Total hip replacement - College of Occupational Therapists

Guideline recommendations
assessment, but their role in this area, particularly in relation to joint protection and
energy conservation management, should be recognised. Additionally this is relevant
when considering post- operative rehabilitation, to maximise function and effective pain
management. While evidence on the occupational therapist’s role in pain management
was not specifically targeted in this guideline’s literature search strategy, it is an area of
practice where occupational therapists can contribute to the multidisciplinary
intervention.
7. It is recommended that service users are given advice on effective pain
management strategies, to decrease pre- operative pain experience and
sleep disturbance, and enhance post- operative physical function.
(Berge et al 2004, B; Montin et al 2007, C; Parsons et al 2009, C)
1 B
Evidence on the use of occupational therapy standardised assessments or outcome
measures as part of intervention with service users receiving a total hip replacement
was lacking in the literature identified. Three small scale and low-level evidence studies
were appraised. Each addressed a different issue, but all involved the use of outcome
measures within their research.
The Canadian Occupational Performance Measure (COPM © ) was used in one study to
rate service user functional abilities in activities of daily living, specifically focusing on
community activities (Gillen et al 2007). The ratings were self- reported performance and
satisfaction with performance. The study identified that COPM © provides a valid and
reliable method to evaluate community functioning based on self- report.
COPM © was also used as an outcome measure pre- operatively and at follow- up after
total hip replacement in a Swedish study (Oberg et al 2005). Findings indicated a
reduction in the number and severity of problems and a statistically significant
improvement in both performance and satisfaction using this measure. This study also
used the Functional Assessment System (FAS) of lower extremity dysfunction, and the
generic health survey SF- 36®. In the SF- 36® data, service users showed a statistically
significant improvement in almost all domains, and the FAS showed statistically
significant improvements in the variables reflecting lower extremity functions related to
hip problems. The authors suggested that all the instruments delivered important
information on the functional and activity status of service users.
In the third study, Kiefer and Emery (2004) used the Functional Independence Measure
(FIM) to look at the functional gains in self care, mobility and locomotion of service
users, and found that it was able to identify improvement in functional performance.
The value of standardised assessments and outcome measures in the acute setting are
fully recognised. However, expert opinion from the guideline development group is that
the use of these routinely would be challenging, particularly given the short length of
stay and limited opportunity for therapist intervention during elective inpatient care. It
is also relevant to note that given the core treatment is the total hip replacement
surgery, and that intervention involves a multidisciplinary approach, it can be difficult to
extract the occupational therapy specific contribution to the service user’s outcomes,
particularly in the short time span.
Service users requiring further intervention or rehabilitation, potentially more likely
following a traumatic history to the hip replacement or complex individual needs, may
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