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

This study aimed to develop an occupational advice intervention to support the return to work of patients post hip and knee replacements. Using quantitative, qualitative and rapid review methods, the intervention was developed and shown to be deliverable. The clinical and cost effectiveness of the intervention is now being evaluated. 

Why did we do this research?

Hip and knee replacements are regularly carried out on patients who are working. However, there is little evidence about the needs of these patients and a lack of guidance to support their return to work. The aim of the study was to develop a multidisciplinary occupational advice intervention to support the return to work of patients post-surgery. 

What did we do?

The study used different methods of research (qualitative and quantitative) to identify; the population likely to benefit from the intervention, current care, and outcomes important to patients. All the information gathered was mapped through a framework (intervention mapping) to develop the intervention.  The intervention developed included; information resources for patients and employers, a personalised return to work plan, a return-to-work coordinator and co-ordination from the healthcare team to support patient and staff performance objectives. The intervention was then assessed on 26 patients across three NHS trusts. 

Who was involved?

Overall the study involved 154 patients, 110 stakeholders including general practitioners, surgeons, employers and health professionals and 152 respondents to a survey relating to current care.

What did we find?

The overall results showed that the intervention developed to support the return to work of patients post hip and knee replacement surgery was deliverable. 

What happens next?

As a result of this research study, funding for a further randomised control trial has been awarded.  This will assess the clinical effectiveness and cost-effectiveness of the occupational advice intervention and evaluate whether it improves the rates and timing of sustained return to work for patients post hip and knee replacements compared to standard care. 


  • Baker P, Kottam L, Coole C, Drummond A, McDaid C, Rangan A. Development of an occupational advice intervention for patients undergoing elective hip and knee replacement: a Delphi study. BMJ OPEN. 2020:10(7) DOI: 10.1136/bmjopen-2019-036191
  • Baker P, Coole C, Drummond A, Khan S, McDaid C, Hewitt, C, et al. Occupational advice to help people return to work following lower limb arthroplasty: the OPAL intervention mapping study. Health Technol Assess. 2020;24(45):1-408. DOI: 10.3310/hta24450
  • Tsang B, McDonald D, McNamara I, Kottam L, Rangan A, Baker P. National survey of occupational advice for lower limb arthroplasty patients. Occupational Medicine-Oxford. 2020:70(2):123-126. DOI: 10.1093/occmed/kqaa006
  • Nouri F, Coole C, Baker P, Drummond A. Return to work advice after total hip and knee replacement. Occupational Medicine-Oxford. 2020:70(2):113-118. DOI:  10.1093/occmed/kqaa014
  • Coole, C., Baker, P., McDaid, C., Drummond A. Using intervention mapping to develop an occupational advice intervention to aid return to work following hip and knee replacement in the United Kingdom. BMC health services research. 2020:20(1). DOI: 10.1186/s12913-020-05375-3
  • Nouri F, Coole C, Narayanasamy M, Baker P, Khan S, Drummond A. Managing Employees Undergoing Total Hip and Knee Replacement: Experiences of Workplace Representatives. Journal of Occupational Rehabilitation. 2019:29(2):451-461. Doi: 10.1007/s10926-018-9805-7 DOI: 10.1007/s10926-018-9805-7
  • Coole C, Nouri F, Narayanasamy M, Baker P, Drummond A. Total hip and knee replacement and return to work: clinicians’ perspectives. Disability and Rehabilitation. 2019:43(9):1247-1254. DOI: 10.1080/09638288.2019.1654000
  • Baker P, Coole C, Drummond A, McDaid C, Khan S, Thomson L, et al. Development of an occupational advice intervention for patients undergoing lower limb arthroplasty (the OPAL study). BMC Health Services Research. 2018;18(504). DOI: 10.1186/s12913-018-3238-z

Other outputs


Twitter accounts @OPALTrial

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The research was commissioned by NIHR HTA programme (Award ID: 15/28/02) and a grant of £612,929.55 awarded. The project was started in July 2016 and completed in April 2019.

Study Registration

The study was registered on PROSPERO: 

Catriona McDaid, Sarah Ronaldson, Kath Wright, Paul Baker. Occupational advice interventions for elective surgical procedures: a rapid evidence synthesis. PROSPERO 2016 CRD42016045235 Available from:

The study was registered on the ISRCTN register:


Occupational advice for patients undergoing arthroplasty of the lower limb (OPAL)


Catriona McDaid
Catherine Hewitt
Sarah Ronaldson
Elizabeth Coleman 
Department of Health Sciences, University of York, York, UK

Gerry Richardson 
Centre for Health Economics, University of York, York, UK

Paul Baker
Amar Rangan
Lucksy Kottam
Amanda Goodman
South Tees NHS Trust, Middlesborough, UK

Avril Drummond
Carol Coole
Sayeed Khan
Louise Thomson
Khosrow Sehat 
Fiona Nouri
Melanie Narayanasamy
Nottingham University/ Nottingham Hospitals NHS Trust, Nottingham, UK

Iain NcNamara
Orthopaedic Surgeon (PI Norfolk and Norwich hospital site, Norwich, UK)

David A McDonald
Physiotherapist – Golden Jubilee Hospital Glasgow, Glasgow, UK

Judith Fitch
BOA Patient liaison group