PHYSICAL THERAPY TRANSFERS FOR TOTAL HIP REPLACEMENT PATIENT INFORMATION NAME OF PT.: DOB: AGE: WIEGHT: HEIGHT: SEX: PATIENT MEDICAL HISTORY • • Lives alone Has a pet cat • • • PATIENT EDUCATION FOR THR PRECAUTIONS (POSTERIOR LATERAL) • NO HIP FLEXION PASS 90 DEGREES o Do not bend down to pick up objects from floor o Do not sit on low surfaces o Use a raised toilet seat • NO HIP ADDUCTION ON THE AFFECTED SIDE o Do not cross legs • NO HIP INTERNAL ROTATION ON THE AFFECTED SIDE o Do not turn toes in o While standing always turn towards the affected side o Do not roll in bed THE ROLE OF PHYSICAL THERAPY • Bed mobility and transfers Gait training with assisted devices • Active range of motion (AROM) exercises • Balance exercises • Proprioceptive training • Lower extremity circulation • PHYSICAL THERAPY TRANSFERS FOR TOTAL HIP REPLACEMENT SUPINE TO BEDSIDE SITTING TRANSFER • When entering the patient's room, always remember to wash your hands! o Using proper hand washing techniques (perform proper aseptic techniques) • Evaluate the room’s surroundings o Check for clues on the patient's status. • Prior to starting the therapy session, introduce yourself • • • • • • • o Give your ▪ Name ▪ Job title ▪ Purpose for the visit Prior to touching the patient, get the patient's consent to therapy. Check the patient's pain status Asks when was the last time that they had their medication. o 45 minutes, prior to a visit allows time for the pain medication to kick in. o “Hi! I’m NAME . I will be you pt for this today / session. Reason for visit “ o “Today I will assist you in Getting you up out of bed. Is that okay with you?” o “How is your pain doing? Are you having any pain?“ Prior to getting the patient out of the bed, always check to make sure the bed wheels are in a lock position. Make sure that you ask the patient's permission to undrape. o If the patient gives you permission to undrape them, remove the drapes out of the way so that they do not get in the way of the transfer. Go over the hip precautions with your patient. o No hip flexion pass 90 degrees ▪ This can include them bending down to touch the floor or using the restroom without a raise toilet seat. o No hip adduction on the affected side ▪ No crossing of the legs. ▪ No adduction of the hip o No hip internal rotation on the affected side ▪ Make sure that there's no internal rotation going on. ▪ Rolling in bed is a contraindication for this. Once the patient understands their precautions, give clear and concise instructions on how to transfer will occur. o “Here we are going to do a POSITION to POSITION transfer” o Example; Here we are going to do a supine to bedside sitting transfer • First: ask the patient to push up with their arms into a long sitting position. • • • • o Explain to the patient that you will hold their effective leg and move with them as you have them rotate towards the side of the bed. o The patient is allowed to use their unaffected side to assist with the transfer. Have the patient move towards the edge of the bed by scooting forward, to prepare for the sit to stand portion of the transfer. Prior to getting the patient in the wheelchair, check to make sure that the brakes are locked. o Remove both leg rests. So that they do not get in the way of the transfer. o Check the height of the wheelchair to make sure that it does not break the hip precautions for the patient, adding a pillow will increase the height. Apply a gate belt to the patient o To ensure safety throughout the transfer. Ask the patient if there are any lines or tubing that may be occluded by the gait belt. o Prior to the transfer move, the Foley catheter from under the bed to the wheelchair. ▪ Ensure that the Foley catheter does not touch the ground ▪ Any lines or tubing do not get pulled during the transfer. pt. weight bearing is tolerated and weaker on the affected side. She has full strength on the unaffected side. • During the transfer, guard the affected side in case their knee buckles. • Prior to the transfer, explain to the patient that they can push up through their upper extremities and move into standing as the patient counts to three. • You will perform a pivot transfer continuously guarding the affected side, then explain to the patient to reach back on the armrest of the wheelchair, to assist in sitting. • Having the patient keep their affected leg Extended helps to prevent hip flexion during seating • Once seated, the leg rest can be placed back on the wheelchair. • Prior to transferring the patient back to the bed, • • • • o Make sure that the wheels are locked on the wheelchair and remove the leg rest. o transfer any lines or tubing back to the bed. Ask the patient to scoot forward towards the edge of the wheelchair, to prepare them for the wheelchair to bed transfer. Guard the patients affected side and asks the patient on their count of three to push into a standing position. Using a pivot transfer, rotate the patient towards the bed. Continuously guarding the effected side. Have the patient reach back and scoot their self onto the bed BEDSIDE SITTING TO SUPINE TRANSFER • Remove the gate belt and explain to the patient to use their arms to help push their self back into the bed. • Explain that you will be supporting and moving their affected leg through the transfer to prevent breaking hip precautions. • • • • • o Then have the patient rotate towards the head of the bed. Prior to leaving the patient, make sure the head in rails are up and the head of the bed is at 30 degrees or more. The patient seat should be lined up with the fold of the bed. Place a pillow or roll between the knees to prevent hip adduction. Leave the patient with a call button for their safety. Their tray and reach and ask the patient if there is anything you can do to make them comfortable.