Speaking With a Hospital-Based Physical Therapist

May 23, 2018

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This week’s blog post is a little different. We decided to reach out to a variety of individuals with unique knowledge of the joint replacement process, from healthcare professionals to past patients, and ask them some questions about joint replacement surgery and the joint replacement process. This week features Ashton Mullett-Moon. She is a physical therapist who spent 4 years working in a hospital setting, specifically working with post-operative knee and hip replacement patients. Here are her answers to some of our questions.

1. Besides resources created by you or your current organization, what is one or two beneficial informative or motivational resources you would recommend to individuals going through the joint replacement process?

Increased body weight means increased stress through the joints of your body. The hospital I work at completes a joint class designed for each surgery. It focuses on what happens during surgery, how to prepare, recovery, therapy (lead by a therapist), equipment considerations, home modifications as well as a Q&A with book. It is also recommended for people to bring a coach to assist. Additionally, a second motivational aspect that patients should be aware of is support groups. People do well with these. They get to know other people undergoing surgery around the same time. I’ve had several patients that find someone in pre-op or during testing that is undergoing surgery at a similar time…so it connects people.

2. What is a purchase of around $100 or less that you would recommend to someone prehabing before or rehabilitating after joint replacement surgery.

Slightly more than $100, but I would recommend a Polar Ice Active Ice Therapy System, or similar. After surgery, ice is a patient’s best friend and normal ice bags and newer ones that are alcohol-based, don’t conform well to the area that had surgery. It’s also something that is beneficial in the future for other injuries or joint replacements. It’s an ice cube model that runs cold water through a cover that is placed around the area to assist with pain, swelling and best of all, it comes with various sizes to allow for multiple areas to be treated. https://www.amazon.com/Polar-Products-Active-Therapy-System/dp/B001ALNM3A/ref=sr_1_1?s=industrial&ie=UTF8&qid=1526419919&sr=1-1&keywords=polar+ice+machine

3. If you were in the elevator with someone considering joint replacement surgery and only had a minute to speak with them, what would you say to them?

Make sure that you trust and talk to your physician. At the end of the day, the physician completing the surgery needs to understand what your goals are. Do you want to run, walk, pick up grandchildren, etc.? Additionally, ensure that you trust the physician because if patients don’t like/trust the physician, then outcomes are typically worse. Lastly, make sure you have a coach or friend who will help motivate you and ensure that you do your exercises. It saves time, as well as prevents complications down the road.

4. What is one of the most important investments someone going through the joint replacement process can make? (Could be money, time, energy, etc.)

Preparation prior. Especially knowing insurance considerations these days. What will insurance cover, will you be able to go to a facility? If you need equipment, prepare to get anything you need. Even if it is waiting until you see your therapists, so you know where to find the equipment. Additionally, if you are unable to go to a facility due to insurance, then have a plan such as going to friend or family house, moving bed to the first floor, etc. This may be accomplished by a joint replacement class or discussion with physician staff. Third, seek out pre-hab to learn some exercises prior to surgery to help with strengthening muscles to assist with recovery.

5. In the last five years, what is different or new for someone going through the joint replacement process?

A lot has changed over the last five years. The biggest thing that patients aren’t aware of is how the joint replacements are completed and the recovery. I’ve had patients that report they were in bed for 3 days and then went to a rehabilitation facility for two weeks. Patients are told that bones are cut off and replaced and pain control was not the best. Now, patients are getting up the same day as surgery, approximately 4 hours after, or may go home the same day. Also, surgeons are no longer cutting off all the bone, so to speak, but sanding down the bone to limit how much bone is cut, and improving the fit of the prosthesis.

6. What is the best advice you’ve heard for someone considering joint replacement surgery? What is the worst advice?

Best advice: take every opportunity to learn about your surgery from physician, joint classes, and therapists prior to surgery. Worst advice: rest and if you start hurting, stop it immediately. This advice is harmful as I tell patients, “you had surgery, it’s going to hurt. But, it’s short-term hurting for long-term return to function and moving ahead with your life.”

7. What are bad recommendations you here in terms of deciding to have a joint replacement or in terms of any aspect of the joint replacement process?

Bad recommendations include any surgeon can complete the surgery, laying in bed is the best medicine, therapy is optional, and pain control needs to be controlled in hospital, don’t go home if you have pain.

8. What is a unique belief, thought, or idea who have regarding joint replacement surgery or the joint replacement process that may not be common or a lot of people might not agree with?

Moving forward with joint replacements where emphasis will be placed on the patient to complete items independently, removing burden from therapists and axillary staff to educate patients at a in-depth level.

9. What changes do you see in regards to joint replacement surgery, prehabilitation, rehabilitation, or patient education in the near future (3-5 years).

Soon, I see pre-hab with joint classes to move to an online format where patients watch the videos online at home, go to pre-hab once or twice prior to surgery to have questions answered, will have cleansing wipes mailed to them (removing nursing component prior to surgery). After surgery patients will be leaving the hospital in less than 24 hours to go home, have home health care for several days with the possibility of telehealth, and then move to outpatient therapy. In surgery, use of computers/AI to assist as well as surgeons using MRI to make better fitting models of the joint will become the norm. In general, the process will be streamlined and emphasis will be on the patient prior to surgery to remove hospital or facility burden. Additionally, with insurances, they will move to home health care and then outpatient therapy to limit hospital expenses. This will especially be true for the patients who are in good health. For patients who do not have good home support and/or will not be compliant with therapy, I think the physicians will begin limiting surgery and make the patient consider alternative treatments prior to surgery, like what they do with weight loss/bariatric surgeries: involvement of cognitive behavior therapy, nutritionist, pain management, etc. Patients will need to take control of their health in the future if surgeons are going to do the surgery, so they have the best outcomes.

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