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 Gillen et al (2007) Cohort study Aim: to examine effect of occupational therapy intervention focused on improving community skills after a lower extremity major joint replacement (hip and knee replacement) Recruitment: n=107 THR n=32 TKR n=72 Mean age 63.7 years Male: female ratio = 33.6%:66.4% Private rehabilitation centre United States of America. Total hip or knee replacement Occupational therapy – community reintegration programme – range of external activities Five predetermined goals: • Entering and exiting a vehicle • Shopping • Managing outdoor obstacles • Participating safely in the community • Travelling to and from outpatient appointments. Pre- and postintervention Adapted version of Canadian Occupational Performance Measure (COPM © ) used pre- and post- test Client rates functional abilities in activities of daily living, rating level of performance and satisfaction with performance Confidence scale researcher devised. Following practice of community skills in a natural environment, satisfaction with performance, and performance of community skills – rated higher (p
Appendix 5: Evidence- based review tables Source Design and participants Intervention Outcomes Results Quality and comment Heine et al (2004) Qualitative study – grounded theory to explore service user perceptions Aim: participants’ views of what factors contribute to a feeling of readiness for discharge if sent home 5–7 days postoperatively Purposive sampling of five participants from a single acute setting Age range 43–79 years Male: female ratio = 3:2 Australia. Total hip replacement. In- depth unstructured interviews – 30–75 minutes Due to be discharged in 1–2 days Prior to discharge participants were asked: ‘When are you going home’, and ‘Tell me how you feel about going home’. Three major categories emerged from the data: a) Feeling safe b) Confidence c) Family and friends. These categories represented the general pattern of readiness for discharge, despite the discharge process being unique for each service user Service users need to feel safe or secure about their return home – can be enhanced by providing information at a pre- operative stage as well as prior to discharge. Grade D – Very Low Limitations: • Essentially case study accounts • No pilot study and analysis reported all relevant topic areas covered after only five participants • No tape recording of interviews – field note only • Not clear if researcher involved in treatment. Hol et al (2010) Systematic review Aim: to determine whether immediate post-operative unrestricted weightbearing may have an influence on bony consolidation and eventual loosening of uncemented femoral stem in total hip replacement Criteria: 1. THR for osteoarthritis 2. Intervention postoperatively full weightbearing with aid 3. Primary outcome was osseous integration, loosening of subsidence and femoral migration. 13 studies: 10 RCTs, three controlled clinical trials. Uncemented primary total hip replacement Full weightbearing immediately postoperatively. Degree of subsidence and osseous integration of femoral stem after THR and full weightbearing protocol. Subsidence of femoral stem – all occurred within the first 3 months and after that was stable Main result is that immediate unrestricted weightbearing is not contra- indicated in people with primary uncemented THR Moderate – strong evidence for full weight-bearing immediately postoperative with uncemented THR – can allow quicker rehabilitation and return to functional independence Despite variety of methods study shows minimal risk of stem migration with full weightbearing Supportive of accelerated rehabilitation programs. Grade B – Moderate Downgraded from Grade A due to limitations: • Not all studies were randomised controlled trials • Small sample sizes (range 23–80) • Pooling not considered to be feasible due to differences in studies • Use of assistive device and exact description of weight bearing status unclear • Different methods of quantifying migration of femoral stem used. College of Occupational Therapists 85
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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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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
Page 124: Download for Occupational therapy f
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Total hip replacement - College of Occupational Therapists

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