Development of an occupational advice intervention for patients undergoing elective hip and knee replacement: a Delphi study

• Main Authors: Catherine Hewitt, Gerry Richardson, Elizabeth Coleman, Amar Rangan, Catriona McDaid, Avril Drummond, Paul Baker, Lucksy Kottam, Carol Coole, Sayeed Khan, Louise Thomson, Iain McNamara, David McDonald, Judith Fitch, Reece Walker, Amanda Goodman, Sarah Ronaldson, Fiona Nouri, Melanie Narayanasamy
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2020-07-01
• Series: BMJ Open
• Online Access: https://bmjopen.bmj.com/content/10/7/e036191.full

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