The paper deals with the case study of Mrs. Anitha Smith. She has been referred to occupational therapist after total hip replacement. Occupational therapy refers to team of social workers, nurses, physiotherapist working as a part of multidisciplinary team. The aim of the occupational therapy is to enhance self-independence of client and ensure safety during recovery process (Blom et al., 2016). The paper highlights the occupational performance issues observed after interview with the client. The strengths of clients are identified and based on overall assessment SMART (Smart Measurable Achievable Realistic Time bound) goals and interventions are discussed. The intervention strategies are developed as a part of the role of occupational therapist based on evidence from literature.
In order to develop interventions for the client an interview was conducted to gain sufficient knowledge on her background. The background assessment was guided by the Person-Environment-Occupational Performance (PEOP) model. It is a transactive system model that helps focus on the client’s extrinsic and intrinsic influences on activities of daily living (Arcand-Dusseault & Egan, 2015).
Mrs. Anitha Smith is 76 years old living in single storey house in a small town. She was social, active and independent before the surgery. Mrs. Anita is not having good sleep due to facilities schedule. She is lacking good nutrition as she is having slow meals. She has good fluid intact and has lost weight recently. She needs physical assistance for moving out of bed as she has low body strength and restricted flexibility due to which she is toileting on bed. It may severely impact her daily life activities. She is under medication for pain and blood pressure.
Her mental function is not intact due to post surgery medications. She is stressed due to pain and poor mobility. She has poor mental well being due to recent death of her husband. She seems to have good self esteem. The patient has reduced balance. Nneuromusculoskeletal and functions related mobility such as joint mobility, joint stability, gait patterns, are all impacted in the replaced hip. She has good coordination and is mentally alert. She has good reasoning when focused.
Mrs. Anita loves her independence, good work ethic and gives importance to social participation. Currently she is dependent on state pension income. She lives in her one storey building with just one step at the back of entrance. Her home has here bedrooms and two bathrooms. She is widow, living alone. She is friendly and exhibits socially appropriate behavior. She has support of friends but she is withdrawing from communication. She has no loved ones nearby her.
Mrs. Anita engages in wide range of occupations. She loves going out with friends, travelling, shopping, gardening activities and home Management. She is involved in self-care and kitchen work. She independently involves in grocery shopping.
It is evident from the PEOP assessment of Mrs. Anita that the primary issues are:
Based on the PEOP model of assessment it was found that Mrs Anita’s strength is her high self esteem, social support from neighbors and friends. Social connectedness will help overcome emotional stress and gain confidence (Brembo et al., 2017). She has good coordination, is mentally alert, and is indicative of good cognition. She has good reasoning when focused. She is following the doctors instructions and the given hip precautions. It means if she is educated about the precautions to be taken to improve mobility she will recover quickly. It indicates that she will participate actively in recovery process (Goyal et al., 2017). In addition, she values her independence and was independent prior to hip replacement. She is motivated to return home. Therefore, providing adequate support and technique to improve her physical independence will restore her previous activities such as cooking, home Management, shopping and others.
Considering the occupational performance issues it can be concluded that the required performance skills are: gripping walker, controlling limbs, control of walker, have proper gait cycle and improve balance. The required body functions are: mobility of joints, and improved lower body strength. After interview and assessment specific, achievable, measurable and realistic and time bound occupational therapy goals are set for patient.
Mrs. Anita can receive health care service at her home. Initially, she will continue the inpatient rehabilitation. After achieving the short-term goals such as using the walker, she will be discharged. Prior to which she will be given a facility protocol for hip replacement. Prior to discharge the patient will be provided with guidelines and materials for education on her illness to ensure safety. It includes how to ensure safe environment such as removing obstacles from path to prevent fall and ensure sufficient lighting in washroom, kitchen and hall area (Goyal et al., 2017).
Mrs. Anita will be given training on use of assistive device such as walker with precautions during bathing and technique to get in and out of tub, and in shower, getting in and out of car. Walker is assistive device that prevents fall and risk of injury by helping to balance and maintain hip position (Mikkelsen et al., 2014).Training on yard work, laundry and shopping using appropriate shoes, walker, gait belt, glasses followed by training on having grip and control of walker will be provided to the client.
To improve mobilization, the client will be trained by physiotherapist on post operative exercises. Exercises that can be performed while on bed-
Standing exercises holding firm surfaces to complete a simple painting in standing
These exercises are designed to restore strength, dynamic stability and mobility to hip. It will help client to return to daily life activities or occupations (Villadsen et al., 2014).
Training on advanced exercises and activities (to be repeated 4 times a day with ten times each session)
Advanced exercises are necessary because hip muscles are weakened due to pain after fall and surgery (Villadsen et al., 2014).
Training and instruction on correct use of assistive devices such as trochanter roll. Trochanter roll aid in hip alignment when the body is unable to support itself without causing injury. It prevents external rotation of hip (Blom et al., 2016). It is important for client to learn to change positions properly on bed to relieve pressure with a little pain possible. Transferring to bed is risky and holds high risk of fall and injury (Mikkelsen et al., 2014). Training includes teaching how to use trapezbar when transferring in bed and kitchen trolley. The patient requires instructions on use of compression stockings. She will given instructions on method of wearing of SCD device. Daily use of compression stockings helps to reduce the development of deep vein thrombosis and aid in pain Management (Singh & Lewallen, 2014).
Music therapy has been found effective technique for relaxation in various chronic diseases. It is in effective in marinating body-mind in calm and composed state. Music will help Anita to relax and relieve stress caused by pain and bereavement (Hsu et al., 2016).
In conclusion, occupational therapy is vital for helping patients of hip replacement surgery to improve functional limitations while promoting safety and success. The assignment was helpful in providing deep insights into occupational therapy interventions for hip replacement. It helped in developing reasoning skills, assessment based on the interview and identification of risks and strength associated with client.
Arcand-Dusseault, C., & Egan, M. (2015). Occupations and personal projects: A comparison of the concepts. British Journal of Occupational Therapy, 78(5), 303-310.
Blom, A. W., Artz, N., Beswick, A. D., Burston, A., Dieppe, P., Elvers, K. T., ... & Lenguerrand, E. (2016). Occupational therapy in total hip replacement: systematic review and feasibility randomised controlled trial.
Brembo, E. A., Kapstad, H., Van Dulmen, S., & Eide, H. (2017). Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study. Health and Quality of Life Outcomes, 15(1), 68.
Emerson, R. H., Barrington, J. W., Olugbode, O., Lovald, S., Watson, H., & Ong, K. (2014). Comparison of Local Infiltration Analgesia to Bupivacaine Wound Infiltration as Part of a Multimodal Pain Program in Total Hip Replacement. Journal of surgical orthopaedic advances, 24(4), 235-241.
Goyal, N., Chen, A. F., Padgett, S. E., Tan, T. L., Kheir, M. M., Hopper, R. H., ... & Hozack, W. J. (2017). Otto Aufranc Award: A multicenter, randomized study of outpatient versus inpatient total hip arthroplasty. Clinical Orthopaedics and Related Research®, 475(2), 364-372.
Horstmann, T., Listringhaus, R., Brauner, T., Grau, S., & Mündermann, A. (2013). Minimizing preoperative and postoperative limping in patients after total hip arthroplasty: relevance of hip muscle strength and endurance. American Journal of Physical Medicine & Rehabilitation, 92(12), 1060-1069.
Hsu, C. C., Chen, W. M., Chen, S. R., Tseng, Y. T., & Lin, P. C. (2016). Effectiveness of music listening in patients with total knee replacement during CPM rehabilitation. Biological research for nursing, 18(1), 68-75.
Mikkelsen, L. R., Petersen, M. K., Søballe, K., Mikkelsen, S., & Mechlenburg, I. (2014). Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study. European journal of physical and rehabilitation medicine, 50(4), 383-393.
Ollivier, M., Frey, S., Parratte, S., Flecher, X., & Argenson, J. N. (2014). Pre-operative function, motivation and duration of symptoms predict sporting participation after total hip replacement. Bone Joint J, 96(8), 1041-1046.
Singh, J. A., & Lewallen, D. G. (2014). Patient-level improvements in pain and activities of daily living after total knee arthroplasty. Rheumatology, 53(2), 313-320.
Villadsen, A., Overgaard, S., Holsgaard-Larsen, A., Christensen, R., & Roos, E. M. (2014). Postoperative effects of neuromuscular exercise prior to hip or knee arthroplasty: a randomised controlled trial. Annals of the rheumatic diseases, 73(6), 1130-1137.
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