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Original research
Development of an occupational advice intervention for patients undergoing elective hip and knee replacement: a Delphi study
  1. Paul Baker1,2,
  2. Lucksy Kottam1,
  3. Carol Coole3,
  4. Avril Drummond4,
  5. Catriona McDaid5,
  6. Amar Rangan1,2,6
  7. On behalf of the OPAL study group
    1. 1Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
    2. 2Department of Health Sciences, University of York, York, UK
    3. 3School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
    4. 4Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
    5. 5York Trials Unit, University of York, York, UK
    6. 6Faculty of Medical Sciences & Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
    1. Correspondence to Paul Baker; paul.baker1{at}nhs.net

    Abstract

    Objective To obtain consensus on the content and delivery of an occupational advice intervention for patients undergoing primary hip and knee replacement surgery. The primary targets for the intervention were (1) patients, carers and employers through the provision of individualised support and information about returning to work and (2) hospital orthopaedic teams through the development of a framework and materials to enable this support and information to be delivered.

    Design Modified Delphi study as part of a wider intervention development study (The Occupational advice for Patients undergoing Arthroplasty of the Lower limb (OPAL) study: Health Technology Assessment Reference 15/28/02) (ISRCTN27426982).

    Setting Five stakeholder groups (patients, employers, orthopaedic surgeons, general practitioners, allied health professionals and nurses) recruited from across the UK.

    Participants Sixty-six participants.

    Methods Statements for the Delphi process were developed relating to the content, format, delivery, timing and measurement of an occupational advice intervention. The statements were based on evidence gathered through the OPAL study that was processed using an intervention mapping framework. Intervention content was examined in round 1 and intervention format, delivery, timing and measurement were examined in round 2. In round 3, the developed intervention was presented to the stakeholder groups for comment.

    Consensus For rounds 1 and 2, consensus was defined as 70% agreement or disagreement on a 4-point scale. Statements reaching consensus were ranked according to the distribution of responses to create a hierarchy of agreement. Round 3 comments were used to revise the final version of the developed occupational advice intervention.

    Results Consensus was reached for 36 of 64 round 1 content statements (all agreement). In round 2, 13 questions were carried forward and an additional 81 statements were presented. Of these, 49 reached consensus (44 agreement/5 disagreement). Eleven respondents provided an appraisal of the intervention in round 3.

    Conclusions The Delphi process informed the development of an occupational advice intervention as part of a wider intervention development study. Stakeholder agreement was achieved for a large number of intervention elements encompassing the content, format, delivery and timing of the intervention. The effectiveness and cost-effectiveness of the developed intervention will require evaluation in a randomised controlled trial.

    Trial registration number International Standard Randomised Controlled Trials Number Trial ID: ISRCTN27426982

    • return to work
    • hip replacement
    • knee replacement
    • occupational advice
    • employment
    • surgery
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    Footnotes

    • Collaborators OPAL Collaborators: The following researchers contributed to the concept, design, delivery and analysis of the OPAL study: Sayeed Khan (Make UK, the Manufacturers Organisation), Louise Thomson (Faculty of Medicine and Health Sciences, University of Nottingham), Catherine Hewitt and Catriona McDaid (York Trials Unit, University of York), Iain McNamara (Norfolk and Norwich University Hospital NHS Foundation Trust), David McDonald (University of Stirling), Judith Fitch (British Orthopaedic Association Patient Liaison Group), Gerry Richardson (Centre for Health Economics, University of York). The authors acknowledge the contributions of other members of the wider OPAL study team: Reece Walker and Amanda Goodman (South Tees Hospitals NHS Foundation Trust); Sarah Ronaldson and Elizabeth Coleman (York University); Dr Fiona Nouri and Dr Melanie Narayanasamy (University of Nottingham).

    • Contributors PB: If the chief investigator for the OPAL study. Contributed to the conception of the study, the design of the work; the acquisition, analysis, or interpretation of data for the work; drafted the manuscript. LK: Contributed to the design of the work; the acquisition, analysis or interpretation of data for the work; drafted the manuscript. CC: Contributed to the conception of the study, the design of the work; the interpretation of data for the work; edited the manuscript. AD: Contributed to the conception of the study, the design of the work; the interpretation of data for the work; edited the manuscript. CM: Contributed to the conception of the study, the design of the work; the interpretation of data for the work; edited the manuscript. AR: Contributed to the design of the work; the acquisition, analysis or interpretation of data for the work; drafted the manuscript.

    • Funding This project was funded by the National Institute for Health Research Health Technology Assessment (HTA) programme (project number 15/28/02). Further information available at https://www.journalslibrary.nihr.ac.uk/programmes/hta/152802/%23/

    • Disclaimer This report presents independent research commissioned by the National Institute for Health Research (NIHR). The views and opinions expressed by the authors in this publication are those of the authors and do not necessarily reflect those of the National Health Service, the National Institute for Health Research, Medical Research Council, Central Commissioning Facility, NIHR Evaluations, Trials and Studies Coordinating Centre, the Health Technology Assessment Programme or the Department of Health.

    • Competing interests AR is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). CM is a member of the NIHR HTA and EME Editorial Boards.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Ethics approval This study was reviewed and given favourable opinion by the East Midlands - Derby Research Ethics Committee (16/EM/0341) and approved by the Health Research Authority in UK.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. Anonymised data detailing the individual participants responses within each round of the OPAL Delphi study is available on request. Please submit requests in writing to the Department of Research and Innovation, South Tees Hospitals NHS Foundation Trust, Marton Rd, Middlesbrough, UK.