Occupational advice for Patients undergoing Arthroplasty of the Lower limb: An intervention development and feasibility study (The OPAL Study)

Paul Baker, Carol Coole, Avril Drummond, Sayeed Khan, Catriona Maria McDaid, Catherine Elizabeth Hewitt, Lucksy Kottam, Sarah Jane Ronaldson, Coleman Elizabeth, David McDonald, Fiona Nouri, Melanie Narayanasamy, Iain McNamara, Judith Fitch, Louise Thomson, Gerry Richardson, Amar Rangan

Research output: Contribution to journalArticlepeer-review


Hip and knee replacements are regularly performed for patients who work. There is little evidence about these patients’ needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively.
To develop an occupational advice intervention to support early recovery to usual activities including work which is tailored to the requirements of patients undergoing hip and knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks
Design An intervention mapping (IM) approach was used to develop the intervention. The research methods employed were: rapid evidence synthesis; qualitative interviews with patients and stakeholders; prospective cohort study; survey of clinical practice; modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the IM process.
Orthopaedic departments within NHS secondary care.
Patients in work, and intending to return to work following primary elective hip and knee replacement surgery; healthcare professionals and employers.
Occupational advice intervention.
Main outcome measures
Development of an occupational advice intervention. Fidelity of the developed intervention when delivered in a clinical setting. Patient and clinician perspectives of the intervention. Preliminary assessments of intervention effectiveness and cost.
A cohort study (154 patients), 110 stakeholder interviews, survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, personalized return to work plan and co-ordination from the healthcare team to support the delivery of 13 patient and 20 staff performance objectives (POs). To support delivery, a range of tools (e.g. occupational checklists, patient workbooks, employer information), roles (e.g. return-to-work coordinator) and training resources were created. Feasibility was assessed in 21 of the 26 patients recruited from 3 NHS trusts. Adherence with the defined performance objectives was 75% for patient POs and 74% for staff POs. The intervention was generally well received although the short timeframe available for implementation and concurrent research evaluation led to some confusion amongst patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff.
Implementation and uptake of the intervention was not standardized and was limited by the study timeframe. Evaluation of the intervention involved a small number of patients which limited the ability to assess it.
The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention
Future work
The intervention warrants a randomised controlled trial to assess its clinical and cost effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure adoption is sustained.
This project was funded by the NIHR Health Technology Assessment programme (project number 15/28/02)
Trial Registrations
International Standard Randomised Controlled Trials Number Trial ID: ISRCTN27426982 International prospective register of systematic reviews (PROSPERO) Registration: CRD42016045235
Original languageEnglish
Pages (from-to)1-444
Number of pages444
JournalNIHR Journals Library
Issue number45
Early online date1 Sept 2020
Publication statusE-pub ahead of print - 1 Sept 2020

Bibliographical note

© Queen’s Printer and Controller of HMSO 2020. This work was produced by Baker et al. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.

Cite this