Total hip replacement - College of Occupational Therapists

Appendix 5: Evidence- based review tables
Source Design and participants Intervention Outcomes Results Quality and comment
Naylor et al (2008) Prospective, cohort,
longitudinal study
Aim to address two questions:
1. Are either severe other joint
disease or obesity associated
with a slower rate of
recovery after total hip or
knee replacement surgery
2. Are they associated with less
absolute recovery up to one
year post- surgery
n=122 consecutive service
users. At 52 weeks (55 knee, 44
hip) 99 remaining
Mean age and male: female
ratio depends on stratification
Australia.
Total hip or knee
replacement.
Measured 2, 6, 12, 26
and 52 weeks postoperatively.
• Visual analogue scale
for pain
• 15m Walk Test
• Timed Up and Go
• Walking aid utilisation
(at 52 weeks only)
• Global improvement –
using a five-level scale,
(taken at 52 weeks
only).
Subset questionnaires:
• WOMAC
• SF- 36®.
Participants with severe other joint
disease recovered more slowly in
terms of mobility than the nonsevere
group (p=0.005). They also
walked more slowly on the Walk
Test, and took longer on the Timed
up and Go Test. They also had a
greater chance of using a walking
aid at 52 weeks (95% confidence
interval)
A similar profile was obtained for
the obese compared to non- obese
group
Participants with severe other joint
disease had significantly higher body
mass index (p=0.01) and recovered
more slowly (walking, stiffness,
function). Rate of recovery in terms
of pain and mobility were similar.
Grade C – Low
Limitations:
• Not possible to control for
extrinsic influences;
surgeon volume, etc.
• Subset who completed
additional self- reported
outcomes not clearly
identified
• Lack of ability to blind the
trial received but two
observers trained to carry
out the observation.
Nickinson
et al (2009)
Prospective cohort study
Aim: to investigate the
presence and rates of anxiety
and depression in post- surgical
service users
Hip and knee replacement
service users within a onemonth
period at specialist
orthopaedic hospital
n=56
Mean age 67 years
Male: female ratio = 33:23
27 were undergoing THR (22
primary, 5 revision)
United Kingdom.
Total hip or knee
replacement.
• Anxiety
• Length of stay.
Hospital Anxiety and
Depression Scale – score
of ≥8 was deemed to be
diagnostic
Completed on the day
prior to surgery, then on
each post- operative day
up to and including day
of discharge.
Anxiety:
• Post- operatively 17/39 anxious
prior to discharge. No variables
were significant predictors of
anxiety (p>0.05)
• Mean time point for development
of anxiety 1.94 days. Service users
most anxious at 2.47 days.
Depression:
• No subjects depressed preoperatively
– post- operatively 28
service users (50%) became
depressed prior to discharge
• Mean time point for development
of depression 2.43 days
• On day of discharge only three
scores remained above diagnostic
level for depression – suggests
depression transient.
Grade C – Low
Limitations:
• Small study sample limits
applicability
• Limited information re
surgery
• Responder bias
• Service users not followed
up after discharge
• Not possible to separate
out THR from TKR within
final results and findings.
Mean LOS of 5 days for depressed or
anxious service users (4 days for
non- anxious/depressed patients).
94
Occupational therapy for adults undergoing total hip replacement