瑞士全髋关节置换术后继续或停止髋关节预防措施的临床理由:一项定性研究

Jaroslaw Krygowski, Leah Reicherzer, Thimo Marcin
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引用次数: 0

摘要

背景:越来越多的证据表明,人们对初级全髋关节置换术后为降低术后脱位风险而采取常规髋关节预防措施的必要性产生了怀疑。然而,在瑞士,髋关节预防措施仍是术后护理中的常规且广泛使用的处方。我们的目的是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。方法:采用方便抽样策略,对瑞士一家住院康复诊所附近的外科医生、物理治疗师和职业治疗师进行了 14 次半结构式专家访谈。数据分析遵循 Mayring 的归纳和演绎结构内容分析原则。这些类别包括脱位发生率和潜在风险因素;目前对髋关节预防措施的偏好和使用情况;这些措施对身体功能、焦虑或费用的影响;以及患者对运动限制的遵守情况。髋关节外科医生通常会开具髋关节预防措施处方,但各不相同。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臼的风险开具个性化处方,治疗师对此表示欢迎。结论:外科医生缺乏明确的指示会导致急症医院以外的治疗师产生歧义。需要对髋关节预防措施的必要性和性质有一个共同的认识,需要协会提供指导,或者至少需要外科医生向治疗师提供具体的指导。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical reasoning for the continuation or discontinuation of hip precautions after total hip arthroplasty in Switzerland: a qualitative study
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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