1. Coole C, Nouri F, Narayanasamy, Drummond A
Return to work advice for patients undergoing hip or knee replacement: a qualitative study of AHPs and nurses
Coole C, Nouri F, Narayanasamy, Drummond A
School of Health Sciences, University of Nottingham
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BACKGROUND
Although an increasing proportion of the working population are undergoing total hip or
knee replacement (THR/TKR), not all return to work1. Of those who do, a considerable
number do so for fewer hours than preoperatively2 when it might be expected that their
work ability would improve. However, no studies have investigated the work-related
advice given to THR/TKR patients from the perspective of clinicians in secondary care.
We therefore sought the experiences and perceptions of AHPs and nurses on the
development of an occupational advice intervention to be delivered prior to surgery.
METHODS
A convenience sample of 12 AHPs and nurses were recruited from three NHS hospital orthopaedic teams as part of a larger NIHR funded study. Semi-structured interviews were digitally recorded and transcribed verbatim. Data were analysed thematically using framework methods3. Ethical approval was obtained from the Health Research Authority.
Perceptions regarding an occupational advice intervention
RESULTS
Participants included five occupational therapists, four physiotherapists and three nurse practitioners. Two were male, the rest female. Eight were Band 7, three Band 6 and one Band 5. The main themes identified were the advice currently given to patients regarding return to work, and participants’ perceptions regarding the delivery of an occupational advice intervention.
Current advice about resuming work
Priorities
….it wouldn’t be my personal priority or what I was concerned about. So for example the most common postoperative complication is delirium and that really contributes significantly to length of stay (4, OT)
Reactive
They don’t tend to ask us – but then I think that’s because we’re not asking them anything about work (5,OT)
Feasibility
A really high quality outpatient sort of post-op rehab plan is actually quite labour intensive – it does require a lot of resource (3, OT)
Generic
The Trust has adopted a rule that if you have a sedentary job you can’t return until six weeks post-op. If you have a heavy manual lifting carrying job, you can’t return until three months (7, Physio)
Need
Because I think they know they’re coming in for surgery, everything’s all prepared, they’ve sorted everything out (7, Physio)
Conflation
And we wouldn’t anticipate them getting back to work before probably six weeks, particularly if they needed to drive, because it’s not recommended they drive until at least six weeks post surgery (3, OT)
Beliefs
We probably don’t talk about it as much as we probably could do just because most of the patients that come to us are over the age of sort of (10, Nurse)
Awareness
So no, we’re not involved in that part of the process and I’m not sure what information [is given to patients about work] (11, OT)
Remit
Deferred
In many ways I’d be quite keen to avoid [writing fitness to work reports] because I think you’d get yourself into a different kind of relationship
(1, Physio)
And also we often do say you’ll go and see your consultant at your eight week check so that you can discuss it with them too (12, Physio)
CONCLUSIONS
Hospital clinicians perceived only a small proportion of patients might need an occupational advice intervention, and felt this was not a treatment priority. Consequently current advice is largely reactive and generic, associated with blanket timescales of work absence, driving advice and follow-up appointments. If an occupational advice intervention prior to THR/ TKR is to be developed and implemented, it will need to address the knowledge, skills and attitudes of clinicians and the resources required for delivery.
REFERENCES
1. Scott CEH, Turnbull GS, MacDonald D et al (2017) Activity levels and return to work following total knee arthroplasty in patients under 65 years of age. Bone Joint; 99-B: Tilbury C, Leichtenberg CS, Tordoir RL et al (2015) Return to work after total hip and knee arthroplasty: results from a clinical study. Rheumatol Int 35: Ritchie J, Lewis J. Qualitative research practice: a guide for social science students and researchers London: Sage