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 Johansson et al (2010) Cohort study Aim: examine impact of preoperative functional status on early post- operative outcomes after total hip replacement n=75 Mean age: 67 years Male: female ratio = 39:36 Body Mass Index of
Appendix 5: Evidence- based review tables Source Design and participants Intervention Outcomes Results Quality and comment Khan et al (2008) Cochrane Systematic Review Aim: to assess evidence for effectiveness of organised multidisciplinary rehabilitation on activity and participation in adults (18+) following hip or knee replacement surgery for chronic arthropathy Included RCTs covering multidisciplinary rehabilitation with routine services, hip or knee joint replacement Five trials (n=619) met inclusion criteria – two inpatient rehabilitation (n=261) and three home- based settings (n=358) Studies: United Kingdom, Iceland, Australia and United States. Total hip or knee replacement followed by multidisciplinary rehabilitation defined as: • Two or more disciplines involved • Home, hospital or outpatient • Early or late timing • Use of critical pathways • Use of pain management strategies. Control intervention – lower level or different type of intervention, equivalent in a different setting or waiting list conditions. • Impairment (e.g. joint range of movement and muscle weakness) • Activity limitation (e.g. mobility transfer skills, independence in activities of daily living) • Restriction in participation (e.g. extended activities of daily living, societal reintegration, quality of life). Others: cost of episode of care, length of stay, service utilisation, readmission, mortality rates, carer burden. • No studies providing direct evidence that multidisciplinary rehabilitation following THR/TKR achieved better outcomes compared with no treatment • Evidence for the effectiveness of multidisciplinary rehabilitation in both inpatient and home- based settings • Not possible to suggest best ‘dose’ of therapy • Modest support that following hip replacement people should be assessed for need for appropriate rehabilitative intervention. Evidence that multidisciplinary rehabilitation programmes can have a positive impact on service userrelated outcomes, such as function and quality or life, as well as institutional outcomes, e.g. length of stay and cost. Grade A – High Limitations: • Studies themselves were low quality • Small numbers and methodological weaknesses • Difficulties with combining information due to heterogeneity of studies – could not perform metaanalysis • Best evidence synthesis using a qualitative analysis completed. Kiefer and Emery (2004) Cohort retrospective review Aim: to measure functional gains in self- care, mobility and locomotion of service users after total hip replacement from baseline to discharge. Also compare grip strength to normative data in over 60 age group, and examine the relationship between grip strength and functional performance measures after THR Rehabilitation unit n=41 Mean age 72.9 years Male: female ratio = 13:28 United Kingdom. Total hip replacement. Functional Independence Measure (FIM) Jamar Dynamometer Measures at baseline and discharge. • FIM subscale scores improved 2.1 points on average. Statistically significant improvement made in 10 subscales of self- care, mobility and locomotion (p≤0.05) • Grip strength significantly less than expected norms in 6 of 14 subgroups after surgery • No significant correlation between grip strength and FIM subscale (at 0.05). Improvement of functional performance made on all FIM subscales. Grip strength after THR was moderately decreased from the norm • Significant improvement in all FIM areas other than eating and cognition where score was independent at baseline (p≤0.05). Grade C – Low Limitations: • Small sample size • Exclusion criterion makes it difficult to generalize – no upper limb issues • No pre- surgery measures to compare against • No control group to compare. College of Occupational Therapists 89
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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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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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Guideline recommendations The inter
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Page 115 and 116: References Evidence references Bere
Page 117 and 118: References Lin JJ, Kaplan RJ (2004)
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Page 121 and 122: References Health and Care Professi
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Total hip replacement - College of Occupational Therapists

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