Abstract
Background: Approximately 20% of people experience chronic postsurgical pain after total knee replacement. The STAR randomised controlled trial (ISCRTN92545361) evaluated the clinical- and cost-effectiveness of a new multifaceted and personalised care pathway, compared with usual care, for people with pain at three months after total knee replacement. We report trial participants’ experiences of postoperative pain and the acceptability of the STAR care pathway, which consisted of an assessment clinic at three months, and up to six follow-up telephone calls over 12 months. Methods: Semi-structured interviews were conducted with 27 people (10 men, 17 women) between February 2018 and January 2020. Participants were sampled purposively from the care pathway intervention group and interviewed after completion of the final postoperative trial questionnaire at approximately 15 months after knee replacement. Interviews were audio-recorded, transcribed, anonymised and analysed using inductive thematic analysis. Findings: Many participants were unprepared for the severity and impact of postoperative pain, which they described as extreme and constant and that tested their physical and mental endurance. Participants identified ‘low points’ during their recovery, triggered by stiffening, pain or swelling that caused feelings of anxiety, depression, and pain catastrophising. Participants described the STAR assessment clinic as something that seemed “perfectly normal” suggesting it was seamlessly integrated into NHS care. Even in the context of some ongoing pain, the STAR care pathway had provided a source of support and an opportunity to discuss concerns about their ongoing recovery. Conclusions: People who have knee replacement may be unprepared for the severity and impact of postoperative pain, and the hard work of recovery afterwards. This highlights the challenges of preparing patients for total knee replacement and suggests that clinical attention is needed if exercise and mobilising is painful beyond the three month postoperative period. The STAR care pathway is acceptable to people with pain after total knee replacement.
| Original language | English |
|---|---|
| Article number | 451 |
| Journal | BMC Musculoskeletal Disorders |
| Volume | 23 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 13 May 2022 |
Bibliographical note
Funding Information:This study is funded by the National Institute for Health Research (NIHR) [Programme Grant for Applied Research (Grant Reference Number RP-PG-0613–20001)]. The research team acknowledge the support of the NIHR, through the Clinical Research Network. This work was also supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Availability of data and materials
Anonymised data may be shared via the University of Bristol Research Data Repository (https://data.bris.ac.uk/data/). Access to the data will be restricted to ensure that data is only made available to bona fide researchers for ethically approved research projects, on the understanding that confidentiality will be maintained and after a Data Access Agreement has been signed by an institutional signatory.
Funding
This study is funded by the National Institute for Health Research (NIHR) [Programme Grant for Applied Research (Grant Reference Number RP-PG-0613–20001)]. The research team acknowledge the support of the NIHR, through the Clinical Research Network. This work was also supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The authors would like to acknowledge the following people for their help and input into the STAR research programme: Andrew D Beswick, Tim J Peters, Emily Sanderson, Sian Noble, Ashley W. Blom, David A Walsh, Shaun Harris, Kirsty Garfield, Simon White, Andrew Toms, Andrew Judge, Athene Lane, Fiona MacKichan, Nicolas Ambler, Susan Bridgewater, Leigh Morrison, Gemma Munkenbeck, Candida McCabe, Rowenna Stroud, Kate Button, Nigel Arden, Andrew Price, Rafael Pinedo-Villaneuva, Anushka Soni, Stewart Long, Joanne Adams, and the PEP-R group.
ASJC Scopus subject areas
- Rheumatology
- Orthopedics and Sports Medicine