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 Thomas et al (2010) Case study/evaluation Aim: to determine the most frequent reasons for non- use of adaptive equipment prescribed by occupational therapists for service users returning home after THR Convenience sample: nine service users from three different hospitals Average age 66 years Male: female ratio = 6:3 United States of America. Occupational therapy prescription of adaptive equipment following total hip replacement. Semi- structured telephone interview carried out post- surgery varying from 3 months to 4 years after intervention Questions developed by researchers. • 72% stated always used their adaptive equipment • 78% stated little or no inclusion in decision making about equipment. • 85% stated adequate instruction given on use • 51% felt improvement in their medical condition affected length of time using equipment • 57% expressed home environment influenced non- use of equipment. Grade D – Very Low Limitations: • Audit/service evaluation. • No standardised measures used • Small sample, limited information on recruitment • Period post- surgery varied extensively • Number of confounding variables not explored • American healthcare system – all equipment purchased. Ververeli et al (2009) Randomised controlled trial Aim: evaluate the safety and effectiveness of an early rehabilitation protocol for THR service users. Test possibility of accelerating service user return to activities of daily living by minimising post- operative hip precautions n=81, allocation to: Standard rehabilitation group n=43 Mean ages 57.4/59.8 years Male: female ratio = 27:16 Early rehabilitation group n=38 Mean ages 58.8/60.8 years Male: female ratio = 22:16 United States of America. Total hip replacement surgery and allocation by random numbers tables to either: Standard rehabilitation group: Restriction on bending hip and crossing legs at thighs, used equipment, etc. for first month Early rehabilitation group: Instructed not to cross their legs at the thighs, but otherwise no restrictions. Could bend the hip when they were comfortable and ride in a car. No equipment. Assessed at approximately 4 weeks pre- operatively, and at 1 month, 3 months and 1 year post- operatively Service users completed: • Short Form 12- question Health Questionnaire (SF- 12®) • Harris Hip Score • Diary of the number of days until they walked with a cane, walked without a cane, drove and walked without a limp. Service users also instructed to write any comments regarding their level of satisfaction and status of recovery. • Early rehabilitation group were faster to ambulate with only a cane (p=0.03, moderately strong effect 0.48) and walked without a limp sooner (p=0.003, strong effect size 0.70) • Overall correlation between number of days walked with and without any assistive equipment (r=6), and early rehabilitation group were also faster to walk without a cane (p
Appendix 5: Evidence- based review tables Source Design and participants Intervention Outcomes Results Quality and comment Vincent et al (2007) Retrospective comparative study Aim: does obesity affect inpatient rehabilitation outcomes after total hip replacement 178 medical records analysed Subjects stratified into four groups: Non- obese n=46 Overweight n=62 Obese n=50 Severely obese n=19 Gender and age varied across the groups United States of America. Total hip replacement Interdisciplinary rehabilitation programme – 3 hours of daily supervised therapy from physical and occupational therapists Occupational therapists instructed activities of daily living for 30–45 minutes in the morning Group session of upper extremity activity Additionally three times a week advanced activities of daily living. Data analysed against: • Functional independence FIM scores (at admission and on discharge) • Length of stay • FIM efficiency scores (change in FIM score divided by LOS) • Hospital charges • Discharge disposition location. • Revision THR service users had lower FIM score on admission and discharge • Changes in FIM scores between admission and discharge were not significantly different between four sub- groups (p>0.05) • Length of stay was significantly greater in the severely obese group compared with the nonobese 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 115 and 116: References Evidence references Bere
Page 117 and 118: References Lin JJ, Kaplan RJ (2004)
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Page 121 and 122: References Health and Care Professi
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