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Hip precautions after primary total hip arthroplasty: a qualitative exploration of clinical reasoning.
- Source :
-
Disability & Rehabilitation . Jun2022, Vol. 44 Issue 12, p2842-2848. 7p. - Publication Year :
- 2022
-
Abstract
- Hip precautions are movement restrictions that are often advised following primary total hip arthroplasty (PTHA) for osteoarthritis (OA), but there is limited evidence supporting their effectiveness in preventing dislocation. This study aimed to explore the clinical reasoning behind the continuation and discontinuation of hip precautions following PTHA for OA. Semi-structured interviews were conducted with therapists and surgeons at six centres using precautions and six centres not using precautions across secondary or tertiary NHS sites in England. Interviews were transcribed verbatim and thematically analysed. Interviews were conducted with fourteen surgeons and eighteen therapists. Of these clinicians, eight surgeons and ten therapists routinely advised precautions. Clinicians continued to use precautions to avoid dislocation by creating a boundary to movement, particularly important when dealing with patients who "push" these boundaries. Clinicians discontinued precautions because of a perceived negative impact on patients and the lack of supporting evidence. In the absence of a rise in dislocation rates for these centres, others have now changed practice. This study offers insight into the clinical reasoning behind the continuation and discontinuation of hip precautions following PTHA for OA. The use of precautions remains controversial and further work is required to determine whether or not they should be advised. Redesign of future rehabilitation pathways for primary total hip arthroplasty should take into account viewpoints from across the multidisciplinary team to aid decision making. Concern for patient behaviours, dislocation and litigation may be barriers to changing practice for rehabilitation after primary total hip arthroplasty. Clinicians may be discontinuing hip precautions because of known surgical advances, a perceived negative impact on patients and a lack of supporting evidence for historical practice. Individualised rehabilitation considerations are necessary for patients with risk factors that predispose them to dislocation after primary total hip arthroplasty, regardless of whether hip precautions are advised as standard at their given centre. [ABSTRACT FROM AUTHOR]
- Subjects :
- *TOTAL hip replacement
*HIP osteoarthritis
*RESEARCH methodology
*PHYSICAL therapy
*INTERVIEWING
*TERTIARY care
*SURGERY
*PATIENTS
*THERAPEUTIC immobilization
*HIP joint dislocation
*QUALITATIVE research
*NATIONAL health services
*OCCUPATIONAL therapy
*TREATMENT effectiveness
*COST analysis
*DESCRIPTIVE statistics
*RESEARCH funding
*SECONDARY care (Medicine)
*THEMATIC analysis
*JUDGMENT sampling
*REFLEXIVITY
*MEDICAL logic
Subjects
Details
- Language :
- English
- ISSN :
- 09638288
- Volume :
- 44
- Issue :
- 12
- Database :
- Academic Search Index
- Journal :
- Disability & Rehabilitation
- Publication Type :
- Academic Journal
- Accession number :
- 157610995
- Full Text :
- https://doi.org/10.1080/09638288.2020.1845825