Total hip replacement - College of Occupational Therapists

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Introduction Weight- bearing restrictions may also be in place. There is disparity in the length of time to which it is recommended that precautions should be adhered, but this is usually between six weeks and three months, as directed by the surgeon (this can vary from surgeon to surgeon within the same department). As more evidence becomes available to challenge the efficacy of hip precautions, this is an area of practice likely to see ongoing change, and occupational therapists should, therefore, take this into account when implementing the recommendations in this practice guideline. 1.4 Practice requirement for the guideline Occupational therapy is a key intervention for individuals receiving a total hip replacement, as identified within the Musculoskeletal Services Framework (DH 2006), National Audit Office report (NAO 2003), and good practice guidance (BOA 2006) outlined in section 1.2. The number of occupational therapists specifically working across the care pathway with adults who have osteoarthritis or who receive a total hip replacement is not known. However, given the number of hip replacements across the four UK countries, it is predicted that a considerable proportion of the 32,454 occupational therapists registered with the Health and Care Professions Council (HCPC 2012a), may come into contact with service users receiving a hip replacement at some stage during their health or social care intervention. A UK national survey of occupational therapists reported that the mean percentage of department/service resources used to support service users receiving a total hip replacement was 39 per cent. It also indicated that on average, an excess of two hours was spent in face- to- face contact, and over one hour in non- direct contact (Drummond et al 2012). To date there has been no formal national guidance for occupational therapists working with service users who have received a total hip replacement. Known evidence from both the literature (McMurray et al 2000, Drummond et al 2012), and from expert practitioners involved in the College of Occupational Therapists Specialist Section – Trauma and Orthopaedics, has, however, confirmed that differences exist in practice across the UK in areas which include pre- operative assessment and education processes, use of hip precautions and equipment provision. The number of service users undergoing total hip replacement in the UK is high. This demand for orthopaedic services, combined with the pressures of waiting list management, means there is a constant drive for improved efficiency in service provision. In this context, and with the significant variation in practice across the UK, the publication of a practice guideline for occupational therapy and total hip replacement is intended to assist clinicians and managers in achieving the best possible outcomes for the service user, utilising resources in line with evidence and best practice. 1.5 Topic identification process Total hip replacement, as a guideline development topic, was identified by the College of Occupational Therapists Specialist Section for Trauma and Orthopaedics (COTSS – Trauma and Orthopaedics). A decision was made to focus the guideline on total hip replacement both as an elective procedure and following trauma (i.e. fractured neck of femur). While it is recognised that there are differences for the service user having elective compared to trauma 12 Occupational therapy for adults undergoing total hip replacement
Introduction surgery, the role of the occupational therapist and the care pathway will have many similarities. The decision was made not to expand the guideline further to include other types of surgery following hip fracture (such as hemiarthroplasty) as it was felt this was addressed in other available national clinical guidelines (SIGN 2009, NICE 2011). A proposal to produce a practice guideline for occupational therapy within the field of total hip replacement was developed by the COTSS –Trauma and Orthopaedics, and this was subsequently approved by the College of Occupational Therapists’ Practice Publications Group in March 2011. 1.6 Conflicts of interest All guideline development group members (core group and co- opted), stakeholders and external peer reviewers were asked to declare any pecuniary or non- pecuniary conflict of interest, in line with the guideline development procedures (COT 2011a). Declarations were made as follows: • Membership of the College of Occupational Therapists Specialist Section - Trauma and Orthopaedics by five members of the core guideline development group. • Membership of the College of Occupational Therapists Specialist Section - Older People by one member of the core guideline development group. • Position as an Officer of the College of Occupational Therapists by the co- opted editorial lead. • Position as an Officer of the College of Occupational Therapists by the two co- opted critical appraisers. • A therapeutic or operational service head relationship between a member of the guideline development group and the service users consulted in Scotland. • An external peer reviewer was an author of one of the items of evidence. • External peer reviewers and stakeholders identified their membership of professional organisations. The nature of the involvement in all declarations made above was not determined as being a risk to the transparency or impartiality of the guideline development. College of Occupational Therapists 13
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 and 14: 1 Introduction Total hip replacemen
Page 15 and 16: Introduction Health education of pu
Page 17 and 18: Introduction In terms of best pract
Page 19: Introduction other members of the m
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
Page 29 and 30: Guideline development process contr
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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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 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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Total hip replacement - College of Occupational Therapists

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