title: A biopsychosocial approach to returning to preoperative levels of physical activity following total hip replacement
title: insights from older patients
titleType: Subtitle
Creators: name: Ejuoneatse, Olu
Publisher: name: Lancaster University
Year: 2024

description: 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.