Abstract: We included three trials with a total of 492 participants who had received 530 THA. The evidence presented with a high risk of performance, detection and reporting bias. One study (81 participants) compared outcomes for participants randomised to the provision of hip precautions, equipment and functional restrictions versus no provision of hip precautions, equipment or functional restrictions. Due to the quality of evidence being very low, we are uncertain if the provision of hip precautions, equipment and functional restrictions improved function measured using the Harris Hip Score at 12 month follow-up, or health-related quality of life (HRQOL) measured by the Short Form-12 at four week follow-up, compared to not providing this. There were no incidences of hip dislocation or adverse events in either group during the initial 12 postoperative months. The study did not measure pain score, global assessment of treatment success or total adverse events. One study (265 participants; 303 THAs) evaluated the provision of hip precautions with versus without the prescription of postoperative equipment and restrictions to functional activities. Due to the quality of evidence being very low, we are uncertain if perceived satisfaction in the rate of recovery differed in people who were not prescribed postoperative equipment and restrictions (135/151 satisfied) compared to those prescribed equipment and restrictions (113/152) (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.75 to 0.93; 265 participants, one trial; number needed to treat for an additional beneficial outcome (NNTB) = 7). Due to the low quality evidence, we are uncertain if the incidence of hip dislocation differed between participants provided with hip precautions with (1/152) compared to without providing equipment or restrictions post-THA (0/151) (RR 2.98, 95% CI 0.12 to 72.59). The study did not measure pain, function, HRQOL, re-operation rates or total adverse events. One study (146 participants) investigated the provision of an enhanced postoperative education and rehabilitation service on hospital discharge to promote functional ADL versus a conventional rehabilitation intervention in the community. This study was of very low quality evidence. We were uncertain if the provision of enhanced postoperative education and rehabilitation improved function at six months follow-up, when assessed using the Objective and Subjective Functional Capability Index (146 participants, one trial; P > 0.05; no numerical results provided) compared to conventional rehabilitation. The study did not measure pain score, HRQOL, global assessment of treatment success, hip dislocation, re-operation rate or total adverse events. Very low quality evidence is available from single trials, thus we are uncertain if hip precautions with or without the addition of equipment and functional restrictions are effective in preventing dislocation and improving outcomes after THA. There is also insufficient evidence to support or refute the adoption of a postoperative community rehabilitation programme consisting of functional reintegration and education compared to conventional rehabilitation strategies based on functional outcomes. Further high-quality trials are warranted to assess the outcomes of different occupational therapy interventions both in the short and longer-term for those who undergo THA. An assessment of the impact of such interventions on pain and restriction on personal ADL, EADL and instrumental ADL is needed, and also of functional integration-type interventions rather than just hip precautions, equipment and restrictions.

Plain-language summary: This Cochrane review is current to 29 April 2016. We searched the available evidence and included three studies, which had 492 people who had received a THA. Two of these studies investigated providing people with equipment, such as raised toilet seats and rails, and restricting their body movements (one of these studies also provided people with physiotherapy). One study investigated teaching participants about doing certain activities of daily living in a safe way to promote self-care without the risk of dislocating the new hip. The interventions were different and thus we did not combine the results. One study compared outcomes for participants randomised to the provision of hip precautions, equipment and functional restrictions versus no provision of hip precautions or equipment or functional restrictions. This is the main comparator in the review. Health-related quality of life (lower scores mean better quality of life) We cannot tell from our results whether the intervention has an important effect on health-related quality of life (no numerical results provided) because the sample size was small and the study design flawed. Function We cannot tell from our results whether the intervention has an important effect on functional outcomes (no numerical results provided) because the sample size was small and the study design flawed. Complications and adverse events There were no dislocations or adverse events. Outcomes of interest not measured Pain, treatment success and re-operation rate were not measured. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of the evidence. Due to issues relating to the small number of participants, size of studies and study conduct, including poorly blinding assessors to group allocation, we rated the quality of the evidence as 'very low'. Further research is highly likely to change the conclusions drawn from these results. We are uncertain whether the interventions improved outcomes.