It is not yet established whether occupational therapy for people after total hip arthroplasty is effective in improving outcomes or reducing the risk of adverse events

Summary of Smith, T. O., Jepson, P., Beswick, A., Sands, G., Drummond, A., Davis, E. T. & Sackley, C. M. ( 2016). Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. The Cochrane Library, 7, CD010815, doi: 10.1002/14651858.CD010815.pub2 Objective: Occupational therapists commonly work with people after total hip arthroplasty (THA) with the aim of improving function and preventing dislocation. The aim of this review was to determine the efficacy of providing assistive devices, education, environmental modifications and training in activities of daily living (ADL) for people undergoing total hip arthroplasty. Design: Systematic review of randomised controlled trials (RCTs), quasi‐RCTs and cluster RCTs. Participants: People who underwent primary THA surgery or revision THA. All types of prostheses, fixation methods and surgical approaches were included. Interventions: Provision of assistive devices to prevent dislocation, education regarding hip precautions, home modifications and ADL training for either basic or extended ADLs and advice regarding recovery after THA. Interventions took place post‐operatively. Studies were eligible if the intervention was provided by a health professional who was not an occupational therapist as long as the content of the intervention was compatible with accepted occupational therapy practice. Outcome measures of interest: pain, function, health‐related quality of life, global assessment of treatment success, reoperation rate, hip dislocation and adverse events. Main findings: Three trials (with 492 participants) conducted in North America were included in the review. The included studies were considered at risk of bias in regards to blinding of outcome assessment and selective reporting. The studies were not pooled due to heterogeneity. One study compared provision of hip precautions, equipment and functional restrictions and outpatient physiotherapy with outpatient therapy alone. A second study compared the provision of hip precautions plus post‐operative equipment and functional restriction with control treatment which involved provision of hip precautions alone. The third study compared an enhanced post‐operative rehabilitation and education program with usual rehabilitation. None of the studies found a difference between intervention and control groups in terms of hip function or dislocation. Results from one of the studies suggested that people who were not advised of precautions experienced an earlier recovery. Authors’ conclusions: It is currently unclear whether the prescription of equipment and advice regarding functional limitations for people after THA is beneficial due to the very low quality evidence available from three single studies.