Total hip replacement - College of Occupational Therapists

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Appendix 5: Evidence- based review tables Source Design and participants Intervention Outcomes Results Quality and comment Peak et al (2005) Randomised controlled trial Hypothesis: dislocation is more likely to occur in service users who are not placed on postoperative functional restrictions (PFR) following total hip replacement Randomised pre- operatively Of 630 eligible consecutive service users, 265 (303 hips) consented to be randomised into ‘restricted’ or ‘unrestricted’ group Restricted group n=152 Unrestricted group n=151 Mean age 58.3 years Male: female ratio = 139:126 United States of America. THR – both groups: limit range of flexion, external and internal rotation, and avoid adduction during first 6 weeks Restricted group: to maintain abduction while in bed, used raising equipment, prevented from sleeping on side, from driving or being a car passenger Unrestricted group: not required to follow additional restrictions, could choose to use equipment for comfort. Self- administered survey/ diary to check compliance Completed surveys returned at first postoperative visit – 6 weeks after surgery Final survey at second follow- up visit about 6 months after surgery • Number of dislocations • Service user satisfaction related to maximised functional independence/ resumption of roles • Length of hospital stay • Cost. At 6 month follow-up, unrestricted group reported a much greater degree of satisfaction re return to preoperative daily activities. (p
Appendix 5: Evidence- based review tables Source Design and participants Intervention Outcomes Results Quality and comment Rivard et al (2003) Case control study Aim: to determine difference in discharge destination and overall LOS between service users having a total hip replacement receiving preoperative assessment or teaching at home compared to pre- admission clinic n=268 (analysis 206) Intervention group: n=102 Mean age 66.97 years Male: female = 39%:61% Control group: n=104 Mean age 67.4 years Male: female ratio = 41%:59% Total hip replacement Group A – Intervention: preoperative home visit 1–2 weeks prior to surgery. 1:1 teaching and assess home environment directly Group B – Control: attended preoperative assessment clinic within 1–2 weeks of surgery. Received teaching in a group setting, and therapists relied on client/family reports for information about the home environment. Discharge disposition Length of hospital stay. No significant difference in either discharge disposition or length of stay between Group A or Group B Issues raised re the complexity of resource allocation and the importance of qualitative dimensions of care The study found that length of stay or whether the service users were discharged directly home was not affected by the location of preoperative teaching As confounding variables controlled, could assume that any differences in outcomes post- operatively are as a result of the intervention differences. Grade B – Moderate Upgraded from Grade C due to: • Well conducted study with comparative groups of good size • Considered age, number of co- morbidities and living alone as variables that could impact length of hospital stay • Administered WOMAC – no significant differences between the two groups. Limitations: • Comparison depends on replication of teaching/ visits. Canada. Siggeirsdottir et al (2005) Randomised controlled trial Aim: to compare the outcome in a group of service users who experienced a shorter hospital stay with preoperative education (augmented with home rehabilitation and nursing) with that in a group of service users who were subjected to current practices in postoperative rehabilitation n=50 – random allocation to: Study group (SG) n=27 Control group (CG) n=23 Mean age 68 years Male: female ratio = 24:26 Iceland. Total hip replacement Study group (SG): • Pre- operative education/training • Occupational therapy and physiotherapy follow- up at home • Daily outpatient nurse visits for as long as required • Provision of a telephone number to contact with any questions. Control group (CG): • Treatment according to the clinical procedures already in use. Day before the operation and 2, 4 and 6 months after operation • Function • Pain • Quality of life. This included: • Oxford Hip Score • Nottingham Health Profile (part 1) • Functional scores of Meurle d’Abuigne and Postel • Harris Hip Score • A general questionnaire was also used. • Hospital stay for the study group significantly shorter than the control group (p
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Occupational therapy for adults und
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Occupational therapy for adults und
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Contents Foreword by Professor Avri
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Foreword I am delighted to have bee
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Key recommendations for implementat
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Key recommendations for implementat
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1 Introduction Total hip replacemen
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Introduction Health education of pu
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Introduction In terms of best pract
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Introduction other members of the m
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Introduction surgery, the role of t
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3 Guideline scope 3.1 Clinical ques
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Guideline scope • There are no re
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4 Guideline development process Det
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Guideline development process contr
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5 Guideline methodology 5.1 Guideli
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Guideline methodology 5.3 Criteria
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Guideline methodology Table 3: Grad
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Guideline methodology A recommendat
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6 Background to clinical condition
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7 Guideline recommendations The rec
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Guideline recommendations The inter
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Guideline recommendations mean leng
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Guideline recommendations assessmen
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Guideline recommendations suggestio
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Guideline recommendations and were
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Guideline recommendations 11. It is
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Page 69 and 70: 9 Implementation of the guideline T
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Page 73 and 74: Recommendations for future research
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Page 77 and 78: Appendix 2: Acknowledgements A2.4 C
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Page 115 and 116: References Evidence references Bere
Page 117 and 118: References Lin JJ, Kaplan RJ (2004)
Page 119 and 120: References Wang W, Morrison TA, Gel
Page 121 and 122: References Health and Care Professi
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Total hip replacement - College of Occupational Therapists

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