Transcript Abstract - Wild Apricot

Introduction
• There exists a paucity of research regarding the role of
OT with elective total joint replacement (TJR) patients.
• Determining this role will help support further OT
research on efficacy and best practice within this
population.
• There appears to exist a significant variation in the
clinical practice of OT’s within the elective TJR
population. (Munin et 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)
(Centers for Disease Control and Prevention, 2010).
• 2009:
– 75% of TJR patients received some form of post-acute rehab:
• home-based therapy
• skilled nursing facility,
• acute/intensive inpatient rehabilitation program
(Dejong et 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-analysis of data determined only weak evidence supports the
benefits of OT intervention for elective THR patients (College of Occupational
Therapists: Specialist Section, Trauma and Orthopaedics, 2012).
• Evidence supports the involvement of OT’s during the pre-op
educational process (Couteyre et al, 2007).
• Research suggests criteria for d/c from the hospital include that
patients:
– Are able to perform self-care, including med-management
– Are able to understand the signs and symptoms indicating return to
the hospital
– Are able to perform ADL’s with minimal assistance
• Research does not report who determines whether or not these
goals are met.
(Raphael et al, 2011)
Literature Review
• Study of elective TJR patients in Norway
revealed that rehab there typically included PT
and medical interventions by a doctor, but not
always OT or social services interventions
• It was found that patients reported unaddressed difficulties with activities of daily
living and home-related activities
(Grotle et 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, patientcentered, 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
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Collection of results is ongoing.
Survey has been posted online for 1 week.
N=10
9 OT’s, 1 COTA’
4 Full-time, 4 Part-time, 2 PRN
Of these, 8 had worked at some point in
another treatment setting (SNF,
outpatient, home health, peds, mental
health, or inpatient rehab).
Preliminary Results: Demographics
2 to 5
Years in OT
Years in Acute Care
6 to 10
11 to 15
16 to 20
2
2
1
20+
2 to 5
6 to 10
3
1
11 to 15
2
3
6
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 of OT depts that 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 shoehorn
• 60%: 3-1 commode, dressing stick
– Anterior THR: 50%
• 100%: elevated toilet seat, shower chair/tub bench
• 25%: 3-1 commode, reacher, sock aid, long sponge, long shoehorn,
dressing stick
– Posterior THR: 100%
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100%: Reacher, Sock aid
80%: 3-1 Commode, Shower chair/tub bench, long sponge
60%: elevated toilet seat, long shoehorn
30%: dressing stick
20%: leg lifter, elastic laces
Equipment Recommendations
• Percent of respondents that personally issued/recommend
certain AE/DME as standard to ALL patients:
– TKR: 30%
• 100%: Shower chair/tub bench, reacher
• 66%: elevated toilet seat, sock aid, long sponge, long shoehorn
– Anterior THR: 70%
• 71%: elevated toilet seat, shower chair/tub bench, reacher, sock aid
• 57%: 3-1 commode, long sponge, long shoehorn
• 28%: dressing stick
– Posterior THR: 80%
• 100%: Reacher, sock aid
• 75%: 3-1 commode, elevated toilet seat, shower chair/tub bench, long
handle sponge
• 62%: long shoehorn
• 38%: leg lifter, dressing stick
• 25%: elastic laces
Discharge Recommendations: TKR
90%
80%
70%
60%
Home without OT f/u
50%
40%
Home with HHOT
30%
20%
SNF/Sub-acute rehab
10%
Acute/Inpatient rehab
0%
None
1 to 25%
26 to 50%
51 to 75%
76 to 100%
Discharge Recommendations: Ant THR
70
Home without OT f/u
60
50
Home with HHOT
40
SNF/Sub-acute rehab
30
20
Acute/Inpatient rehab
10
0
None
1 to 25%
26 to 50%
51 to 75%
76 to 100%
Discharge Recommendations: Post
THR
120
100
80
Home without OT f/u
Home with HHOT
60
SNF/Sub-acute rehab
Acute/Inpatient rehab
40
20
0
None
1 to 25%
26 to 50%
51 to 75%
76 to 100%
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.
• OT depts issued 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.
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References
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References
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References
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