Using intervention mapping to develop an occupational advice intervention to aid return to work following hip and knee replacement in the United Kingdom

Abstract

Background: There are increasing numbers of total hip replacements (THR) and total knee replacements (TKR) being performed in patients of working age. Providing patients undergoing TKR and THR with return to work advice might facilitate return to work. The aim of this paper is to report on the process used to systematically develop an occupational advice intervention to be delivered in hospital for those undergoing arthroplasty. Methods: The six-step Intervention Mapping (IM) approach to development, implementation and evaluation of a theory and evidence-based interventions was followed. This paper reports on the development of the intervention covered by steps 1 to 4 of the IM process. Steps 1-3 gathered data on current practice and barriers to change using a mixed methods approach (cohort study of patients undergoing THR or TKR, stakeholder interviews, survey of practice, evidence synthesis) and provided a theoretical framework for intervention development. Step 4 used information from steps 1-3 in combination with a Delphi consensus process to develop the intervention and the associated tools and materials to facilitate its delivery. Results: The final intervention identified included a number of core principles including: early patient identification; delivery of key information to patients and their employers; assessment and support by a member of the orthopaedic team; procedures for escalation based on patient need; mechanisms to support communication; and training and support for the clinical teams delivering care. A total of 13 patient and 20 staff performance objectives as delivery requirements, were supported by a range of tools, roles and training resources. The intervention addressed outcomes based at the individual and interpersonal levels of the ecological model. Conclusions: Following the IM approach resulted in a structured and justified occupational intervention for delivery in secondary care for patients undergoing total hip and knee replacement. The feasibility of the intervention will subsequently be tested alongside further investigation to establish its effectiveness and cost-effectiveness.

Using intervention mapping to develop evidence-based toolkits that support workers on long-term sick leave and their managers

“…To our knowledge, in comparison to other IM studies for RTW interventions [ 78 , 79 ] this is the first time IM approach that has been applied for a RTW intervention to be used directly by employers, managers and the workers themselves, without the involvement of healthcare professionals (HCP), RTW coordinators or providers (the provision of three coaching sessions in this intervention is provided to facilitate intervention engagement). This is important given that traditional RTW support, mostly offered by HCP or providers, tends to be inconsistent and does not always reach people with poor mental wellbeing [ 80 ].…”

Does Consulting an Occupational Medicine Specialist Decrease Time to Return to Work Among Total Knee Arthroplasty Patients? A 12-Month Prospective Multicenter Cohort Study

“…Moreover, in line with the hierarchy of risk management it is more ethical to start with adjusting the work to the patient’s needs, especially if the work is knee-straining. Recent studies have shown that interventions supporting RTW in arthroplasty patients based on knowledge for safe recovery, also regarding work-related activities, and sustainable RTW are being developed [ 11 , 29 , 30 ]. Managing too high patient expectations has also been suggested in TKA patients for better patient-reported outcome as well as RTW [ 12 , 31 , 32 ].…”

“…When the orthopedic surgeon refers patients with hindering factors for RTW to their OMS, preferably before surgery, this might enhance a timely RTW if the OMS is able to act accordingly. RTW advise probably should also be individualized and needs involvement of the employer, as has been found in an intervention mapping approach to develop a clinical occupational advice intervention for knee arthroplasty patients [ 11 , 38 ]. M/-eHealth could be another promising add-on intervention, since it can provide personalized and frequent advice for TKA patients regarding timely performance of activities based on for instance activity trackers, self-reported recovery and algorithms [ 29 , 34 ].…”

“…Known prognostic factors effecting RTW are patient characteristics, such as age, gender, Body Mass Index (BMI) and physical function score, as well as workrelated characteristics, such as sense of urgency to RTW, having a handicap accessible workplace, preoperative sick leave, and having knee-straining work [4,5]. Active referral by the orthopedic surgeon to an occupational health expert is expected to enhance RTW [9][10][11][12].…”