Accessibility statement

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


Hip and knee arthritis causes pain which limits physical function and can affect ability to work. Hip and knee replacements are proven to relieve pain and improve function, and help many patients of working age to continue working or get back to work. Currently there is variation in the advice and support given about sickness absence, recovery to usual activities and return to work after these procedures. Earlier, sustainable, return to work improves the health of patients and benefits their employers and society. It is therefore important to better understand what is currently being done and how current care can be improved.

In this study, information will be collected about the issues patients face when returning to work after hip and knee replacement in order to develop an ‘occupational advice intervention' which is tailored to their requirements, and that will provide support and advice to enhance their early recovery to usual activities, including work. The aim of this study is 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.


To develop an occupational advice manual 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.


Two phase research programme delivered over 27 months using a six-stage intervention mapping approach:

Phase 1 (Months 1-13): Intervention mapping stages 1-3:

  • Needs assessment (including rapid evidence synthesis, prospective cohort analysis and structured stakeholder interviews)
  • Identification of intended outcomes and performance objectives
  • Selection of theory-based methods and practical strategies

Phase 2: (Months 10-27): Intervention mapping stages 4-6:

  • Development of components and materials for the manualised occupational advice intervention using a modified Delphi process
  • Adoption and implementation of the intervention
  • Evaluation and feasibility testing

Setting: A minimum of three NHS hospitals in the UK and two Higher Education Institutions.

Participants and exposures

Patients will be involved as research participants in Phases 1 and 2.

Phase 1 will commence with an assessment of current practice and an individual needs assessment related to occupational advice and return to work after hip and knee replacement surgery. This will involve a rapid review of existing evidence evaluating outcome tools measuring activity, participation, workplace disability, return to work and occupational advice interventions across surgical conditions. We will also conduct a prospective cohort study of patients on the waiting list for hip or knee replacement who are currently working. Patients that intend to return to work and patients that do not intend to return to work will be recruited to the cohort study. A minimum of 150 patients will be recruited from the participating centres. Information about pre-surgical activity, work roles, absenteeism and work place disability will be collected pre-operatively and at 8, 16 and 24 weeks post operatively using questionnaires. This data will enable recovery and return to usual activities to be mapped and provide information about current support and advice delivered at each of the recruiting centres. At each centre individual qualitative interviews will be undertaken in 10-15 patients in the ‘return to work’ group and three patients in the ‘do not intend to return to work group’. Additionally, interviews with surgeons, allied health professionals (AHPs) and nurses, general practitioners (GPs) and employers will be undertaken. These interviews will provide detailed information about the shortcomings and difficulties in current care and support available and identify possible solutions and improvements to overcome them.

The information collected in Phase 1 will identify who and what needs to change in order for workers to make a successful return to work following surgery. We will then be able to generate a list of potential intervention components matched to each individual performance objective.

In Phase 2 the potential intervention components identified during Phase 1 will be reviewed by stakeholder groups using a modified 3-round Delphi consensus process to agree the content of the final intervention. The intervention will then be manualised and an implementation and evaluation plan will be designed. Following implementation at each centre, the intervention will then be evaluated using further stakeholder interviews. This will assess the acceptability, practicality and feasibility of the intervention as an intervention for clinical practice and also a potential trial intervention for any subsequent clinical trial. The final intervention will be revised and refined based on feedback from this process.

The project is summarised in OPAL Flow chart (PDF , 122kb)

Who can participate?

In the first part of the study, patients undergoing a hip or knee replacement who are aged 16 and over can take part. In the second part of the study, patients undergoing a hip or knee replacement who are aged 16 and over and are intending to return to work following surgery can take part.

What are the possible benefits and risks of participating?
There may be no direct benefit to participants. However, the information we collect from the study will help us understand patients’ experiences of the support and advice they receive and will identify improvements that might be made in the future. Participants will be helping to shape and improve advice for those patients hoping to return to work after hip or knee replacement in the future. There are no notable risks involved with participating.

Where is the study run from?

  1. South Tees NHS Trust(UK)
  2. Nottingham University and Nottingham City Hospital (UK)
  3. Norfolk and Norwich University Hospital (UK)
  4. Northumbria NHS Trust (UK)

Project Funder

This project is funded by the NIHR Health Technology Assessment Programme (Project No HTA 15/28/02). Further details are available at

Privacy Notice: How we use your research data


Funder (s): NIHR Health Technology Assessment Programme
Start Date:  July 2016
Expiry Date: September 2018


Internal Staff

External Collaborators

  • Paul Baker, South Tees NHS Trust
  • Amar Rangan, South Tees NHS Trust
  • Lucksy Kottam, South Tees NHS Trust
  • Amanda Goodman, South Tees NHS Trust
  • Avril Drummond, Nottingham University/Nottingham Hospitals NHS Trust
  • Carol Coole, Nottingham University/Nottingham Hospitals NHS Trust
  • Sayeed Khan, Nottingham University/Nottingham Hospitals NHS Trust
  • Louise Thomson, Nottingham University/Nottingham Hospitals NHS Trust
  • Khosrow Sehat, Nottingham University/Nottingham Hospitals NHS Trust
  • Iain McNamara: Orthopaedic Surgeon (PI Norfolk and Norwich hospital site)
  • David McDonald: Physiotherapist – Golden Jubilee Hospital Glasgow
  • Judith Fitch: Patient – BOA Patient liaison group

Main contacts