AUTHORS ' CONCLUSIONS Very low quality evidence is available from single trials , thus we are uncertain if hip pre caution s with or without the addition of equipment and functional restrictions are effective in preventing dislocation and improving outcomes after THA .
BACKGROUND Total hip arthroplasty ( THA ) is one of the most common orthopaedic operations performed worldwide .
Painful osteoarthritis of the hip is the primary indication for THA .
Following THA , people have conventionally been provided with equipment , such as raised toilet seats and chairs , and educated to avoid activities that could cause the hip joint to be in a position of flexion over 90 degrees , or adduction or rotation past the midline .
These aspects of occupational therapy have been advocated to reduce the risks of prosthesis dislocation .
However , the appropriateness of these recommendations has been question ed .
OBJECTIVES To assess the effects of provision of assistive devices , education on hip pre caution s , environmental modifications and training in activities of daily living ( ADL ) and extended ADL ( EADL ) for people undergoing THA .
Environmental assessment and modification to prevent falls in older people.
UNLABELLED To assess the effectiveness of an environmental falls prevention intervention delivered by qualified occupational therapists or unqualified trained assessors . DESIGN A pilot three-armed r and omized controlled trial . SETTING Airedale National Health Service Trust catchment , North and West Yorkshire , Engl and . PARTICIPANTS Two hundred thirty-eight community-dwelling adults aged 70 and older with a history of falls in the previous year . INTERVENTION Assessment and modification of the home environment of people at greater risk of falls .  MEASUREMENTS Fear of falling was the primary outcome measure , and an analysis of covariance was conducted on the area under the curve at 12 months . As a secondary outcome , falls were analysed using negative binomial regression . Quality of life and independence in activities of daily living ( ADLs ) were also measured . RESULTS The intervention had no effect on fear of falling ( P=.63 ) . The occupational therapy group had significantly fewer falls than controls 12 months after the assessment ( incidence rate ratio (IRR)=0.54 , 95 % confidence interval (CI)=0.36 - 0.83 , P=.005 ) . There was no significant effect on falls in the trained assessor group ( IRR=0.78 , 95 % CI=0.51 - 1.21 , P=.34 ) . CONCLUSION Environmental assessment had no effect on fear of falling . Environmental assessment prescribed by an occupational therapist significantly reduced the number of falls in high-risk individuals whereas that prescribed by a trained assessor did not . Further research in other setting s is needed to confirm this , to explore the mechanisms , and to estimate cost-effectiveness
AUTHORS ' CONCLUSIONS Very low quality evidence is available from single trials , thus we are uncertain if hip pre caution s with or without the addition of equipment and functional restrictions are effective in preventing dislocation and improving outcomes after THA .
BACKGROUND Total hip arthroplasty ( THA ) is one of the most common orthopaedic operations performed worldwide .
Painful osteoarthritis of the hip is the primary indication for THA .
Following THA , people have conventionally been provided with equipment , such as raised toilet seats and chairs , and educated to avoid activities that could cause the hip joint to be in a position of flexion over 90 degrees , or adduction or rotation past the midline .
These aspects of occupational therapy have been advocated to reduce the risks of prosthesis dislocation .
However , the appropriateness of these recommendations has been question ed .
OBJECTIVES To assess the effects of provision of assistive devices , education on hip pre caution s , environmental modifications and training in activities of daily living ( ADL ) and extended ADL ( EADL ) for people undergoing THA .