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 Crowe and Henderson (2003) Randomised controlled trial (RCT) Aim: What is the effect on length of stay of individually tailored preoperative rehabilitation for clients with more complex needs undergoing hip or knee replacement 133 subjects with complex needs receiving elective hip or knee replacement Rehabilitation group n=65 Mean age 66.9 years Male: female ratio = 14:51 Usual care group = 68 Mean age 70.7 years Male: female ratio = 13:55 Canada. Total hip or knee replacement – random allocation to: Usual care group: standard preoperative clinic visit 1–2 weeks prior to surgery Rehabilitation group: individualised and multidisciplinary Counselling/education Occupational therapy: environmental preparation, education, strategies to improve preoperative functioning, energy consideration and task simplification. Some received a home visit. Pre- operative baseline measures: • Oxford Hip Score • Spielberger State Anxiety Inventory (state component). Post- operatively: • Number of days to meeting discharge criteria • Actual length of stay • Discharge destination • Post- operative complications. Rehabilitation intervention group less anxious before surgery and better prepared in advance for return home • Average number of days to achieve discharge criteria was significantly shorter among preoperative rehabilitation group (p=0.021) • Length of stay was significantly shorter on average among service users receiving rehabilitation (p=0.032) • Average number of days to meet each individual discharge criteria lower, but most not statistically significant • Significant difference seen in the mean number of days required to have made plans for discharge (equipment, arranged provision of meals), with most in the rehabilitation group having made arrangements prior to admission (p
Appendix 5: Evidence- based review tables Source Design and participants Intervention Outcomes Results Quality and comment Drummond et al (2012) National postal survey Aim: What is routine practice in UK occupational therapy in advising on hip precautions following primary THR Recruitment: advertising at conferences, COT Specialist Sections, personal contacts and 233 UK NHS hospitals n=236 Postal survey using questionnaire designed by authors and based on literature and expert opinion Piloted prior to main survey United Kingdom. Hip precautions post elective total hip replacement. • Approximate proportion of caseload THR treated and therapy hours/per service user • Movements service users told to avoid • Activities discussed and practised • When and why precautions taught • Provision of equipment/ home visits and followup • Estimated effect of precautions on LOS • Length of time precautions applied • Use of protocols and service user information. Response rate of 72% – 174 suitable for analysis (66%) • Generally national agreement on movements service users asked to avoid: flexion, adduction and internal/external rotation • Common activities discussed kitchen activities, bath/shower transfers, car transfers, stripwashing/dressing techniques. • Common practiced: bed, chair and toilet transfers and dressing • Service users seen pre- surgery from over 8 weeks to 1 week • Reasons for precautions – most popular surgical opinion (72.4%) • Most common equipment prescribed raised toilet seat (94.8%) • Majority of services did not routinely carry out home visits • Precautions observed range from 6 weeks to over 12 weeks. Grade C – Low Limitations: • Responses dependent on interest – may not be complete response • The questionnaire not included – difficult to appraise objectivity of questions • Excluded private hospitals – shorter waiting times and access to a range of providers may make rationale for not including less viable • Did not appear to take into account those services with no precautions. Fielden et al (2003) Qualitative study Aim: to investigate service user expectations of and satisfaction with in- hospital discharge planning after THR in early and late discharge service user groups Purposive sample: 33 (over 18 years) recruited during visit to preassessment clinic 19 in early discharge group and 14 in late group, Two metropolitan hospitals New Zealand. Total hip replacement Early discharge group – fewer than 5 days in hospital Late discharge group – 5 or more days in hospital. In- depth semi- structured interview 30 minutes on day of discharge and again 4–8 weeks later either in hospital at follow-up or in their homes Open- ended questions focused on outcome aspects, allowed for service user individual report of experiences. • No clear difference between two groups. Themes categorised into readying self; recovering mobility; and transition to wellness • Written information at preassessment appreciated, however reports that there is little if any time for individualised question relevant to their specific concerns • Lack of clarity about discharge planning and roles of multidisciplinary team • Value of equipment to recovery highlighted • Concerns re being told different things by multidisciplinary team members resulting in confusion and difficulty planning for recovery, e.g. when can they drive. Grade C – Low Limitations: • Only two hospitals sampled – can’t generalise • Minimal information on sample characteristics. College of Occupational Therapists 83
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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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Page 73 and 74: Recommendations for future research
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Page 77 and 78: Appendix 2: Acknowledgements A2.4 C
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Page 87 and 88: Appendix 5: Evidence- based review
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Page 113 and 114: Appendix 6: Glossary and abbreviati
Page 115 and 116: References Evidence references Bere
Page 117 and 118: References Lin JJ, Kaplan RJ (2004)
Page 119 and 120: References Wang W, Morrison TA, Gel
Page 121 and 122: References Health and Care Professi
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