OPAL

Full title

Occupational support for Patients undergoing Arthroplasty of the Lower limb trial (OPAL)

Background

Hip and knee arthritis causes pain which limits physical function and can affect ability to work. Hip and knee replacements relieve pain and improve function, and help many patients of working age to continue working or get back to work.

There is variation in the advice and support given about recovery to usual activities and return to work after surgery. Earlier return to work improves the health of patients, benefiting their employers and society.

It is important to better understand what is currently being done and how current care can be improved.

What we did

The aim of this study was to investigate the feasibility of conducting a full scale trial, evaluating whether an ‘occupational advice programme’ delivered to working adults, starting before hip or knee joint replacement surgery, improves speed of recovery to usual activities including work.

This study has two separate parts, lasting for a total of 27 months.

1. Information about work roles and return to work collected from a variety of individuals including surgeons, allied health professionals (AHPs), general practitioners (GPs), employers and patients using questionnaires and interviews.

Patients in this part of the study were asked to complete a questionnaire while in hospital, then follow up questionnaires at 8, 16 and 24 weeks after their operation. Patients taking part in an interview would discuss in detail about their work, and what advice and support they received to help them return to work and their usual activities following their surgery.

2. Information from the first part was used to develop the ‘occupational advice programme’. The aim was to test the acceptability, practicality and feasibility of this programme.

What we found

A cohort study of 154 patients, 110 stakeholder interviews, 152 survey respondents of practice and evidence synthesis provided the necessary information to develop the intervention.

The programme included information resources, a personalised return-to-work plan and co-ordination from the healthcare team to support the delivery of 13 patient and 20 staff performance objectives.

To support delivery, a range of tools (e.g. occupational checklists, patient workbooks and employer information), roles (e.g. return-to-work co-ordinator) and training resources were created.

Feasibility was assessed for 21 of the 26 patients recruited from three NHS trusts. Adherence to the performance objectives was 75% for patient performance objectives and 74% for staff performance objectives.

The intervention was generally well receive, supports best practice and demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues required further attention.