in past occupations or become involved in new physical or social activities. Post- operative rehabilitation to facilitate community re integration is frequently most appropriately, and more likely, to be provided via reablement, community services and day hospitals. However, resources may not always exist, which may cause a barrier to provision. Further rehabilitation may, therefore, need to be promoted by encouraging the service user and their family to be proactive in facilitating self- rehabilitation. 7.7.2 Evidence Two low-level quality studies were identified via the literature search that considered activity post- surgery. Although quite different in their context, they both highlighted issues around engagement in physical activity or the wider community following hip replacement. A total hip replacement, with its impact on reducing pain and increasing physical function, could be predicted to result in an increase in physical activity post- operatively. A cohort study in the Netherlands (de Groot et al 2008) identified that actual physical activity on objective measurement had not increased as much as expected at six months following hip surgery (0.7% improvement compared to baseline measures). The activity measured, using an activity monitor, included movement- related activities (for example, walking and cycling) together with body postures (sitting and standing) and changes in body posture (for example, sit to stand movements). Service users self- reported the time 56 Occupational therapy for adults undergoing total hip replacement
Guideline recommendations spent in recreational, household and occupational activities, using a modification of the Physical Activity Scale for the Elderly. There was, however, variation between the objectively measured activity data and service user self- reported accounts. Service users reported an 86 per cent increase in activity. The outcomes were measured six months post- operatively, a relatively short period of time following major surgery, and there may have been some self- report bias. Given the potentially low level of physical activity it is considered important that service user’s needs and goals for ‘activity’ be identified. A study carried out in the United States of America (Gillen et al 2007) examined the effect of occupational therapy intervention that focused on improving community skills post- operatively. Activities targeted were based on five pre- determined goals, specifically entering and exiting a vehicle; shopping; managing outdoor obstacles; participating safely in the community and travelling to and from outpatient appointments. The intervention took place in a single 45 minute session and the study involved 107 individuals who had received either a hip or knee replacement. Performance and satisfaction with performance were measured using an adapted version of the Canadian Occupational Performance Measure. Confidence was measured with a researcher- designed scale. Outcomes were positive with overall higher ratings on all measures post- intervention, indicating the benefit of practice within the natural environment. It should be noted that the occupational therapy intervention was provided via a private rehabilitation centre, that the measures were self- reported and there was no follow- up to determine the longer term benefits. To optimise rehabilitation outcomes, there should be a focus on enhancing community participation and decreasing activity limitations. The focus of acute intervention is likely to mean a strong concentration on fitness for discharge. It is, however, important that the pre- operative assessment in particular provides advice and suggestions for goals that the service user can work towards once they have returned home. The acute sector occupational therapy service is unlikely to have the resources available to provide the kind of follow up community intervention as described by Gillen et al, and therefore onward referral is most likely to be indicated. The potential of reablement/rehabilitation services post- total hip replacement may be significantly impacted on by the availability of local services and the eligibility criteria. Encouraging and empowering the service user with tools and confidence to be proactive in achieving long- term goals without therapist input is therefore important. 24. It is recommended that occupational therapists encourage early discussion and goal setting for community reintegration, including social and physical activities. (de Groot et al 2008, D; Gillen et al 2007, C) 25. It is suggested that where specific needs are identified, the occupational therapist refers the service user on to community rehabilitation, reablement or intermediate care services to enhance community reintegration. (de Groot et al 2008, D; Gillen et al 2007, C) 1 C 2 C College of Occupational Therapists 57
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Occupational therapy for adults und
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Occupational therapy for adults und
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Contents Foreword by Professor Avri
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Foreword I am delighted to have bee
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Key recommendations for implementat
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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
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Page 53 and 54: Guideline recommendations 11. It is
Page 55 and 56: Guideline recommendations environme
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Page 61 and 62: Guideline recommendations an accele
Page 63: Guideline recommendations In terms
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
Page 113 and 114: 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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Total hip replacement - College of Occupational Therapists

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