Hippity Hop Hip Precautions After Hip Operation Protocol
- Slides: 41
Hippity. Hop: Hip Precautions After Hip Operation Protocol Courtney J Lightfoot Ph. D student, University of Nottingham courtney. lightfoot@nottingham. ac. uk Lightfoot C J, Sehat K R, Drury G, Brewin C, Coole C, and Drummond A
Total Hip Replacement (THR) • Surgical treatment considered when the hip joint becomes damaged and causes persistent problems • Effective method to relieve pain, improve functional ability, and quality of life (Qo. L) • >83, 000 performed in 20151 • Dislocation recognised complication with incidence rates 1 -15%2 1. National Joint Registry, 2016; 2. Resptrepo et al. , 2011
Hip Precautions • To protect new joint and ↓↓ risk of dislocation Hip precautions Avoidance of specific movement 6 weeks Impact on daily life
Hip Precautions • Although routinely provided there are large discrepancies in the provision of hip precautions • Movements to avoid • Length of time to follow • Reasons for teaching • Equipment provision Drummond et al. , 2012
Hip Precautions • Although routinely provided there are large discrepancies in the provision of hip precautions Adduction Flexion Movements to avoid Internal/external rotation Drummond et al. , 2012
Hip Precautions • Although routinely provided there are large discrepancies in the provision of hip precautions 6 weeks Drummond et al. , 2012 Length of time to follow 12 weeks
Hip Precautions Smith and Sackley, 2016
Hip Precautions • Although routinely provided there are large discrepancies in the provision of hip precautions OT practice Surgical approach used Surgical opinion Reasons for teaching Team decision Hospital policy length of stay Evidence based Drummond et al. , 2012
Hip Precautions • Although routinely provided there are large discrepancies in the provision of hip precautions Chair / bed raisers Raised toilet seat Dressing aids Equipment provision Perching stools Long handled reachers Drummond et al. , 2012
Hip Precautions Smith and Sackley, 2016
Literature Review • Current research is equivocal, with conflicting evidence Not needed Dislocations occur due to undesirable movements that cannot be avoided 1 1. Gromov et al. , 2015. 2. Smith et al. , 2012. Long term use Counselling patients to avoid bending and to be vigilant during functional transfers 2
Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation rates
Literature Review • No additional benefit for ↓ ↓ dislocation rates Study Dislocation rates (n/total (%)) Hip precautions No hip precautions Ververeli et al. , 2009 0 / 43 (0%) 0 / 38 (0%) Peak et al. , 2005 1 / 152 (0. 66%) 0 / 151 (0%) Barrett et al. , 2013 1 / 44 (2. 3%) 0 / 43 (0%) Duwelius et al. , 2007 0 / 43 (0%) Khan et al. , 2006 4 / 100 (4%) 0 / 100 (0%) Mikkelsen et al. , 2014 2 / 146 (1. 4%) 6 / 219 (2. 7%) Barnsley et al. , 2015; van der Weegan et al. , 2016
Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation rates • Slower return to ADLs
Literature Review • Slower return to ADLs Ververeli et al. , 2009
Literature Review • Slower return to ADLs Peak et al. , 2005
Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation rates • Slower return to ADLs • ↓↓patient satisfaction
Literature Review • ↓↓patient satisfaction Percentage (%) of patients who were satisfied with the pace of their recovery Peak et al. , 2005 Hip precautions No hip precautions 74. 3% 89. 4%
Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation rates • Slower return to ADLs • ↓↓patient satisfaction • Sleep deprivation
Literature Review • Sleep deprivation 68. 4% patients in restricted group and 65. 6% patients in unrestricted group rated sleeping fully supine “uncomfortable” Peak et al. , 2005 ‘Sleep deprivation leads to increased anxiety and decreased satisfaction’ O’Grady et al. , 2003
Literature Review • Sleep deprivation 14% patients in unrestricted group began side-sleeping on night of surgery Significant differences in side-sleeping were noted at all follow-up time periods Peak et al. , 2005
Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation rates • Slower return to ADLs • ↓↓patient satisfaction • Sleep deprivation • Significant £
Literature Review • Significant £ Cost savings of $655 … abduction pillow ($120) elevated toilet seat ($65) elevated chair ($955 to purchase, $15/day to rent) Peak et al. , 2005 Therapy time per patient (minutes) Mean (Range) Face‐to‐face contact Non‐patient contact 139. 72 (25 ‐ 540) 73. 15 (0 – 48) Drummond et al. , 2012
Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation rates 1 • Slower return to ADLs 2 • ↓↓patient satisfaction 3 • Sleep deprivation 4 • Significant £ 5 1. Barnsley et al. , 2015; van der Weegan et al. , 2016 2. Ververeli et al. , 2009; Peak et al. , 2005 3. Peak et al. , 2005 4. Peak et al. , 2005; O’Grady, 2003; 5. Peak et al. , 2005; Drummond et al. , 2012
Literature Review • Strong opposing clinical opinions • Main difficulties in evaluating key literature: 1. Lack of robust methodology 2. Underpowered studies 3. Focus on dislocation
Research Aims Hippity. Hop 1. To compare outcomes of hip precautions vs. no hip precautions 2. To explore patients’ experiences of the regimes 3. To explore staff members’ perceptions of the service 4. To assess the costs of providing each regime
Study Design Impractical – service based Unrealistic provision RCT Potential for widespread contamination and protocol infringement Number of participants required to demonstrate a difference would be very large
Study Design Using a local Trust who are moving to a no precautions model of care as an opportunity to model the study around this service change Before After
Intervention ‘Routine’ (previous) treatment ‘New’ treatment strategy ‐ Hip precautions taught ‐ Patients encouraged to move as they are able ‐ Patients provided with ‘safe height’ ‐ Equipment routinely provided ‐ Equipment only provided to those who require it
Sample Size Treatment regimes Recruit = 342 participants (171 per group/ treatment regime) • Pre-defined margin of equivalence = 0. 5 SD • Confounding factors • 25% attrition rate Interviews Recruit = 40 participants (20 staff & 20 patients) • Sufficient diversity
Population and Recruitment • Elective THR patients Inclusion Exclusion Aged ≥ 18 years Do not speak or read English Elective primary THR Revision or ‘complex’ surgery Provide informed consent Dementia • Approached at preoperative assessment
Outcomes Pre-op Baseline Surgery Oxford Hip Score (pain and function) Qo. L ADLs mood 1 week 6 weeks 3 months sleep satisfaction dislocation Sample of cohort equipment time
Qualitative Interviews • Sample of patients from phase one and two, and orthopaedic staff Patient inclusion Participated in cohort study Staff inclusion Provide care to patients undergoing THR • Selected using maximum variation purposive sampling • Interview guidelines developed as study progresses
Results To date … Phase One 304 letters sent out 302 approached 182 consented 9 non returners 173 baseline completed 8 withdrawn 3 late returners 162 baseline for analysis 8 cancelled surgery 9 unfit for surgery
Results 145 baselines and surgery Phase One / Two Phase One 27 baselines complete 4 missed 6 to contact 118 baselines complete 17 one week complete 3 missed 10 awaiting return 115 one week complete 8 to send out 2 awaiting return 1 non returner 4 non returners 112 six weeks complete 23 awaiting return 20 to send out 1 non returner 74 three months complete 8 six weeks complete
Results To date … Phase Two 84 letters sent out 62 approached 42 consented 17 baseline completed
Next Steps Treatment regimes Recruitment ends = February 2018 Interviews Recruit: • 10 clinical staff (November 2017 – January 2018) • 10 patients (January 2018 – May 2018) Cost Assess 10 patients
Thank you Courtney J Lightfoot courtney. lightfoot@nottingham. ac. uk Courtney. JLight
Literature Review Key reviews Key papers 1. Sharma et al. , 2009 1. Talbot et al. , 2002 2. Barnsley et al. , 2015 2. Peak et al. , 2005 3. van der Weegan et al. , 2016 3. Restrepo et al. , 2011 4. Smith et al. , 2016
• Peak et al. , 2005
• Drummond et al. , 2012
- A hip a hop a hippity hop
- Hip to the hippity hop
- Old school hip hop quiz
- Poem about hip hop
- The squirrel poem summary
- Standard precautions and transmission-based precautions
- Hop by hop choke packet
- Choke packet in congestion control
- Hop to hop
- Principles of congestion control
- Hop on hop off delhi
- Hop by hop choke packet
- No bending lifting twisting
- After me after me after me
- John 14 1-3
- Bronkse
- Father of hip hop
- São elementos constituintes da dança
- Curiosidades do freestyle
- Hip hop questions to ask
- Spreschen
- Hip hop prezentace
- O hip hop tem sua filosofia propria com valores
- History of rap music timeline
- Hip hop presentation
- Hip hop for php
- Hip hop php
- Flocabulary shakespeare is hip hop
- Hip hop music magazines
- Hip hop turkeys
- Shakespeare flocabulary quiz answers
- Universal precautions in operation theatre
- First hop redundancy protocol
- In the ssl record protocol operation pad_2 is
- Precautions when moving materials manually
- Precautions in specimen collection
- Universal precautions training
- Transmission based precautions meaning
- Chapter 16 infection control and standard precautions
- Definition of standard precautions
- Seizure precautions bed rails
- Precautions for hot weather concreting