Running head: OCCUPATIONAL PROFILE & INTERVENTION PLAN

Occupational Profile and Intervention Plan

Jenna Babcock
Touro University

Occupational Profile

OCCUPATIONAL PROFILE & INTERVENTION PLAN

Ms. L is an 81 year old female seeking occupational therapy services due to a fall she
sustained while at her home which resulted in a hip fracture to her right hip. She was admitted to
HealthSouth, an inpatient rehabilitation facility on August 20, 2014, after she underwent an
anterolateral open reduction internal fixation (ORIF) hip arthroplasty. Her current concerns are
the care of her home and animals which are about a two hour drive from the facility. Ms. L has
dedicated her life to saving animals that have been strays around the Las Vegas area and beyond.
The animals she shelters include cats, dogs, and any other animal that is need of a home; she has
a total of 24 cats and 10 dogs. She has a niece in the Las Vegas area but does not see her often.
Therefore, she has relied on a friend who picks up needed clothes and supplies from her home.
Ms. L also has a significant fear of falling and will not stand up without some assistance
in order to perform bladder and bowel management and showering. She is weight bearing as
tolerated (WBAT) but she is very afraid of falling so she uses a wheelchair in order to transfer
from the bed to the bathroom and therapy. Also, due to her fear of falling, she will not weight
bear unless she is wearing stable footwear because when barefoot she falls backwards due to her
poor back posture. She currently performs her Activities of Daily Living (ADLs) such as
grooming in her bed or in a wheelchair near the sink. Before her injury, Ms. L required modified
independence (Mod I) and only used a walker for transport in her home and community. Due to
her use of the walker and tending to her animals, she has excellent weight bearing tolerance in
her arms.
Ms. L feels successful when she can bathe with minimal assistance and perform
grooming at the sink with setup. A barrier affecting her success with these daily occupations is
her fear of falling when standing. Even with the use of a walker, Ms. L is very concerned with
falling backwards due to her affected hip and back. She only has one set of clothes from home

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that a friend had brought her so she primarily dresses in the facilitys gown that is provided. She
would have liked to gather clothes and items from her home but did not have any time due to the
sudden injury and her arrival at the hospital for surgery and then to inpatient rehabilitation.
Ms. Ls current environment supports her desired occupations consisting of her ADLs
such as bathing and grooming. In the inpatient rehabilitation facility, she is able to bathe and
groom with some assistance and rehabilitation of her injured leg. However, her environment is
also inhibiting her desired occupations of dressing, eating, and taking care of her home and
animals. She is unable to pick out what clothing she would like to wear due to limited resources.
Her diet consists of strict vegetarian foods and she is unaware of what ingredients and cooking
methods are used in the facility. For example, she will only eat eggs that are from cage free
chickens because she believes animals should be treated humanely. Ms. L does not feel complete
unless she is caring for her animals which she has been doing for 35 years.
Ms. Ls history is very eventful and she shares her life experience with much enthusiasm.
She is originally from London and has been a dancer for the majority of her younger life. She
came to the United States of America (U.S.A.) in the 1950s to begin her dancing career in Las
Vegas when the Strip was first developing and becoming a hot spot for the entertainment
industry. She grew up in London during the end of World War II and spoke about the differences
between Europe and the U.S. For example, when Ms. L moved to the U.S.A. she found hot
water to be a treasure. In London, hot water was not available as it was being used by World
War II troops. In the U.S. her dancing career flourished and she remained in the Las Vegas area.
When she retired from dancing, she began her current occupation of rescuing animals in the Las
Vegas area, spaying and neutering them, and finding homes. When the ladies were back stage
preparing for a show, she said they would chat about kids, cooking, home making, and family.

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She did not find any of those things appealing and instead gravitated towards the arts such as
painting and theater. Ms. L never married or had any children; she spoke of this as being taboo
in her era and she is very proud of her independence.
Ms. L values her independence and her ability to care for animals and her home. She is
interested in helping others as much as she can and has dedicated her life for the past 30 years.
She is still active in painting and creating art within her home and community. Ms. L is able to
do this independently in a spare room that includes all of her art supplies. One of her many life
lessens she addressed was when getting older, all your friends slowly disappear and to be sure to
treasure them while they are still here. She is currently 81 years old and spoke about her only
having a few friends left that would be able to physically help her at home when she is
discharged.
Ms. Ls daily life roles consist of tending to her animals and operating her non-profit
business that supports her and her animals. Before she was injured, Ms. L was actively looking
for property in the Las Vegas area near amenities that are needed for her but are not currently
provided in her remote area. She has trouble with accessing health care and access to
transportation in her town. Another one of her daily life roles is attending social engagements
with friends in the Las Vegas area; however, due to her living in a remote area, it is difficult for
her to meet them on a regular basis. Now it is even more difficult due to her injury; she relies on
friends to come visit her at the inpatient rehabilitation facility.
Ms. Ls patterns of engagement in maintaining her role in the non-profit animal shelter
has changed over time. As she has gotten older, she is unable to tend to the animals on her own
and must rely on volunteers to pick up necessary items such as food and supplies for her various
animals. Due to her not having many friends or family in the current area, the chances of

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traveling outside of her home are slim. She has expressed her frustration with growing old and
her body not moving the way it once did for her.
Ms. Ls priorities for her occupational performance is to be able to maintain and keep her
animal shelter running and providing awareness to her local community on the importance of
spaying and neutering animals in order to decrease the number of strays in the area. A desired
outcome of hers is to be as independent as possible while performing her activities of daily living
(ADLs) as she once did before her injury. While in therapy, Ms. L has learned the importance of
prevention and health and wellness in relation to her body. Before her injury, she was not aware
of her posture while performing ADLs and her current compensatory strategies she used when
ambulating in her environment. She hopes to return to her previous level of functioning after
rehabilitation so she can continue her roles and quality of life.
Occupational Analysis
Ms. L is currently in an inpatient rehabilitation facility for medically stable patients that
can participate in three hours of intervention a day, five to six days per week. Occupational
therapists in this setting often treat patients utilizing a biomechanical frame of reference;
however other occupation based interventions may be implemented based on her occupational
profile. This setting contains an interdisciplinary based team approach when treating patients.
Physical therapists, occupational therapists, speech therapists, nurses, physicians, and caregivers
are all part of the integral team to provide care for the patients.
When Ms. L was first admitted to the inpatient rehab facility, she stated she would like to
shower. She was not able to bathe herself for several days due to her injury and transfer to the
rehabilitation facility. Ms. L required minimal assistance (Min A) when bathing herself in the
shower. She was unable to wash, rinse, and dry her right lower leg and buttocks while showering

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on a shower chair (SC). The right lower leg was difficult to reach due to her hip precautions, and
the buttock was difficult due to the reaching that is required. The OT addressed these concerns
with Ms. L and assisted her with the rest of the showering activity. In order to transfer from the
bed to the wheelchair, Ms. L required her footwear that she was wearing when the injury
occurred. She has a significant fear of falling and her sandals help prevent her from falling
backwards if she was barefoot. The physicians order states she is weight bearing as tolerated
(WBAT) on her right leg so the OT assisted her in the transfer from bed to wheelchair. These
sandals are not very stable; however, they are the only footwear Ms. L had with her when she
was rushed off to the hospital after sustaining her fall. The OT suggested more stable footwear
in the form of walking shoes that provide more balance support. Ms. L does not like to give up
her fashion footwear for comfort.
Her thoracic region of her back is slightly rounded and she has had this all her life; it
affects her posture when standing upright, therefore she requires a walker to ambulate while at
home. After her shower, Ms. L was able to perform grooming activities such as, washing her
face, combing her hair, and brushing her teeth at the sink in her wheelchair.
Ms. L is seeking occupational therapy for her right hip in which she received an ORIF
surgery due to a fall. Areas of the American Occupational Therapy Associations (AOTA) 2014
Occupational Therapy Practice Framework (OTPF) that Ms. L struggles with the most are
ADLs which include bathing, toileting, and dressing. Instrumental activities of daily living
(IADLs) that have been impacted include her ability to care for pets, driving and community
mobility, and home management (AOTA, 2014). When arriving to the inpatient facility, she did
not sleep well due to the pain in her leg and the required immobilizer she was required to wear.
Once the physician permitted her to doff the immobilizer at night, she began to sleep with more

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comfort. Ms. L is also experiencing lack of a social network while she is at the inpatient facility.
Her volunteers for the pet shelter and friends live in a remote area which hinders Ms. Ls ability
to keep connected with them.
Finally, Ms. Ls performance patterns which include routines, roles, and habits have been
significantly impacted due to her injury. She is unable to resume her current role of managing
the pet shelter and all the volunteers. Furthermore, her routines and habits surrounding ADLs
have been impacted. She can no longer function in her home safely and independently. With no
caregivers, Ms. L will be forced to seek temporary residence at the time of her discharge.
Problem List
1. Client requires Min A for bathing due to R THA.
2. Client requires Mod A when transferring bed wheelchair due to fear of falling.
3. Client requires Mod A when performing toilet transfer due to R THA.
4. Client requires Mod A when dressing LE due to R THA & hip precautions.
5. Client is unable to sleep due to physical context restraints.
Ms. Ls priorities with regard to ADLs are ranked from most important to least. Bathing
as independently as possible is a top priority for Ms. L. Upon her arrival to the inpatient facility,
she stated she would like to be able to bathe. She values her independence and the ability to care
for herself at her young age of 81 years old. Upon initial evaluation, Ms. L required minimal
assistance (Min A) when using a shower commode. She was able to wash, rinse, and dry eight
body parts. A second priority for Ms. L is to be functional in transferring from bed to wheelchair
with modified independence (Mod I). She currently requires moderate assistance (Mod A) which
includes lifting assistance from therapists. Ms. L is only able to perform 50 to 74 percent of the

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effort required due to her significant fear of falling. Ms. Ls third priority is to become Mod I
when transferring to the toilet. She currently requires Mod A which includes lifting assistance
from the therapist while she performs 50-74 percent of the effort. Ms. Ls fourth priority
includes her ability to dress her lower body with moderate independence (Mod I). Due to her hip
precautions, Ms. L should not extend her leg, cross her legs, and externally rotate her affected
hip. She is currently Mod A for dressing her lower body because she requires the assistance of
therapists to don and doff shoes and socks. The final priority for Ms. L is to obtain adequate and
quality sleep while staying at the inpatient facility. Due to her not being in her home setting and
her injury, Ms. L has difficulty sleeping which leads to poor performance for therapy sessions.
Intervention Plan & Outcomes
Long Term Goals
1. Client will complete bathing Mod I using hip kit, SC, long handled sponge by 9/6/14.
2. Client will complete functional mobility Mod I using FWW by 9/10/14.
Short Term Goals
1. Client will bathe SPV using SC, grab bars, nonskid bath mats, long handled sponge,
hip kit by 8/27/14.
2. Client will bathe SU using hip precautions by 8/27/14.
3. Client will transfer bed w/c Min A using FWW by 8/30/14.
4. Client will transfer w/c toilet Min A using FWW by 8/30/14.
Interventions
1. Ms. L will receive education on the proper use of the hip kit and other assistive
devices for bathing activities. The hip kit includes devices such as a reacher, sock aide, dressing
stick, and a long handled sponge. Other devices that would benefit Ms. L are grab bars, nonskid
mat on the tub floor, and a shower chair. The most appropriate intervention approach is
adaptation. Ms. L requires assistance from devices that will enable her to perform ADLs such as

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bathing, toileting, and dressing. Utilizing these devices will revise the current activity demands
to support her performance in the natural setting.
Instruction during therapy sessions will provide the opportunity for Ms. L to practice
using the equipment in the actual environment in which it is intended to be used. According to
Van Oss, Rivers, Macri, Heighton, and Reid (2012), equipment such as nonslip bath strips,
padded bath mats, foot scrubber, raised shower chair were useful, frequently used, and visually
satisfactory. Bathroom modifications should be client centered and properly instructed in safe
use by occupational therapists. According to Wielandt, McKenna, Tooth, and Strong (2001),
many clients do not use their assistive devices because they do not know how to use the
equipment correctly or are only needed on a short term basis. The devices that are commonly
used short term include long handled brushes and toe wipers. Whereas, shower chairs are more
frequently used due to the safety concerns amongst clients. Ms. L will be instructed on the
proper use and application of each device and a home evaluation will be conducted upon
discharge (Van Oss, Rivers, Macri, Heighton, & Reid 2012; Wielandt, McKenna, Tooth, &
Strong, 2001).
According to Hasten, Svensson, and Gardulf (2004), patients who received 45 to 60
minutes of skilled occupational therapy each weekday morning improved functionally with their
ADLs such as bathing, dressing, toileting and grooming. Patients received training on how to
use technical aids in the early phases of rehabilitation. This skilled occupational therapy
increased the patients abilities to perform ADLs and discharged earlier than other patients
(Hagsten, Svensson, & Gardulf, 2004).
This intervention plan will help improve Ms. Ls occupational performance in bathing
and dressing activities with the assistance of devices and compensatory techniques. Goals upon
discharge include her to become modified independent and functionally capable of performing
her occupations in her home and community settings (AOTA, 2014).

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Precautions for Ms. L regarding this intervention plan include safety awareness when
bathing. It is important that Ms. L is cognizant of her bathroom environment and utilizes her
assistive devices properly when bathing as independently as possible. She should be aware of
the proper positioning of her shower chair and devices she will need when performing bathing
tasks. According to this intervention plan, Ms. L will perform bathing once a day for five days
while performing therapy at the inpatient facility. Early treatment after surgery has been
effective for patients with their recovery and returning home more quickly.
The Person-Environment-Occupation Model (PEO) was utilized to guide intervention
planning and goal setting. Since Ms. L is struggling with the task of bathing and her
environment, it is important to establish goals on how to achieve independence regarding her
current limitations due to her THA. Goal setting was established by identifying external and
internal changes that required Ms. L to adapt to her environment and facilitate these adjustments
towards optimal occupational performance.
Ms. L will receive training regarding the proper handling of assistive devices when
bathing. Throughout the intervention plan, Ms. L will perform real task activities which include
proper use of devices in shower, such as shower chair height and how to access tools when in the
shower while following hip precautions.
Ms. Ls response to the intervention will be monitored and assessed by observation and
the utilization of the Functional Independent Measure (FIM) assessment tool. Ms. L will be
asked to repeat tasks learned verbally and physically in order to ensure cognitive recall of
learned information.
2. Ms. L will receive education regarding hip precautions when conducting bathing and
other functional occupations. Hip precautions focus on advising patients to avoid certain
movements and the provision of aids to independence, for up to 6 to 12 weeks post-surgery. Ms.
Ls hip surgery was conducted utilizing an anterolateral approach. This type of surgery requires

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restrictions of the following movements; avoid crossing the legs, avoid external rotation of the
hip, and no extension of the leg. These restrictions allow the joint to develop soft tissue repair.
The most appropriate intervention approach for Ms. L regarding hip precautions while
performing functional activities is to prevent further disability. In order to prevent hip
dislocation of Ms. Ls THA, it is important she receive the necessary education and training
regarding hip precautions and use of devices to allow her to perform ADLs and IADLs (AOTA,
2014).
According to Lubbeke, Stern, Garavaglia, Zurcher, and Hoffmeyer (2007), when patients
received education involving hip precautions and instructions on how to adapt ADLs with these
restrictions, a reduction in the risk of dislocation within six months after THA occurred. Patients
were educated on the restrictions and performing ADLs such as putting on shoes, getting in and
out of chairs and the car. Also, according to Ritter, Harty, Keating, Faris, and Meding (2001), the
anterolateral approach has a lower rate of dislocation than a posterior approach due to its ease of
access and predictive healing pattern (Lubbeke, Stern, Garavaglia, Zurcher, & Hoffmeyer, 2007;
Ritter, Harty, Keating, Faris, & Meding, 2001).
An outcome for this intervention plan will be achieved by prevention. Ms. L will receive
education regarding hip precautions when conducting functional activities which will prevent
further injuries such as a dislocation to her hip. Further education regarding risk of falling and
adapting her environment will allow Ms. L to reduce risk factors when performing ADLs in her
home.
Contraindications for this intervention plan include the hip movements and using
compensatory hip movements such as internal rotation, which can produce a dislocation of the
joint. It is important that Ms. L implements the education she received when utilizing hip
abductor pillows and hip kit when performing ADLs. Precautions will be addressed with Ms. L
regarding her fear of falling and approaches to enhance her self-efficacy when living alone.

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According to this intervention plan, Ms. L will receive hip precaution education within two to
three days after surgery if not before. Also, when performing her ADLs during therapy, Ms. L
will implement hip precautions throughout her entire rehabilitation at the facility.
The Occupational Adaptation model (AOTA) was utilized to guide intervention planning and
goal setting. In order for Ms. L to perform her ADLs with hip precautions, tasks must be
performed in a modified way. The environment, as well as how Ms. L conducts occupations will
need to be adapted. One of Ms. Ls goals is to be able to dress independently; by implementing
hip precautions with the use of assistive devices, will allow Ms. L to become modified
independent.
Ms. L will receive training regarding hip precautions while using assistive devices when
performing her daily occupations. An effective way to educate patients on the use of hip
precautions is the use of pamphlets with pictures demonstrating proper techniques. Also, by
utilizing the education received daily will help Ms. L remember the necessary precautions.
Ms. Ls response to the intervention will be monitored and assessed by observation and the
utilization of the Functional Independent Measure (FIM) assessment tool. Within the FIM, her
cognitive ability will be assessed regarding her ability to recall necessary hip precautions. Ms. L
will be asked to repeat tasks learned verbally and physically in order to ensure cognitive recall of
learned information.
3. Ms. L will receive task-oriented therapy (learning an activity through practice) in
order to improve her functional mobility when transferring from bed to wheelchair with minimal
assistance utilizing her front wheel walker (FWW). It is important that Ms. L strengthens her
muscles surrounding her hip so she can perform her ADLs while in therapy and when she returns
home. Since she has experience utilizing a FWW at home before the fall, it is imperative she
regains that skill. She will perform sit to stand positions when performing ADLs and begin to
apply weight on her affected limb. The most appropriate intervention approach for Ms. L is

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restoring her ability that has been impaired. In order for Ms. L to become more independent in
her functional mobility, it is important she learns the necessary exercises to remediate the
muscles surrounding her hip joint so she can utilize the affected leg more often (AOTA, 2014).
Monticone et al., (2014) found that when implementing task-oriented exercises rather
than traditional strength training exercises alone improved reducing disability and pain,
improving ADLs, and the quality of life in patients who have undergone THA. Patients in the
experimental group received task oriented exercises such as moving from a sit to stand position,
climbing obstacles and stairs, and functional strategies for ADLs. Stationary cycling was added
to improve hip strength and mobility and all of the exercises were performed with increasing
loads on the operated limb. Patients in the control group only received open kinetic chain
exercises such as hip flexion and extension, hip abduction, hip external rotations, isotonic and
isometric quadriceps strengthening, and hamstring curls. Results indicated that the use of taskoriented exercises with full weight bearing rather than traditional interventions improved elderly
patients ADL performance, pain levels, and quality of life after THA (Monticone, Ambrosini,
Rocca, Lorenzon, Ferrante, & Zatti, 2014).
Ms. L will feel a sense of achievement in her goals; therefore her quality of life will
improve by the implementation of this intervention plan. Once her surrounding muscles of the
lower extremity have become strengthened by the use of task oriented therapy, Ms. L should
have a stronger sense of independence when transferring to and from her bed to the wheelchair
so she can perform her ADLs.
Precautions regarding this intervention for Ms. L include adherence to hip precautions
and monitoring when ambulating with an assistive device. It is important for Ms. L to feel safe
when transferring due to her fear of falling. She will receive task oriented therapy within a few
days post-operative and continue until she only needs supervision with transfers.

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In order to grade this intervention plan up and down for Ms. L, tasks will be modified.
For example, in order to grade this activity up, Ms. L will transfer from her bed to wheelchair
while the bed is at different levels of height. Ms. Ls bed at home will not be able to raise or
lower so it is important she develop the necessary muscles in order to transfer at different levels.
To grade this activity down, the bed will remain at a comfortable height for her in order to
transfer using the FWW.
The biomechanical frame of reference was utilized to guide intervention planning and
goal setting. Even though this intervention focuses on task oriented therapy, the use of
biomechanical frame of reference was utilized in order for Ms. L to regain muscle strength and
function, joint integrity and range, and physical endurance. Ms. Ls goals include independence
in functional mobility which will be achieved once her muscles are able to sustain her body when
transferring from bed to wheelchair.
Ms. L will receive education on proper body mechanics when transferring and the
placement of the FWW and wheelchair next to her bed. She will be trained on proper strength
training exercises for muscles surrounding her affected hip and hopefully decrease her fear of
falling once she can perform functional mobility.
Ms. Ls response to the intervention will be monitored and assessed by observation and
the utilization of the Functional Independent Measure (FIM) assessment tool. When she
performs task oriented therapy, it is expected her FIM levels will improve. It is Ms. Ls goal to
return home using only her FWW once again.
4. Ms. L will receive task-specific resistance training to improve her ability to transfer
from wheelchair to toilet so she can complete bowel and bladder management. Ms. L is fearful
of falling and reinjuring her hip. Therefore, her ability to transfer from wheelchair to toilet and
other surfaces has become difficult which is common for people over 65 years of age.
According to Alexander et al., (2001), participants who had THA and underwent 12
weeks of task-specific training increased the overall ability to perform bed and chair rise tasks.

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The task-specific training program was presented to participants with a series of tasks directly
relevant to rising from a bed or chair. The focus was on trunk function, range of motion (ROM),
strength, and balance. Participants in the intervention group received tasks that ranged from easy
to difficult; these included activities such as raising the head of bed and seat height to facilitate
the rise to more difficult by adjusting the seat height lower and limit hand use. They also used
chairs that could recline or tilt. The intervention group improved overall strength and endurance
compared to the control group (Aleander, Galecki, Grenier, Nyquist, Hofmeyer, Grunawalt,
Medell, & Fry-Welch, 2001).
Ms. L values her independence at her age and after her fall; she has lost some of her
functional mobility. This intervention plan will restore her role competence so she can
effectively meet the activity demands in which she engages. By strengthening her upper body
and the surrounding muscles of her affected hip, she will be able to transfer to the toilet using her
FWW.
Precautions regarding this intervention for Ms. L should be focused on monitoring her
risk of falling. It is important that therapists supervise how much weight Ms. L can handle and
monitor endurance when standing and transferring to different surfaces. Ms. L will complete
task-specific training which includes rising from wheelchair to FWW and finally to toilet three
times a week for two weeks.
The Ecology of Human Performance (EHP) model is utilized to guide this intervention
plan for Ms. L. EHP model focuses on the person, context, task, and performance. These are all
interdependent and affect the relationship between the person and the environment and how it
impacts human performance. The EHP model will help identify Ms. Ls goal to restore her
ability to transfer from different modalities in order to perform ADLs.
Ms. L will receive education on proper postures when rising from wheelchair to FWW
and lowering to toilet. She will be taught the difference between anterior and posterior pelvic

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tilts when rising and lowering from different positions. M.s L will be taught the importance of
proper footwear when ambulating utilizing the FWW as well as how to prepare her environment
in order to prevent falls.
Ms. Ls response to the intervention will be monitored and assessed by observation and
the utilization of the Functional Independent Measure (FIM) assessment tool. When she
performs task-specific therapy, it is expected her strength and endurance will improve. It is Ms.
Ls goal to return home using only her FWW once again.

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References
Alexander, N. B., Galecki, A. T., Grenier, M. L., Nyquist, L. V., Hofmeyer, M. R., Grunawalt, J.
C., & FryWelch, D. (2001). TaskSpecific Resistance Training to Improve the Ability of
Activities of Daily LivingImpaired Older Adults to Rise from a Bed and from a
Chair. Journal of the American Geriatrics Society, 49(11), 1418-1427.
American Occupational Therapy Association. (2014). Occupational therapy practice framework:
Domain and process (3rd ed.). American Journal of Occupational Therapy, 68,(Suppl. 1),
S19-S35. http://dx.doi.org/10.5014/ajot.2014 .682006
Hagsten, B., Svensson, O., & Gardulf, A. (2004). Early individualized postoperative
occupational therapy training in 100 patients improves ADL after hip fracture A
randomized trial. Acta Orthopaedica, 75(2), 177-183.
Lbbeke, A., Stern, R., Garavaglia, G., Zurcher, L., & Hoffmeyer, P. (2007). Differences in
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Care & Research, 57(2), 327-334.
Monticone, M., Ambrosini, E., Rocca, B., Lorenzon, C., Ferrante, S., & Zatti, G. (2014). Task
oriented exercises and early full weight-bearing contribute to improving disability after
total hip replacement: a randomized controlled trial. Clinical rehabilitation, 28(7), 658668.
Ritter, M. A., Harty, L. D., Keating, M. E., Faris, P. M., & Meding, J. B. (2001). A clinical

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comparison of the anterolateral and posterolateral approaches to the hip. Clinical

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