A biopsychosocial approach to returning to preoperative levels of physical activity following total hip replacement: insights from older patients

Ejuoneatse, Olu (2024) A biopsychosocial approach to returning to preoperative levels of physical activity following total hip replacement: insights from older patients. Doctoral thesis, University of Cumbria / Lancaster University.

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Abstract

This thesis proposes a biopsychosocial [BPS] analysis of postoperative recovery in Total Hip Replacement [THR] to elucidate understanding of the BPS characteristics influencing recovery. This understanding is vital for future assessment and intervention development especially within the occupational therapy [OT] practice. However, to be able to quantify postoperative recovery using reliable and valid measures, the construct of recovery must first be well defined. Thus, this was defined as return to preoperative levels of physical activity [PA]−specifically the pre-symptomatic [or historic] phase and assessed using the University of California at Los Angeles [UCLA] activity level scale. A pragmatic approach was taken to this research as the most practical method for answering the two research questions [RQs] posed. The RQs were addressed via two studies – a systematic literature review [SLR] and an investigative study utilising an Interpretive Phenomenological Approach [IPA]. The results of each study collectively contribute to the overall purpose of this thesis.

The first RQ was addressed using the results from the SLR that answered the question: “what are the potential biological, psychological, and social outcomes predicting return to preoperative levels of PA following THR?”. This allowed for the development of a BPS representation of all aspects of the patient’s life influencing recovery following THR. However, limited by their quantitative nature, the SLR results revealed a lack of individualised experience in relation to the BPS outcomes influencing recovery. Consequently, detailed insights capable of exploring in-depth all of the BPS influences as they act on the recovery process from an individualised perspective was lacking. As a result, an IPA study was sought to gain deeper understanding from the perspective of women aged 60 and over – a subset of the THR population revealed as being at a disadvantage. Thus, the purpose of study 2 was to gain insight into the lived experiences of PA in historic physically active women aged 60 and over to elucidate understanding of the factors influencing participation and/or return to preoperative levels following THR for the treatment of osteoarthritis [OA]. Results from the SLR indicated OA as the predominant diagnosis for THR amongst participants reason for the specific focus on condition.

Data analysis of the semi-structured interviews and recovery assessment using the UCLA activity level scale conducted amongst four women identified three key factors. First, worsen/poor preoperative functional levels informing low recovery expectations as a result of delayed time until surgery. Second, unsatisfactory support from healthcare professionals, one that was perceived as ageist. Thirdly, individual factors − the two persistent being negative beliefs held about other joint problems [pre-existing/recent] and older age. Better interaction with the healthcare system via individually tailored preoperative education on the recovery process and rehabilitation programs designed to facilitate return to PA may help address these factors. The culmination of both the SLR and IPA study enabled a richer understanding of the biological predispositions, psychological factors, and the social-environmental influences acting on postoperative recovery in THR. This informed the proposition of a theory driven, evidence-based principles to guide the development and implementation of targeted evaluation and interventions based on the combination of the BPS dimensions that influence postoperative recovery − return to preoperative levels of PA following THR.

Item Type:	Thesis/Dissertation (Doctoral)
Departments:	Institute of Health > Psychology and Psychological Therapies
Additional Information:	A thesis submitted for the degree of Doctor of Philosophy, May 2024, word count: 65,139.
Depositing User:	Anna Lupton
Date Deposited:	02 Jul 2024 14:43
Last Modified:	02 Jul 2024 14:45
URI:	https://insight.cumbria.ac.uk/id/eprint/7780

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