Berner Reha Zentrum, Rehabilitation and Sports Medicine, Insel Group, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute of Physiotherapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland.
Swiss Med Wkly. 2024 Jan 4;154:3536. doi: 10.57187/s.3536.
Growing evidence raises doubts about the need for routine hip precautions after primary total hip replacements to reduce the risk of postoperative dislocation. However, hip precautions are still routinely and widely prescribed in postoperative care in Switzerland. We aimed to investigate experts' clinical reasoning for hip precaution recommendations after total hip arthroplasty.
Using a convenience sampling strategy, 14 semi-structured expert interviews were conducted with surgeons, physiotherapists, and occupational therapists in the vicinity of an inpatient rehabilitation clinic in Switzerland. Data analysis followed Mayring's principle of inductive and deductive structuring content analysis.
Expert statements from the interviews were summarised into four main categories and 10 subcategories. Categories included statements on the incidences of dislocation and underlying risk factors; current preferences and use of hip precautions; their effect on physical function, anxiety, or costs; and patient's adherence to the movement restrictions. Hip surgeons routinely prescribed hip precautions, although in different variations. Fear of dislocation and caution are barriers to changing current practice. Some surgeons are considering individualised prescribing based on patients' risk of dislocation, which therapists would welcome.
A lack of clear instructions from the surgeon leads to ambiguity among therapists outside the acute hospital. A shared understanding of the need for and nature of hip precautions, guidelines from societies, or at least specific instructions from surgeons to therapists are warranted.
越来越多的证据对髋关节置换术后常规髋关节预防措施的必要性提出了质疑，以降低术后脱位的风险。然而，髋关节预防措施在瑞士的术后护理中仍然被常规广泛应用。我们旨在调查专家对全髋关节置换术后髋关节预防建议的临床推理。
使用便利抽样策略，在瑞士一家住院康复诊所附近对外科医生、物理治疗师和职业治疗师进行了 14 次半结构化专家访谈。数据分析遵循迈林的归纳和演绎结构内容分析原则。
访谈中的专家陈述总结为四个主要类别和十个子类别。类别包括脱位发生率和潜在风险因素的陈述；当前髋关节预防措施的偏好和使用；对身体功能、焦虑或成本的影响；以及患者对运动限制的遵守情况。髋关节外科医生常规开具髋关节预防措施的处方，尽管有不同的变化。对脱位的恐惧和谨慎是改变当前做法的障碍。一些外科医生正在考虑根据患者脱位的风险进行个体化处方，这将受到治疗师的欢迎。
外科医生缺乏明确的指示导致急性医院以外的治疗师感到困惑。需要有髋关节预防措施的必要性和性质的共识、来自学会的指南，或者至少是外科医生向治疗师提供的具体指示。
