Advanced

Post-discharge use of assistive devices following hemiarthroplasty : comparison of fracture patients with or without hip precautions

Rogmark, Cecilia LU ; Jobory, Ammar LU ; Unger, Oscar; Nilsson, Inger and Dahlqvist, Louise (2018) In Disability and Rehabilitation: Assistive Technology
Abstract

Purpose: To describe which types of assistive devices prescribed and actually used, either due to precautions or due to true functional reasons, after hip fracture-related hemiarthroplasty. Materials and methods: About 394 patients cluster-randomized 2010–2014 at a university hospital. Control group with standard postoperative precautions to reduce dislocations, mandatory assistive devices and knee brace for 6 weeks (in cognitively impaired) compared to non-precaution group with assistive devices only if needed. Postal questionnaire at 6 weeks and 3 months. Results: Both prescription and usage of reacher were higher in the precaution group. About 55% of patients with precautions was instructed to use stocking aids, 21% continued to do... (More)

Purpose: To describe which types of assistive devices prescribed and actually used, either due to precautions or due to true functional reasons, after hip fracture-related hemiarthroplasty. Materials and methods: About 394 patients cluster-randomized 2010–2014 at a university hospital. Control group with standard postoperative precautions to reduce dislocations, mandatory assistive devices and knee brace for 6 weeks (in cognitively impaired) compared to non-precaution group with assistive devices only if needed. Postal questionnaire at 6 weeks and 3 months. Results: Both prescription and usage of reacher were higher in the precaution group. About 55% of patients with precautions was instructed to use stocking aids, 21% continued to do so. Significantly fewer without precautions, 11%, used it at 3 months. Raised toilet seat was used by ∼40% of all pre-fracture and was prescribed to 79% with precautions. It was unchanged at 42% in non-precaution group. Nevertheless, 64% in non-precaution group used a raised toilet both at 6 weeks and 3 months. The usage persisted around 70% in precaution group. Usage of raised chair/bed were similar, even if non-precaution patients was not prescribed such. In the precaution group, 102 were prescribed a knee brace, only 5 used it at 6 weeks. Conclusions: The use of assistive devices did not follow what was prescribed from the hospital, regardless of precautions or not. The use of higher furniture was similar regardless of precautions or not. Other devices were more common in the precaution group. The compliance of knee bracing was low, and bracing should not be standard-of-care.Implications for rehabilitation Hemiarthroplasty is the most common treatment of displaced femoral neck fracture in elderly. Dislocation occur in 2 to 10% of these patients, and traditionally patients have been instructed to be careful when moving their leg and to use a number of assistive devices, in order to reduce the dislocation risk. The evidence base for such precautions is weak and occupational therapy and assistive devices may be costly. The current study shows that prescriptions and instructions from occupational therapists in hospital is more or less not follow after dismissal. Assistive devices should be prescribed based on the hip fracture patient’s true functional needs, and not routinely or due to arthroplasty precautions.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Assistive device, hemiarthroplasty, hip fracture, occupational therapy, precautions, reacher, stocking aids
in
Disability and Rehabilitation: Assistive Technology
publisher
Taylor & Francis
external identifiers
  • scopus:85054924247
ISSN
1748-3107
DOI
10.1080/17483107.2018.1499141
language
English
LU publication?
yes
id
a9fb6d4c-842f-4ba9-b601-793a7bdc56f8
date added to LUP
2018-11-06 12:28:24
date last changed
2019-02-20 11:34:44
@article{a9fb6d4c-842f-4ba9-b601-793a7bdc56f8,
  abstract     = {<p>Purpose: To describe which types of assistive devices prescribed and actually used, either due to precautions or due to true functional reasons, after hip fracture-related hemiarthroplasty. Materials and methods: About 394 patients cluster-randomized 2010–2014 at a university hospital. Control group with standard postoperative precautions to reduce dislocations, mandatory assistive devices and knee brace for 6 weeks (in cognitively impaired) compared to non-precaution group with assistive devices only if needed. Postal questionnaire at 6 weeks and 3 months. Results: Both prescription and usage of reacher were higher in the precaution group. About 55% of patients with precautions was instructed to use stocking aids, 21% continued to do so. Significantly fewer without precautions, 11%, used it at 3 months. Raised toilet seat was used by ∼40% of all pre-fracture and was prescribed to 79% with precautions. It was unchanged at 42% in non-precaution group. Nevertheless, 64% in non-precaution group used a raised toilet both at 6 weeks and 3 months. The usage persisted around 70% in precaution group. Usage of raised chair/bed were similar, even if non-precaution patients was not prescribed such. In the precaution group, 102 were prescribed a knee brace, only 5 used it at 6 weeks. Conclusions: The use of assistive devices did not follow what was prescribed from the hospital, regardless of precautions or not. The use of higher furniture was similar regardless of precautions or not. Other devices were more common in the precaution group. The compliance of knee bracing was low, and bracing should not be standard-of-care.Implications for rehabilitation Hemiarthroplasty is the most common treatment of displaced femoral neck fracture in elderly. Dislocation occur in 2 to 10% of these patients, and traditionally patients have been instructed to be careful when moving their leg and to use a number of assistive devices, in order to reduce the dislocation risk. The evidence base for such precautions is weak and occupational therapy and assistive devices may be costly. The current study shows that prescriptions and instructions from occupational therapists in hospital is more or less not follow after dismissal. Assistive devices should be prescribed based on the hip fracture patient’s true functional needs, and not routinely or due to arthroplasty precautions.</p>},
  author       = {Rogmark, Cecilia and Jobory, Ammar and Unger, Oscar and Nilsson, Inger and Dahlqvist, Louise},
  issn         = {1748-3107},
  keyword      = {Assistive device,hemiarthroplasty,hip fracture,occupational therapy,precautions,reacher,stocking aids},
  language     = {eng},
  month        = {10},
  publisher    = {Taylor & Francis},
  series       = {Disability and Rehabilitation: Assistive Technology},
  title        = {Post-discharge use of assistive devices following hemiarthroplasty : comparison of fracture patients with or without hip precautions},
  url          = {http://dx.doi.org/10.1080/17483107.2018.1499141},
  year         = {2018},
}