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 Hunt et al (2009) Qualitative study Aim: to describe service user experience of accelerated discharge after hip replacement in order to test the acceptability to service users of economically driven shortening of post- operative stay Belfast n=20 Mean age 70 years Male: female ratio 9:11 Liverpool n=15 Mean age 71 years Male: female ratio = 8:7 United Kingdom. Total hip replacement Two groups from two hospitals: 1. Belfast – accelerated discharge programme, aiming for a post- operative stay of 3- 4 days (cases) 2. Liverpool – traditional regimen of discharge after 6–7 days (controls). Semi-structured interviews of service users’ feelings and experiences relating to their intervention. Service users primarily concerned with how attentive and informative hospital staff had been, and did not spontaneously refer to LOS When prompted, they did not question their discharge time, though those with traditional care could not countenance more rapid discharge Service users with accelerated discharge described concerns about consequences of early discharge for them or their family – especially regarding managing pain and mobility problems at home and needing more support. Grade D – Very Low Downgraded from Grade C due to limitations: • Differences in surgical, anaesthetic/preoperative occupational therapy • Time post- surgery and interview length varied • Unclear if any researcher and participant bias • Small sample size • Awareness service users rarely criticise their care when asked overtly • Continuing inflammatory response at least 7 days after surgery: Liverpool sample (longer stay) response would be lower re feeling unwell at discharge. Husted et al (2008) Prospective cohort study Aim: to identify service user characteristics associated with LOS and service user satisfaction after total hip and knee replacement surgery Facility: dedicated fast track joint replacement unit 712 unselected consecutive service users Mean age 69 years Male: female ratio = 272:440 Denmark. Total hip replacement or total knee replacement with fast track therapy and early discharge home within 5 days Standardised protocol throughout multidisciplinary team approach. • Length of stay • Service user satisfaction (11 parameters via written questionnaire completed on discharge). 22 service user characteristics were examined. 92% discharged home in 5 days, 41% in 3 days. 88/712 didn’t attend preoperative meeting. No difference in LOS found between those who did and didn’t attend, or between service users with different surgeons or operations at different times of day Age (older p=0.01), gender (females p=0.01), marital status (living alone p=0.02) had increased chance of staying longer than 3–5 days. There were similar outcomes for use of walking aids (p=0.004) and day of surgery (p=0.001) Study concluded that the accelerated discharge reduced LOS for unselected THR and TKR service users. High service user satisfaction was found for all parts of the stay with a readmission rate similar to other studies. Grade C – Low Limitations: • Service user satisfaction tool not validity/reliability tested • No discussion on population specifics and what happens with complex service user discharge • No follow- up • No mention of outcomes for 8% who stayed more than 5 days • Difficult to determine generalisability of results. 86 Occupational therapy for adults undergoing total hip replacement
Appendix 5: Evidence- based review tables Source Design and participants Intervention Outcomes Results Quality and comment Iyengar et al (2007) Prospective cohort study Aim: role of targeted early rehabilitation at home for service users admitted for elective total hip replacement or total knee replacement – in terms of reduced LOS, reduced cost, readmission rates, complication rates and costs of running scheme considered (cost effectiveness) THR n=220 and TKR n=174 were eligible for rehabilitation at home out of total of 1,034 THR group: Mean age 72.1 years Male: female ratio = 42.7%:57.3% United Kingdom. Total hip or knee replacement, early discharge with home based multidisciplinary team rehabilitation Went home with service user on day of discharge and then saw service user in the home according to individual needs Screening in preoperative clinic by occupational therapist to identify service users who could be discharged earlier with home rehabilitation if resources available in the community. • Length of stay (days) • Duration of home rehabilitation (days) • Number of hospital bed days saved • Complications detected • Readmissions • Cost of home therapy programme. • Targeted early rehabilitation resulted in reduced hospital stay (from 14 to 8.17 days for THR), without any increase in complication rates • THR service users had mean length of stay on rehabilitation scheme of 2.84 days. Targeted early rehabilitation at home after elective THA and TKA releases acute care beds and reduces healthcare costs No evidence of increased complication or readmission rates A multidisciplinary team working closely together was believed to be the key to success of the scheme. Grade C – Low Limitations: • Need more information about the population of the study • Critical functioning criterion screening tool was not tested for validity and reliability • Targeted selection of service users – hence bias to shorter LOS • Long baseline LOS at beginning of study • Study did not compare with a similar selected cohort from the past. Johansson et al (2007) Randomised controlled trial Aim: to determine whether it is possible to increase service user knowledge and certainty about care- related issues, to reach a more empowering learning experience and to exercise a more positive impact on selected clinical outcomes by additional pre- admission education 165 eligible, 123 participated. Group A: n=62 Group B: n=61 Mean age 62.4 years Male: female ratio = 49%:51% Finland. Total hip replacement Randomised to: Group A – face- to- face education with nurses using the concept map method with written educational material Group B – written education and nonsystematic oral education (standard). Data collected 4 weeks before admission, on admission and discharge: • Orthopaedic Patient Knowledge Questionnaire (OPKQ) prior to admission, admission and shortened version on discharge • Modified Empowerment Questionnaire (MEQ) on admission • Clinical outcomes (LOS, length of admission discussion and need for further care) – from medical record. At 2 nd post- test n=55(A); n=51(B) At first post- admission test Group A had significantly better knowledge and certainty of care related issues (p=0.021) than Group B, as well as reporting more positive learning experience (p
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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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7 Guideline recommendations The rec
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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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