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Abstract - Wild Apricot

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Introduction
There exists a paucityofresearchregarding the role ofOT withelective totaljoint replacement (TJR) patients.Determiningthis rolewill helpsupport furtherOT research onefficacyand bestpractice within this population.There appears to exist a significant variation in the clinical practice of OT’s within the elective TJR population.(Muninet al, 2011)In the current environment of limited third-party reimbursement, and the need for justification of all services provided to patients, it is necessary to determine best practice for OT’s.
Literature Review: Impact of TJR
2010:719,000 total knee replacements (TKR)332,000 total hip replacements (THR)(Centersfor Disease Control and Prevention, 2010).2009:75% of TJR patients receivedsome form of post-acuterehab:home-based therapyskillednursingfacility,acute/intensive inpatientrehabilitationprogram(Dejonget al, 2009).Average hospital LOS for THR in the USA:1980’s: 3 weeks(Epstein et al, 1987)2005: 4 days(Herbold et al, 2011)
Literature Review
Meta-analysisofdata determined onlyweak evidencesupportsthe benefits ofOT intervention for elective THR patients(College of Occupational Therapists: Specialist Section, Trauma andOrthopaedics, 2012).Evidencesupportsthe involvement ofOT’sduring thepre-opeducational process(Couteyreet al, 2007).Research suggests criteriaford/cfrom the hospitalinclude that patients:Are able to perform self-care, including med-managementAre able to understand the signs and symptoms indicating return to the hospitalAre able to perform ADL’s with minimal assistanceResearch does not report who determines whether or not these goals are met.(Raphael et al, 2011)
Literature Review
Studyof elective TJR patients inNorwayrevealed thatrehabthere typically includedPT andmedical interventions by a doctor, but not alwaysOT orsocial services interventionsIt was found that patients reported un-addressed difficulties with activities of daily living and home-related activities(Grotleet al, 2010).
Literature review
Assessment of psycho-emotional factors in an elective TJR program revealed that an emphasis on positive feedback was correlated with positive outcomes.(Stavrev&Ilieva, 2003)OT’s are poised to provide holistic, functional, patient-centered, and occupation-based interventions that are presumed to have a positive impact on overall success following elective TJR.Given that the greatest declines in strength/functional performance occur in the immediate post-op period, it can be deduced that OT’s should have evidence to guide their practice during this essential time.(Bade & Stevens-Lapley, 2012)
Problem Statement/Purpose
The OT field lacks participation in tracking outcomes of ADL and IADL performance in the TJR population; when in fact, OT’s would be the most qualified healthcare professionals to determine success in these goals.Lack of research in this area may put OT in danger of being phased out of elective TJR programs.This preliminary study seeks to determine the most recent trends in OT assessment, intervention, and pt education, prior to efficacy research being performed.
Objectives
Demographically describe OT’s treating TJR patients.Calculate the frequency of use of standardized programs/protocol/clinical pathways.Determine OT’s current role in the pre-operative education process.Ascertain time spent on various treatment activities from therapists’ perspectives.Clarify AE commonly recommended or issued.Determine use of standardized assessments and outcome measurements.Summarize common discharge setting recommendations among OT’s.
Methodology
Subjects:OT’s/COTA’s working in acute care (including full-time, part-time,prn).Instrumentation:Survey was created by the researcher and reviewed by several other OT’s, then revised.Data Collection:Online via email, social media (twitter,fb, etc), anonymous via web-link.Data analysis:Descriptive statistics was used to determine trends.
Preliminary Results: Demographics
Collection of results is ongoing.Survey has been posted online for 1 week.N=109 OT’s, 1 COTA’4 Full-time, 4 Part-time, 2 PRNOf these, 8 had worked at some point in another treatment setting (SNF, outpatient, home health,peds, mental health, or inpatient rehab).
Preliminary Results: Demographics
Preliminary Results: TJR Program Characteristics
6 therapists worked at hospitals that have a standardized TJR program/protocol/pathway.All had pre-op education classes.The pre-op education class was mandatory for 4.No pre-op education classes had OT involvement.No therapists reported the use of standardized assessments.2 worked in settings that tracked outcomes to measure the success of the TJR program.
Preliminary Results:Eval& Treatment Activities
All respondents reported they receive OT orders for all TKR, anterior THR, and posterior THR patients.Treatment Activities: See Tables.
Equipment Recommendations
Percent ofOTdeptsthat issued/recommended certain AE/DME as standard to ALL patients:TKR: 30%100%: elevated toilet seat, shower chair/tub bench,reacher, sock aid, long sponge, long shoehorn60%: 3-1 commode, dressing stickAnterior THR: 50%100%: elevated toilet seat, shower chair/tub bench25%: 3-1 commode,reacher, sock aid, long sponge, long shoehorn, dressing stickPosterior THR: 100%100%:Reacher, Sock aid80%: 3-1 Commode, Shower chair/tub bench, long sponge60%: elevated toilet seat, long shoehorn30%: dressing stick20%: leg lifter, elastic laces
Equipment Recommendations
Percent of respondents thatpersonallyissued/recommend certain AE/DME as standard to ALL patients:TKR: 30%100%: Shower chair/tub bench,reacher66%: elevated toilet seat, sock aid, long sponge, long shoehornAnterior THR: 70%71%: elevated toilet seat, shower chair/tub bench,reacher, sock aid57%: 3-1 commode, long sponge, long shoehorn28%: dressing stickPosterior THR: 80%100%:Reacher, sock aid75%: 3-1 commode, elevated toilet seat, shower chair/tub bench, long handle sponge62%: long shoehorn38%: leg lifter, dressing stick25%: elastic laces
Discharge Recommendations: TKR
Discharge Recommendations: Ant THR
Discharge Recommendations: Post THR
Discussion
A Majority of respondents were OT’s, and either full- or part-time employees. There was a diversity of experience levels.A majority of respondents has worked in practice settings other than acute care.Slightly more than half had standardized protocols/pathways for elective TJR patients.All provided pre-op education, but none involved OT.None used standardized assessments, and few tracked outcomes to determine the success of their program.
Discussion
Respondents spent more time on ADL’s and transfers, than on ambulation. No time was spent on exercise for any populations.OTdeptsissued or recommended certain equipment as standard to all posterior THR patients, but only some anterior THR and TKR patients.OT’s personally recommended more equipment to THR patients than TKR patients.
Discussion
OT’s more commonly recommended home health OT or rehab in a skilled nursing facility for THR patients (anterior and posterior) than for TKR patients.Patients frequently discharged home without a recommendation for follow-up from OT afterward.
Conclusion
These results are preliminary, from a very small sample size. Data collection and analysis is ongoing. Interpretation of these results is guarded.OT’s commonly focus on ADL’s and transfers in the immediate post-op period.A diversity of clinical judgment exists in determining the need for adapted equipment.A large amount of patients discharge home without further follow-up from OT.Further research is required to determine efficacy and best practice for OT in the immediate post-op period following elective TJR.
References
American Occupational Therapy Association. (2002). Occupational Therapy Practice Framework: Domain and Process.American Journal of Occupational Therapy,56, 609-39.Bade, M.J. & Stevens-Lapley, J.E. (2012) Restoration of Physical Function in Patients Following Total KneeArthroplasty: An Update on Rehabilitation Practices.Current Opinion in Rheumatology, 24:2.Centers for Disease Control and Prevention.(2010).National Hospital Discharge Survey: 2010 table, Procedures by selected patient characteristics - Number by procedure category and age. Retrieved July 15, 2014, fromhttp://www.cdc.gov/nchs/fastats/inpatient-surgery.htm.College of Occupational Therapists: Specialist Section, Trauma andOrthopaedics. (2012).Occupational Therapy for Adults Undergoing Total Hip Replacement: Practice Guideline. College of Occupational Therapists Ltd: London.Couteyre, E.,Jardin, C.,Givron, P.,Ribinik, P., Revel, M. &Rannou, F. (2007). Could Preoperative Rehabilitation Modify Post-Operative Outcomes After Total Hip and KneeArthroplasty? Elaboration of French Clinical Practice Guidelines.AnnalesDeReadpatationEt DeMedecinePhysique, 50, 189-97.Drummond, A.,Coole, C.,Brewin, C. & Sinclair, E. (2012). Hip Precautions Following Primary Total Hip Replacement: A National Survey of Current Occupational Therapy Practice.British Journal of Occupational Therapy, 75, 164-70.Drummond, A., Edwards, C.,Coole, C. &Brewin, C. (2013). What Do We Tell Patients About Elective Total Hip Replacement in the United Kingdom? An Analysis of Patient Literature.Biomed Central Musculoskeletal Disorders, 14:152-58.Dejong, G.,Hieh, C., Gassaway, J., Horn, S.,Smout, R., Putman, K., James, R., Brown, M., Newman, E. & Foley, M. (2009). Characterizing Rehabilitation Services for Patients with Knee and Hip Replacement in Skilled Nursing Facilities and Inpatient Rehabilitation Facilities.Archives of Physical Medicine & Rehabilitation, 90, 1269-83.
References
Epstein, A.M., Read, J.L. &Hoefer, M. (1987). The Relation of Body Weight to Length of Stay and Charges for Hospital Services for Patients Undergoing Elective Surgery: A Study of Two Procedures.American Journal of Public Health, 77, 993-8.Grotle, M., Garratt, A.M.,Klokkerud, M.,Lochting, I.,Uhlig, T., Hagen, K.B. (2010). What’s in Team Rehabilitation Care AfterArthroplastyfor Osteoarthritis? Results from a Multicenter, Longitudinal Study Assessing Structure, Process, and Outcome.Physical Therapy, 90, 121–31.Herbold, J.A.,Bonistall, K. & Walsh, M.B. (2011). Rehabilitation Following Total Knee Replacement, Total Hip Replacement, and Hip Fracture: A Case-Controlled Comparison.Journal of Geriatric Physical Therapy, 34, 155-60.Keifer, D.E. & Emery, L.J. (2004). Functional Performance and Grip Strength After Total Hip Replacement.Occupational Therapy in Healthcare, 18, 41-56.Keith, R. (1997). Treatment Strength in Rehabilitation.Archives of Physical Medicine & Rehabilitation, 78, 1298-304.Kersten, R.F.M.R., Martin, S., VanRaay, J.J.A.M.,Bulstra, S.K. & Van DenAkker-Scheek, I. (2012). Habitual Physical Activity After Total Knee Replacement.Physical Therapy, 92, 1109-16.Khan, F., Ng, L., Gonzalez, S., Hale, T. & Turner-Stokes, L. (2008). Multidisciplinary RehabilitationProgrammesFollowing Joint Replacement at the Hip and Knee in ChronicArthropathy.Cochrane Database Systematic Reviews, 2:1-51.Kim, S.,Losina, E., Solomon, D.H., Wright, J., Katz, J.N. (2003). Effectiveness of Clinical Pathways for Total Knee and Total HipArthroplasty: A Literature Review.The Journal ofArthroplasty,18, 69-74.
References
McDonald, S.,Hetrick, S.E. & Green, S. (2004).Pre-Operative Education for Hip or Knee Replacement. Retrieved July 10, 2014, fromhttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003526.pub2/fullMunin, M.C., Putman, K., Hsieh, C.H.,Smout, R.J.,Tian, W.,Dejong, G. & Horn, S.D. (2010). Analysis of Rehabilitation Activities within Skilled Nursing and Inpatient Rehabilitation Facilities After Hip Replacement for Acute Hip Fracture.American Journal of Physical Medicine & Rehabilitation,89, 530-40.Oganda, L., Wilson, R.,Archbold, P., Lawler, M., Humphreys, P., O’Brien, S. &Beverland, D. (2002). A Minimal-Incision Technique in Total HipArthroplastyDoes Not Improve Early Postoperative Outcomes.Journal of Bone Joint Surgery, 87:701-10.Raphael, M., Jaeger, M. & VanVlymen, J. (2011). Easily Adoptable Total JointArthroplastyProgram Allows Discharge Home in Two Days.Canadian Journal of Anesthesiology, 58, 902-10.Stavrev, V.P. &Ilieva, E.M. (2003) The Holistic Approach to Rehabilitation of Patients After Total Hip Joint Replacement.FoliaMedica, 45.Thomas, W.N.,Pinkelman, L.A.,Gardine, C.J. (2010). The Reasons for Noncompliance with Adaptive Equipment in Patients Returning Home After a Total Hip Replacement.Physical & Occupational Therapy in Geriatrics, 28, 170-80.Tian, W.,Dejong, G., Brown, M.,Hseih, J. &Zamfirov, Z. (2009). Looking Upstream: Factors Shaping the Demand for Post-Acute Joint Replacement Rehabilitation. Archives of Physical Medicine & Rehabilitation, 90, 1260-8

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Abstract - Wild Apricot