Total hip replacement - College of Occupational Therapists

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Introduction Table 1: UK primary hip joint procedure statistics England and Wales Scotland Northern Ireland Primary hip joint procedures (numbers) 77,800 7,168 1,151 107 Year 2010/11 2009 2010 2010/11 Average age 67.2 68 67.4 67.95 Percentage female 59% 60% 54% 56% Percentage male 41% 40% 46% 44% Source National Joint Registry (2011) NHS National Services Scotland (2010) Belfast Health and Social Care Trust (2011) Southern Health and Social Care Trust (2011) The numbers of primary hip joint replacements completed has been increasing. In England and Wales for example, an additional 19,335 procedures were carried out in 2010/11 compared to 2006/07. Scotland has also seen an increase, with an additional 1,259 procedures undertaken in 2009 compared to 2005. The surgical intervention statistics demonstrate that there is a high volume of service users in the UK undergoing primary total hip replacement, with these numbers continuing to rise in England, Wales and Scotland on an annual basis. 1.2 Context of service delivery The Musculoskeletal Services Framework (Department of Health [DH] 2006), which is endorsed by the College of Occupational Therapists, focuses on best practice guidance to support people with musculoskeletal conditions, whether a result of disease, injury or development disorder. It is intended to assist in the delivery of improved access for service users, and in the reduction of waiting times for treatment. While directly applicable to England, the vision is one which can be universally shared by all occupational therapists working in this field of practice: The vision is that people with musculoskeletal conditions can access high- quality, effective and timely advice, assessment, diagnosis and treatment to enable them to fulfil their optimum health potential and remain independent. (DH 2006, p6) The framework includes a pathway for adults with hip pain, demonstrating the service user flow from pain onset to surgery (Figure 1). Multidisciplinary working and ‘shared care’ are seen as being fundamental to the approach, together with integrated care pathways based on the entire journey taken by a service user. The framework identifies the involvement of occupational therapists early in the pathway, a requirement previously highlighted in the report Hip replacements: An update published by the National Audit Office (NAO 2003). Occupational therapists should be involved in active management within the community; at the musculoskeletal interface clinic; in multiprofessional pre- operative assessment with 6 Occupational therapy for adults undergoing total hip replacement
Introduction Health education of public/ information Patient choice on decision to consult Patient choice Acute unit or community Agreed booking (see Choose and book) Orthopaedic consultant Rheumatology consultant List for surgery Pre-surgery assessment clinic Consultant team review Discharge planning Home equipment organisation Post-operative exercise explanation Promote selfmanagement Multiprofessional Feedback from specialist Outcomet measure 1 2 GP Active management Facilitate selfmanagement Give patient information Self-referral physiotherapy as first line Interface with other primary care services, e.g. podiatry, occupational therapy 3 Direct listing of routine cases under locally agreed protocol and consent 4 6 1 Musculoskeletal interface clinics Extended-scope physiotherapists GPwSls Nurse practitioners provide training opportunity for SPRs Function and education Specialist assessment/ investigation/injection Agreement of patient to be listed for surgery, interface with podiatry/occupational therapy Patient information Specialised therapies 7 5 2 Pre-listing assessment Fitness for surgery and education Identification of discharge needs Nurse-led Booked admission and discharge 8 Inpatient and outpatient follow-up Shared between physiotherapist/nurse/consultant team as locally agreed Figure 1 Hip and knee pain patient flow from pain onset to surgery for adult elective patients (DH 2006 p9 Reproduced under the Open Government Licence v1.0. Available at: http://www.nationalarchives.gov.uk/doc/open-government-licence) College of Occupational Therapists 7
Page 1 and 2: Occupational therapy for adults und
Page 3 and 4: Occupational therapy for adults und
Page 5 and 6: Contents Foreword by Professor Avri
Page 7 and 8: Foreword I am delighted to have bee
Page 9 and 10: Key recommendations for implementat
Page 11 and 12: Key recommendations for implementat
Page 13: 1 Introduction Total hip replacemen
Page 17 and 18: Introduction In terms of best pract
Page 19 and 20: Introduction other members of the m
Page 21 and 22: Introduction surgery, the role of t
Page 23 and 24: 3 Guideline scope 3.1 Clinical ques
Page 25 and 26: Guideline scope • There are no re
Page 27 and 28: 4 Guideline development process Det
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Page 31 and 32: 5 Guideline methodology 5.1 Guideli
Page 33 and 34: Guideline methodology 5.3 Criteria
Page 35 and 36: Guideline methodology Table 3: Grad
Page 37 and 38: Guideline methodology A recommendat
Page 39 and 40: 6 Background to clinical condition
Page 41 and 42: 7 Guideline recommendations The rec
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Guideline recommendations spent in
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Service user perspectives of the re
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9 Implementation of the guideline T
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Implementation of the guideline The
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Recommendations for future research
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Appendix 1: Guideline development g
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Appendix 2: Acknowledgements A2.4 C
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Appendix 3: Service user consultati
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Appendix 5: Evidence- based review
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Appendix 6: Glossary and abbreviati
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References Evidence references Bere
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References Lin JJ, Kaplan RJ (2004)
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References Wang W, Morrison TA, Gel
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References Health and Care Professi
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