Efficacy of Early ADLs in the Postoperative Total Joint Replacement Population

Activities of Daily Living (ADL) in Acute Care prevent functional decline while hospitalized (Shearer, et al). Individualized Occupational Therapy (OT) training early during hospitalization improves ADL independence and increases the likelihood of returning to independent living post hospitalization (Hagsten, et al). Little evidence exists on the timing of ADL intervention in a patient’s day and its impact on hospital throughput. This study’s purpose was to determine if an early morning ADL session with an occupational therapist post total joint replacement had a positive effect on discharge percentage rate by noon or length of stay (LOS). We hypothesized an early morning ADL on day of discharge would reduce patient functional deficits and hospital operational barriers to facilitate throughput. Patients for an early morning ADL session (occurring before 10am) were identified the evening before with nursing. Over 3 months, 156 patients met the inclusion criteria of which 107 had an early ADL. 85.9% of the early ADL group discharged the same day and 31.7% left by noon. Sixty-five percent of patients without an early ADL left the same day and less than1% left by noon. Overall LOS of those receiving an early ADL was 0.6 hours shorter than those who did not. Specifically, total knee arthroplasty (TKA) patients showed a slightly greater impact. Ninety-six patients had a TKA and of these, 92.2% of the early ADL group left the same day compared to 71.8% who did not. 31.2% of those receiving an early morning ADL left by noon and the LOS was 2.9 hours shorter on average. No TKA patients without an early morning ADL left by noon. Early morning ADL’s result in greater number of discharges by noon and lower LOS. Focusing on similar surgical interventions repetitively, i.e. TKA, and at higher volumes appeared to demonstrate greater benefit from the earlier ADL session by optimizing operational workflows and limiting process deviations between patients.

References

Shearer, T., & Guthrie, S. (2013). Facilitating early activities of daily living retraining to prevent functional decline in older adults. Australian Occupational Therapy Journal, 60(5), 319–325. https://doi.org/10.1111/1440-1630.12070

Lavezza, A., Hoyer, E., Friedman, L. A., Daley, K., Steele, A., Rosen, S., & Young, D. (n.d.). Activities of Daily Living Assessment Early in Hospitalization Is Associated With Key Outcomes. American Journal of Occupational Therapy, 77(5). https://doi.org/10.5014/ajot.2023.050167

Hagsten, B., Svensson, O., & Gardulf, A. (2004). Early individualized postoperative occupational therapy training in 100 patients improves ADL after hip fracture, A randomized trial. Acta Orthopaedica Scandinavica, 75(2), 177–183. https://doi.org/10.1080/00016470412331294435