Hippity Hop Hip Precautions After Hip Operation Protocol
![Hippity. Hop: Hip Precautions After Hip Operation Protocol Courtney J Lightfoot Ph. D student, Hippity. Hop: Hip Precautions After Hip Operation Protocol Courtney J Lightfoot Ph. D student,](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-1.jpg)
![Total Hip Replacement (THR) • Surgical treatment considered when the hip joint becomes damaged Total Hip Replacement (THR) • Surgical treatment considered when the hip joint becomes damaged](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-2.jpg)
![Hip Precautions • To protect new joint and ↓↓ risk of dislocation Hip precautions Hip Precautions • To protect new joint and ↓↓ risk of dislocation Hip precautions](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-3.jpg)
![Hip Precautions • Although routinely provided there are large discrepancies in the provision of Hip Precautions • Although routinely provided there are large discrepancies in the provision of](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-4.jpg)
![Hip Precautions • Although routinely provided there are large discrepancies in the provision of Hip Precautions • Although routinely provided there are large discrepancies in the provision of](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-5.jpg)
![Hip Precautions • Although routinely provided there are large discrepancies in the provision of Hip Precautions • Although routinely provided there are large discrepancies in the provision of](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-6.jpg)
![Hip Precautions Smith and Sackley, 2016 Hip Precautions Smith and Sackley, 2016](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-7.jpg)
![Hip Precautions • Although routinely provided there are large discrepancies in the provision of Hip Precautions • Although routinely provided there are large discrepancies in the provision of](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-8.jpg)
![Hip Precautions • Although routinely provided there are large discrepancies in the provision of Hip Precautions • Although routinely provided there are large discrepancies in the provision of](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-9.jpg)
![Hip Precautions Smith and Sackley, 2016 Hip Precautions Smith and Sackley, 2016](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-10.jpg)
![Literature Review • Current research is equivocal, with conflicting evidence Not needed Dislocations occur Literature Review • Current research is equivocal, with conflicting evidence Not needed Dislocations occur](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-11.jpg)
![Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-12.jpg)
![Literature Review • No additional benefit for ↓ ↓ dislocation rates Study Dislocation rates Literature Review • No additional benefit for ↓ ↓ dislocation rates Study Dislocation rates](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-13.jpg)
![Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-14.jpg)
![Literature Review • Slower return to ADLs Ververeli et al. , 2009 Literature Review • Slower return to ADLs Ververeli et al. , 2009](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-15.jpg)
![Literature Review • Slower return to ADLs Peak et al. , 2005 Literature Review • Slower return to ADLs Peak et al. , 2005](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-16.jpg)
![Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-17.jpg)
![Literature Review • ↓↓patient satisfaction Percentage (%) of patients who were satisfied with the Literature Review • ↓↓patient satisfaction Percentage (%) of patients who were satisfied with the](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-18.jpg)
![Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-19.jpg)
![Literature Review • Sleep deprivation 68. 4% patients in restricted group and 65. 6% Literature Review • Sleep deprivation 68. 4% patients in restricted group and 65. 6%](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-20.jpg)
![Literature Review • Sleep deprivation 14% patients in unrestricted group began side-sleeping on night Literature Review • Sleep deprivation 14% patients in unrestricted group began side-sleeping on night](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-21.jpg)
![Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-22.jpg)
![Literature Review • Significant £ Cost savings of $655 … abduction pillow ($120) elevated Literature Review • Significant £ Cost savings of $655 … abduction pillow ($120) elevated](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-23.jpg)
![Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-24.jpg)
![Literature Review • Strong opposing clinical opinions • Main difficulties in evaluating key literature: Literature Review • Strong opposing clinical opinions • Main difficulties in evaluating key literature:](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-25.jpg)
![Research Aims Hippity. Hop 1. To compare outcomes of hip precautions vs. no hip Research Aims Hippity. Hop 1. To compare outcomes of hip precautions vs. no hip](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-26.jpg)
![Study Design Impractical – service based Unrealistic provision RCT Potential for widespread contamination and Study Design Impractical – service based Unrealistic provision RCT Potential for widespread contamination and](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-27.jpg)
![Study Design Using a local Trust who are moving to a no precautions model Study Design Using a local Trust who are moving to a no precautions model](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-28.jpg)
![Intervention ‘Routine’ (previous) treatment ‘New’ treatment strategy ‐ Hip precautions taught ‐ Patients encouraged Intervention ‘Routine’ (previous) treatment ‘New’ treatment strategy ‐ Hip precautions taught ‐ Patients encouraged](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-29.jpg)
![Sample Size Treatment regimes Recruit = 342 participants (171 per group/ treatment regime) • Sample Size Treatment regimes Recruit = 342 participants (171 per group/ treatment regime) •](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-30.jpg)
![Population and Recruitment • Elective THR patients Inclusion Exclusion Aged ≥ 18 years Do Population and Recruitment • Elective THR patients Inclusion Exclusion Aged ≥ 18 years Do](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-31.jpg)
![Outcomes Pre-op Baseline Surgery Oxford Hip Score (pain and function) Qo. L ADLs mood Outcomes Pre-op Baseline Surgery Oxford Hip Score (pain and function) Qo. L ADLs mood](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-32.jpg)
![Qualitative Interviews • Sample of patients from phase one and two, and orthopaedic staff Qualitative Interviews • Sample of patients from phase one and two, and orthopaedic staff](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-33.jpg)
![Results To date … Phase One 304 letters sent out 302 approached 182 consented Results To date … Phase One 304 letters sent out 302 approached 182 consented](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-34.jpg)
![Results 145 baselines and surgery Phase One / Two Phase One 27 baselines complete Results 145 baselines and surgery Phase One / Two Phase One 27 baselines complete](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-35.jpg)
![Results To date … Phase Two 84 letters sent out 62 approached 42 consented Results To date … Phase Two 84 letters sent out 62 approached 42 consented](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-36.jpg)
![Next Steps Treatment regimes Recruitment ends = February 2018 Interviews Recruit: • 10 clinical Next Steps Treatment regimes Recruitment ends = February 2018 Interviews Recruit: • 10 clinical](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-37.jpg)
![Thank you Courtney J Lightfoot courtney. lightfoot@nottingham. ac. uk Courtney. JLight Thank you Courtney J Lightfoot courtney. lightfoot@nottingham. ac. uk Courtney. JLight](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-38.jpg)
![Literature Review Key reviews Key papers 1. Sharma et al. , 2009 1. Talbot Literature Review Key reviews Key papers 1. Sharma et al. , 2009 1. Talbot](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-39.jpg)
![• Peak et al. , 2005 • Peak et al. , 2005](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-40.jpg)
![• Drummond et al. , 2012 • Drummond et al. , 2012](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-41.jpg)
- Slides: 41
![Hippity Hop Hip Precautions After Hip Operation Protocol Courtney J Lightfoot Ph D student Hippity. Hop: Hip Precautions After Hip Operation Protocol Courtney J Lightfoot Ph. D student,](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-1.jpg)
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 Total Hip Replacement (THR) • Surgical treatment considered when the hip joint becomes damaged](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-2.jpg)
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 Hip Precautions • To protect new joint and ↓↓ risk of dislocation Hip precautions](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-3.jpg)
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 • Although routinely provided there are large discrepancies in the provision of](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-4.jpg)
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 • Although routinely provided there are large discrepancies in the provision of](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-5.jpg)
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 • Although routinely provided there are large discrepancies in the provision of](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-6.jpg)
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 Smith and Sackley, 2016](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-7.jpg)
Hip Precautions Smith and Sackley, 2016
![Hip Precautions Although routinely provided there are large discrepancies in the provision of Hip Precautions • Although routinely provided there are large discrepancies in the provision of](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-8.jpg)
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 • Although routinely provided there are large discrepancies in the provision of](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-9.jpg)
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 Hip Precautions Smith and Sackley, 2016](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-10.jpg)
Hip Precautions Smith and Sackley, 2016
![Literature Review Current research is equivocal with conflicting evidence Not needed Dislocations occur Literature Review • Current research is equivocal, with conflicting evidence Not needed Dislocations occur](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-11.jpg)
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 Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-12.jpg)
Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation rates
![Literature Review No additional benefit for dislocation rates Study Dislocation rates Literature Review • No additional benefit for ↓ ↓ dislocation rates Study Dislocation rates](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-13.jpg)
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 Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-14.jpg)
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 Ververeli et al. , 2009](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-15.jpg)
Literature Review • Slower return to ADLs Ververeli et al. , 2009
![Literature Review Slower return to ADLs Peak et al 2005 Literature Review • Slower return to ADLs Peak et al. , 2005](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-16.jpg)
Literature Review • Slower return to ADLs Peak et al. , 2005
![Literature Review Hip precautions No additional benefit for dislocation Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-17.jpg)
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 Literature Review • ↓↓patient satisfaction Percentage (%) of patients who were satisfied with the](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-18.jpg)
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 Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-19.jpg)
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 Literature Review • Sleep deprivation 68. 4% patients in restricted group and 65. 6%](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-20.jpg)
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 sidesleeping on night Literature Review • Sleep deprivation 14% patients in unrestricted group began side-sleeping on night](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-21.jpg)
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 Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-22.jpg)
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 Literature Review • Significant £ Cost savings of $655 … abduction pillow ($120) elevated](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-23.jpg)
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 Literature Review Hip precautions = ↓ • No additional benefit for ↓ ↓ dislocation](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-24.jpg)
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 Literature Review • Strong opposing clinical opinions • Main difficulties in evaluating key literature:](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-25.jpg)
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 Research Aims Hippity. Hop 1. To compare outcomes of hip precautions vs. no hip](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-26.jpg)
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 Study Design Impractical – service based Unrealistic provision RCT Potential for widespread contamination and](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-27.jpg)
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 Study Design Using a local Trust who are moving to a no precautions model](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-28.jpg)
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 Intervention ‘Routine’ (previous) treatment ‘New’ treatment strategy ‐ Hip precautions taught ‐ Patients encouraged](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-29.jpg)
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 Sample Size Treatment regimes Recruit = 342 participants (171 per group/ treatment regime) •](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-30.jpg)
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 Population and Recruitment • Elective THR patients Inclusion Exclusion Aged ≥ 18 years Do](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-31.jpg)
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 Preop Baseline Surgery Oxford Hip Score pain and function Qo L ADLs mood Outcomes Pre-op Baseline Surgery Oxford Hip Score (pain and function) Qo. L ADLs mood](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-32.jpg)
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 Qualitative Interviews • Sample of patients from phase one and two, and orthopaedic staff](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-33.jpg)
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 Results To date … Phase One 304 letters sent out 302 approached 182 consented](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-34.jpg)
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 Results 145 baselines and surgery Phase One / Two Phase One 27 baselines complete](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-35.jpg)
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 Results To date … Phase Two 84 letters sent out 62 approached 42 consented](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-36.jpg)
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 Next Steps Treatment regimes Recruitment ends = February 2018 Interviews Recruit: • 10 clinical](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-37.jpg)
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 lightfootnottingham ac uk Courtney JLight Thank you Courtney J Lightfoot courtney. lightfoot@nottingham. ac. uk Courtney. JLight](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-38.jpg)
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 Literature Review Key reviews Key papers 1. Sharma et al. , 2009 1. Talbot](https://slidetodoc.com/presentation_image_h/d5a5edd993c53743b62eff8a189f0207/image-39.jpg)
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