Hip precautions after hip operation (HippityHop): Protocol for a before and after study evaluating hip precautions following total hip replacement

Abstract

IntroductionHip precautions are routinely used despite inconclusive evidence that they reduce dislocations, and concern that they impede activities of daily living. HippityHop compares a change in practice locally from implementing routine hip precautions to no routine precautions, in order to: 1. Compare patient outcomes in quality of life, functional performance, pain, sleep, mood and satisfaction. 2. Ascertain staff and patient perceptions of the two regimes. 3. Determine the cost of precautions.

Challenging traditions to advance occupational therapy

“…This practice still continues despite lack of evidence of its effectiveness. Lightfoot et al (2018), in the first study protocol we have published, describe how they will scrutinize this practice, further enhancing the evidence base for the profession. Searching for 'stroke' in the title of publications in the journal produced 141 results, ranging from the earliest mention being the report of conference in 1961 to the latest (to date) being Kessler et al (2018), published in this issue.…”

“…This practice still continues despite lack of evidence of its effectiveness. Lightfoot et al. (2018), in the first study protocol we have published, describe how they will scrutinize this practice, further enhancing the evidence base for the profession.…”

Evaluation of hip precautions following total hip replacement: a before and after study

“…The study was a before (phase 1) and after (phase 2) observational study design with two consecutive cohorts of patients modelled around the change in delivery of orthopaedic service to patients following THR. The study uses an equivalence design to show comparative efficacy between the two treatments delivered [22], hip precautions (phase 1) and no hip precautions (phase 2); in other words, having no hip precautions was no better or worse to using hip precautions [23]. The study was conducted in the Nottingham Elective Orthopaedic Service at Nottingham City Hospital campus, Nottingham University Hospitals (NUH) NHS Trust, between January 2017 and August 2018.…”

“…A multicentre clustered RCT was not feasible; we had previously discussed conducting a multicentre RCT with several hospitals, but they were not willing to be randomised. The protocol for this study (HippityHop) has been published [23].…”

“…A large multicentred randomised control trial would be required to draw definitive conclusions. However, whilst it would have been preferable to use a randomised controlled trial (RCT) design, this was not possible because of potential contamination issues discussed previously [23]. We explored the possibility of using a cluster RCT design, however the hospitals approached had fixed views on which intervention they wanted to deliver, so this was not feasible.…”