How to Increase Patient Motivation and Outcomes Post-Total Hip Arthroplasty $0.00

How to Increase Patient Motivation and Outcomes Post-Total Hip Arthroplasty

By: Rebecca Moore | Nov 30, 2018
How to Increase Patient Motivation and Outcomes Post-Total Hip Arthroplasty

The hips are the primary weight-bearing joints of the lower quarter. As such, these are high-wear areas that need close monitoring as people age. There’s a linear relationship with age and the prevalence of total hip arthroplasty procedures, with older adults covering the majority of the population. In today’s installment of the Injury Management Series, we’ll be covering current statistics within the total hip arthroplasty population, as well as the impact that psychological factors have on a physical therapist’s ability to treat this condition post-op.


Important Hip Replacement Statistics


Last year, the American Joint Replacement Registry released their Fourth Annual Report on Hip and Knee Arthroplasty Dataz giving us the following insights into the current state of hip replacement procedures:1

  • In 2016, the mean age of patients undergoing full arthroplasty procedures was 66.6 years, while the mean age of those undergoing revisions was 68.4.
  • Males represent the majority of total hip patients under 59 years of age, but females predominate as the population ages.
  • 79% of total hip patients were diagnosed with osteoarthritis at the time of surgery.
  • Out of the 349,996 patients examined, 79.2% had full replacements, 10.3% had hip revisions, 9.4% had partial hip replacement/hemiarthroplasty and 1.1% had hip resurfacing done.
  • 54% of revisions were caused by aseptic loosening, instability/dislocation infection and wear and osteolysis (the last two are interrelated)
  • The majority of early (less than 3 months) revisions were linked to dislocation, infection and periprosthetic fracture.

In order to effectively rehabilitate post-hip arthroplasty and to keep patients from the revision list, it’s important they follow through with their full recovery plan. However, there are many reasons that patient compliance rates drop, and the physical factors are often coupled with or overshadowed by psychological factors. This means that, for peak physical results, we must also treat our patients’ mental health to some capacity.


The Psychology of Patient Motivation after Total Hip Arthroplasty Procedures


Physical therapists are just that: physical therapists. There is very little formal training in addressing the psychological factors that have been proven to impact patient outcomes. Yet, its important for hands-on healthcare professionals to understand how they can play a role in patient motivation.

In a recent study covering the Psychological Aspects of Rehabilitation as Perceived by Physical Therapists, the authors summarized this notion, stating:

“An individual’s injury treatment is influenced by emotional, behavioral, and situational factors. Psychosocial factors, in relation to patients’ experience of pain, may explain why some patients are unable to make a full recovery. The World Health Organization’s, International Classification of Function, Disability and Health recognizes pain as a subjective experience and have suggested healthcare professionals shift from treating in a biomedical perspective to a biopsychosocial perspective. The biopsychosocial model recognizes the biological factors pertaining to the disease, injury, or condition, as well as the psychological factors and social factors that contribute to the patient’s pain and rehabilitation experience that could not otherwise be explained by the biomedical model.”2

What psychological obstacles should physical therapists be on the lookout for before they impact rehabilitation and recovery? Existing research suggests the most common include:2

  • Pain perceptions
  • Catastrophizing
  • Fear
  • Anxiety
  • Depression
  • Anger
  • Self-efficacy
  • Sociodemographics
  • Lack of social support

In serious cases, these issues will require help from mental health specialists to be appropriately managed. In the scope of physical therapy practice, however, there are some important principles that can be followed to increase patient satisfaction and rehabilitation outcomes after total hip arthroplasty procedures.


Top 3 Motivation Principles:

1. Positivity: When speaking with your patients about the progress they’ve made (or even lack thereof), utilize positive verbiage. This can make them feel better about the work that they’ve been doing, potentially motivating them to keep going above and beyond.

2. Communication: Complete transparency is key when establishing strong communication with your patients. You don’t want your patients to blindly trust your rehabilitation plan; you want them to understand why they are doing what they’re doing, what each part of the process will do and why it matters in the long run. Moreover, studies have found that having good rapport and communication with patients is associated with greater adherence to rehabilitation programs, increased motivation and better recovery.2

3. Make Rehab Real Life:After treating patients with total hip replacement for years, Dr. Shawn Burger PT, DPT, CSCS realized that getting them to stick to their rehabilitation protocol was tough; for one reason or another, they seemed to not buy into his traditional, cookie-cutter therapy plans. However, once he started prescribing dynamic exercises that were linked to a functional end goal, his exercise program compliance rates increased drastically.

“What we find when we study adherence rates and compliance for patients, that is, home exercise program compliance, we find that if we don’t tie exercises to function and just a linear A-to-B movement pattern, patients just won’t do them,” said Dr. Burger. “So, the exercises I’ve chosen are all tied back to perform a function, and if we explain that function to patients, they have that light bulb-moment and say ‘Oh, I understand what the function is’ and are much more likely to participate in them.”

Practical Application of these Principles


Following Dr. Burgers’ lead, you can design rehabilitation plans that motivate patients to stay the course. His top five exercises are not only tied to common, everyday functions, but are performed with tools that are easy-to-use both in the clinic and at home, like the TheraBand CLX, TheraBand CLX Door Anchor and TheraBand Stability Trainer; another compliance factor!


Check out his expert exercises in the video series below


Utilize the printable exercise guide to easily share the protocol with patients and colleagues

Resources:

  1. http://www.ajrr.net/images/annual_reports/AJRR-2017-Annual-Report---Final.pdf
  2. Knuth A, Ross-Stewart L, Brent C, Salerno R. Psychological Aspects of Rehabilitation as Perceived by Physical Therapists. J Phy Fit Treatment & Sports. 2018; 2(1): 555579. DOI: 10.19080/JPFMTS.2018.02.555579
OR