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 Wang et al (2010) Prospective cohort study Aim: to investigate factors affecting the short-term outcome of primary total hip replacement and develop a multivariate regression equation to predict the shortterm outcome Elective primary total hip replacement – single service 82% had concurrent preoperative co- morbidities n=97 (101 THR) Mean age 61.65 years Male: female ratio = 35:65 Total hip replacement Four surgeons involved. Self-administered WOMAC at enrolment, 3 months, 1 year and 2 years postoperatively. Statistically significant measure that indicates three main factors in predicting THR outcomes are: preoperative WOMAC Physical Function Score (p=0.0001), gender (p=0.0159) and preoperative co- morbidities (p=0.0246) Predictive model derived and trialled however needs further study on its validity to THR Service users with better preoperative functional scores likely to have higher post- operative scores, and service users with poorer preoperative scores likely to experience greater improvement in function. Grade C – Low Limitations: • Sample size – only 101 hips in regression analysis • Have not stated what is meant by outcome postoperatively, e.g. independent, working, back to normal • The preoperative WOMAC scores had a large standard deviation therefore possible decrease in accuracy of prediction. United States of America. Wong et al (2002) Prospective study Aim: to describe the hospital recovery pattern of older confused and non- confused service users after hip surgery Recruitment: consecutive admissions to a teaching hospital for emergency/elective hip surgery n=54 (not confused on admission). 28 admitted for osteoarthritis, 4 for revision THR and 22 fractured neck of femur Mean age 75.6 years Male: female ratio = 19:35 Canada. Hip surgery – both elective and trauma Measurement of the effect of post- operative acute confusion on recovery pattern of older confused and non- confused service users after hip surgery. Assessed at baseline and on first 4 post- operative days • Cognitive status (using Confusion Assessment Method) • Physiological status • Functional ability (Katz index of Activities of Daily Living) • Sleep satisfaction (using adapted form of Bowan’s method) • Perceived discomfort (Discomfort Screen- Dementia Alzheimer Type). LOS examined in context of acute confusion. Older confused and non- confused service users recover from hip surgery differently. Majority of service users who developed acute confusion were hospitalised for fractured neck of femur • Of 54 service users, at least 12 (23%) developed acute confusion at some point after surgery • Confused and non- confused differed significantly in age, admission diagnosis and LOS (p
Appendix 6: Glossary and abbreviations AIMS BAOT CASP COPM © COT COTTSS – Trauma and Orthopaedics CSI EQ- 5D EQ- VAS FAS FIM Arthritis Impact Scale Self- administered scales covering physical, social and emotional wellbeing, proving an indicator of the outcome of care for people with arthritis. British Association of Occupational Therapists The professional body for all occupational therapy staff in the United Kingdom. Critical Appraisal Skills Programme Programme aiming to support the development of skills in the critical appraisal of scientific research, which provides a number of critical appraisal tools to support this activity. Canadian Occupational Performance Measure An individualised outcome measure which is designed to detect change in an individual’s self- perception of their occupational performance over time. College of Occupational Therapists A wholly owned subsidiary of BAOT operating as a registered charity. The College sets the professional and educational standards for the occupational therapy profession and represents the profession at the national and international levels. College of Occupational Therapists Specialist Section – Trauma and Orthopaedics A branch of COT that promotes best practice in occupational therapy within the specialty of trauma, orthopaedics and rehabilitation of amputees. Caregiver Strain Index Robinson’s index consisting of 13 items that describe stressful aspects of caring. Generic health status measure A standardised instrument for use as a measure of health outcome, providing a descriptive profile and a single index value for health status. Visual Analogue Scale component of the EQ- 5D Records an individual’s self- rated health on a visual analogue scale. Functional Assessment System of lower extremity dysfunction An instrument designed for physiotherapists to evaluate lower limb problems focusing on hip, knee, functional and social variables and pain. Functional Independence Measure An 18- item ordinal scale, which measures independent performance in self- care, sphincter control, transfers, locomotion, communication and social cognition. College of Occupational Therapists 105
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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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Guideline recommendations environme
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Page 117 and 118: References Lin JJ, Kaplan RJ (2004)
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Total hip replacement - College of Occupational Therapists

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