What is OPAL?

Why has the OPAL team developed the OPAL ‘return to work’ program?

The current guidelines on when a patient should return to work after a hip or knee replacement are inconsistent. The OPAL study found that before surgery only a quarter of patients receive advice about their return to work after surgery and the majority of patients do not have access to occupational health services. When patients do receive advice it is often overly cautious and does not take in to account the individual needs of the patient. This means that most patients do not receive any useful structured advice about how to think about and plan their return to work. The OPAL program hopes to provide useful information for patients, employers / work colleagues, G.Ps and hospital orthopaedic teams that takes account of the differing needs of individual patients and supports their return to work process.

Return to work is determined by a variety of factors including the type of work the person does, their work environment, the demands their work places on their body, the ability of their employer to make adaptions to the work place and pattern of work and their recovery following surgery.

Who is the OPAL ‘return to work’ program for?

This ‘return to work’ program is for anyone intending to return to a ‘work’ role after their surgery. This includes people in full-time or part-time employment, people who are self-employed, volunteers or carers.

Why is it important for patients to return to work after surgery?

Being in work has a number of health benefits. These include:

· Mental health: Keeping your mind busy, building confidence and encouraging personal development

· Physical health: Improving you strength, stamina and flexibility as you recover after your hip or knee replacement

· Social health: Encouraging social interaction and the development of support networks

· Financial health: Earning money to support you and your family

Because of these benefits, it is important to try and return to work as soon as you can after your surgery. This booklet will help with this process. Remember you do not need to be 100% fit to engage with work, and working can help you return to 100% fitness.

How will the OPAL program help patients?

The OPAL program will:

· Allow patients to think about the difficulties they are currently having at work and the specific demands of the type of work you do.

· Make them aware that they need to take an active part in their care and make decisions about their own return to work.

· Make their employers and work colleagues aware that they have a role to play in helping their colleague return to work

· Encourage them to make a plan for their recovery after surgery and their eventual return to work that they can share with their employer, work colleagues and healthcare team.

· Encourage them to involve employers at an early stage to allow them to understand the problems they are facing and allow them to make changes to the place or pattern of work that could facilitate eventual return to work.

· Provide them with links to key advice and information about return to work after hip or knee replacement.

· Help them understand that the ideal return to work process relies on co-ordination, communication and planning between themselves as the patient, their healthcare team and their employer. Patients and their employers are often the best people to oversee this process. As the return to work coordinator your job is to help and support patients make a suitable return to work plan n collaboration with their employer.

An overview of the OPAL ‘return to work’ program

The OPAL ‘return to work’ program has a number of elements and involves patients working alongside their employers/managers/work colleagues and members of the hospital orthopaedic team to facilitate their return to work.

The program starts in the outpatient clinic prior to their initial consultation with the surgical team. Patients that are in work and intending to return to work after surgery are identified by the clinic’s healthcare team and provided with an occupational checklist to complete. This checklist is completed before their review by the surgical team and it is taken in to the consultation with them. The surgical team can then use this information alongside their referral letter and any clinical investigation already performed when making their assessment of the patient and advising on the need for treatment. The surgical team will use this information to provide initial advice and support for patients in work and intending to return to work after surgery. This is important, as we know that patients place a great deal of importance on what their surgical team says to them. If they say the right things to begin with and link this to the patient’s job and their return to work we believe it will help to get patients engaged and invested in their own return to work process.

If, after their consultation the surgical team, a decision is made to offer a hip or knee replacement procedure the patients is then offered further advice and information to assist with their return to work. This involves 4 tasks undertaken by the outpatient clinic team:

1. Give the patient the patient ‘return to work’ workbook to read and complete

2. Give the patient the employer ‘return to work’ workbook to share with their employer/manager/work colleagues

3. Send the occupational checklist to the return to work coordinator – The checklist contains the patient’s contact details

4. Explain to the patient that the return to work coordinator will contact them before their operation to discuss their return to work plan

After their appointment the patient will read and complete the patient ‘return to work’ workbook. The workbook encourages them to think about and plan their return to work by breaking it down in to 8 steps:

· STEP 1: Assessing the impact their hip or knee has on their ability to work, the specific demands of their workplace and how having surgery might impact on these

· STEP 2: Setting an approximate date for their return to work

· STEP 3: Developing a return to work plan

· STEP 4: Discussing and reviewing their return to work plan with their return to work coordinator

· STEP 5: Discussing and reviewing their return to work plan with your ‘employer’

· STEP 6: Contacting their ‘employer’ after surgery and updating them on their progress

· STEP 7: Amending their return to work plan based on their recovery after surgery and discussions with their ‘employer’ and hospital staff

· STEP 8: Seeking help after surgery

Each STEP of the workbook contains information and simple exercises for the patient to complete. Leading them through the process of planning their return to work. STEPS 1-5 are completed before surgery and STEPS 6-8 are completed after surgery. The return to work workbook should accompany the patient to all hospital appointments relating to their hip or knee including their admission for surgery.

The role of the return to work coordinator during these STEPs is discussed further in the next section.

Throughout this process other members of the hospital orthopaedic team will be supporting the patient and emphasising the importance of using the OPAL resources to develop a return to work plan. Team members trained in the OPAL program that will be involved in the patients care will include:

· Preoperative assessment and education teams

· Ward nursing teams and doctors

· Inpatient therapy teams

These team members will ensure the patient gets the correct advice and support based on their own return to work plan as documented in their workbook. Discharge letters, fit notes and referral to outpatient therapy services will reflect these plans any be delivered in accordance with OPAL guidance.

After discharge the patient is encouraged to record information about their recovery, keep in regular contact with their employer and ask for help if required. They can ask for help through the return to work helpline that will be regularly checked by the return to work coordinator and any problems actioned accordingly. The program will support patients for up to 16 weeks after their operation after which time their care will be referred back to their primary care team.