title: What does standard rehabilitation practice after total hip replacement in the UK entail? Results of a mixed methods study.
abstract: BACKGROUND
  There is evidence of prolonged poor function in patients following total hip replacement (THR). Studies of progressive resistance training (PRT) interventions to improve function are often compared to 'standard' practice which is not well defined. This study aimed to investigate 'standard' rehabilitation care in the UK after total hip replacement (THR) as well as determine whether PRT was part of 'standard' care.
  
  
  METHODS
  After ethical approval, questionnaire item development about rehabilitation practice was guided by a focus group interview (after informed consent) with physiotherapists (n = 4; >5 years post-qualification) who regularly treated THR patients. An online questionnaire investigating the exercises prescribed and rehabilitation practice following THR was developed and sent to physiotherapists working in hospitals in the UK. The survey was performed from January to May 2011. The survey results were analysed (frequency (%) of responses) focusing on the exercises the physiotherapists considered important, as well as their use of PRT in prescribed regimes.
  
  
  RESULTS
  106 responses were obtained from physiotherapists in the UK. The survey respondents considered that the most important muscles to target in all phases of rehabilitation were the hip abductors (62.2%), followed by the quadriceps (16.9%), and other muscles (21%). Exercise type prescribed revealed no consensus, with weight bearing (42%), functional (45%) and Bed-based/Bridging/Postural exercises (13%) favoured. 83.7% were able to define the basis of progressive resistance training (PRT), but only 33% prescribed it.
  
  
  CONCLUSIONS
  Standard physiotherapy rehabilitation in the UK after THR is variable, and appears to rarely include PRT. This may be a factor in prolonged poor function in some patients after this common operation.
authors.affiliation: School of Medical Sciences, Bangor University, Bangor, UK. tosanwumi@hotmail.com
authors.forename: Tosan
authors.initials: T
authors.lastname: Okoro
authors.forename: Ashok
authors.initials: A
authors.lastname: Ramavath
authors.forename: Jan
authors.initials: J
authors.lastname: Howarth
authors.forename: Jane
authors.initials: J
authors.lastname: Jenkinson
authors.forename: Peter
authors.initials: P
authors.lastname: Maddison
authors.forename: John G
authors.initials: JG
authors.lastname: Andrew
authors.forename: Andrew
authors.initials: A
authors.lastname: Lemmey
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D001291:Attitude of Health Personnel; D001696:Biomechanical Phenomena; D003266:Continuity of Patient Care / Q000592:standards; D017144:Focus Groups; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D020407:Internet; D059825:Physical Therapists / Q000523:psychology / Q000592:standards*; D011182:Postoperative Care / Q000592:standards; D020127:Recovery of Function; D055070:Resistance Training / Q000592:standards*; D059039:Standard of Care; D013222:State Medicine / Q000592:standards; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom