Role of OT in an Interdisciplinary Team Care Approach,Used to Rehabilitate Elective Hip and Knee Arthroplasties: A Systematic Review

PURPOSE: The purpose of this poster presentation is to describe the evidence of effectiveness of occupational therapy interventions in an interdisciplinary team care approach, which is used to rehabilitate elective hip and knee arthroplasty surgeries. However, there is a paucity of evidence and a lack of consensus. Hence the systematic review will explore the functional outcomes that occupational therapy (OT) provides within an interdisciplinary team for elective joint replacement surgery.

DESIGN: This is a systematic review that digitally selected studies that focused on the treatment and outcomes of individuals who had undergone elective joint replacement surgeries. The treatment in these studies were implemented by interdisciplinary teams which included occupational therapy services. Data was retrieved through a digital database and was selected based on whether it met the requirements that related to our focus.

METHOD: Articles were gathered through databases including: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Sage Journal, PROQUEST, Health and Medical Collection, EBSCO Host, Archives of Physical Medicine and Rehabilitation, Journal of Occupational Science, and Cochrane Library. MeSh terms: total joint replacement, occupational therapy, interdisciplinary, occupational, joint replacement surgery, and arthroplasty were utilized and including the boolean term “AND.” Articles were filtered with the inclusion criteria of articles being free, full text, peer reviewed journals, published between 2009-2019, English, and published in any country. Exclusion criteria included non-peer reviewed, non-English, and ongoing studies. The filtering process resulted with five articles.

RESULTS: Five studies were chosen with four themes extracted from the results: interdisciplinary teams, arthroplasty, OT interventions, and functional improvements.

The findings of this systematic review indicated that the role of OT is necessary within the interdisciplinary team for patients undergoing elective joint replacement surgery. Particularly, collaborating with professions such as the physical therapist (PT), nurse, and ancillary staff were vital to promoting the most efficient patient recovery (1). Across the studies, OT’s and PT’s needed to work together in transferring the skills of balance, gait training and general strengthening into the client’s daily occupations. Additionally, total knee and total hip surgeries were among the most prevalent elective joint replacements due to pain and client report of decreased functional engagement (2). To address these deficits, OT interventions encompassed a variety of interventions including education, safety, environmental modifications, car transfers, and proper elevation techniques. Therefore, strong evidence supported inclusion of OT within the interdisciplinary team especially for addressing safety with activities of daily living (ADL) training. As a result, the functional outcomes led to a reduction in inpatient length of stay, overall hospital costs, and patient physical and psychosocial outcomes (3).

CONCLUSION: Our study found a need for OT to be included into an interdisciplinary team approach. After reviewing several peer reviewed articles, the studies infer that OT interventions provide positive outcomes for patients with elective joint replacement surgery. For future research, OTs should conduct more research focused on elective joint replacement surgery so that researchers can obtain adequate evidence. The proposal can aid in creating policies that include OT within an interdisciplinary team for elective joint replacement surgery.Advocacy for inclusion of OT in this practice can promote the therapeutic interventions and beneficial outcomes that OTs provide

References

1. Bozorgi, A. A. J., Ghamkhar, L., Kahlaee, A. H., & Sabouri, H. (2016). The effectiveness of occupational therapy supervised usage of adaptive devices on functional outcomes and independence after total hip replacement in iranian elderly: A randomized controlled trial. Occupational Therapy International, 23(2), 143–153. doi: 10.1002/oti.1419

2. Jepson, P., Sands, G., Beswick, A. D., Davis, E. T., Blom, A. W., & Sackley, C. M. (2016). A feasibility randomised controlled trial of pre-operative occupational therapy to optimise recovery for patients undergoing primary total hip replacement for osteoarthritis (PROOF-THR). Clinical Rehabilitation, 30(2), 156–166. doi: 10.1177/0269215515576811

3. Mallinson, T. R., Bateman, J., Tseng, H. Y., Manheim, L., Almagor, O., Deutsch, A., & Heinemann, A. W. (2011). A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery. Archives of Physical Medicine and Rehabilitation, 92, 712–720. doi: 10.1016/j.apmr.2010.12.007

4. Martín-Martín, L.,M., Valenza-Demet, G., Jiménez-Moleón, J. J., Cabrera-Martos, I., Revelles-Moyano, F., & Valenza, M. C. (2014). Effect of occupational therapy on functional and emotional outcomes after hip fracture treatment: A randomized controlled trial. Clinical Rehabilitation, 28(6), 541-551. doi: 10.1177/0269215513511472