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Development of a complex intervention for people with chronic pain after knee replacement : the STAR care pathway

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Wylde, Vikki, Howells, Nicholas, Bertram, Wendy, Moore, Andrew J., Bruce, J. (Julie), McCabe, Candy, Blom, Ashley W., Dennis, Jane, Burston, Amanda and Gooberman-Hill, Rachael (2018) Development of a complex intervention for people with chronic pain after knee replacement : the STAR care pathway. Trials, 19 (1). doi:10.1186/s13063-017-2391-8 ISSN 1745-6215.

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Official URL: http://dx.doi.org/10.1186/s13063-017-2391-8

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Abstract

Background: Approximately 20% of people who have total knee replacement experience chronic pain afterwards, but there is little evidence about effective interventions for managing this type of pain. This article describes the systematic development and refinement of a complex intervention for people with chronic pain after knee replacement. The intervention is a care pathway involving an assessment clinic and onward referral, with telephone follow-up as required. In the design of this multistage study, we chose to focus on ensuring that the intervention was deliverable, implementable and acceptable.

Methods: In line with the UK Medical Research Council's recommendations for comprehensive development of complex interventions, multiple phases of work were undertaken. Following on from initial development work to design the intervention, the draft intervention content was refined through consensus questionnaires with 22 health professionals and discussion at meetings with 18 healthcare professionals. Testing of intervention delivery and acceptability to patients was undertaken by two health professionals delivering the assessment clinic to ten patients. Views about future implementation within the context of a randomised trial were evaluated through a questionnaire based on the Normalisation Measure Development (NoMAD) instrument with ten health professional stakeholders.

Results: Consensus work with health professionals ensured the components of the intervention were appropriate and informed a number of substantive changes to improve the intervention. Testing of intervention delivery identified a number of logistical issues that were then addressed in the development of a comprehensive intervention training manual. Engagement with stakeholders indicated that the intervention could be successfully implemented in a clinical setting for evaluation in a randomised trial.

Conclusions: This work has informed the development and refinement of a complex intervention for people with chronic pain after knee replacement. The next stage is to evaluate the clinical and cost-effectiveness of the STAR care pathway in a multicentre randomised trial.

Item Type: Journal Article
Subjects: R Medicine > R Medicine (General)
R Medicine > RD Surgery
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Total knee replacement, Knee -- Surgery, Postoperative pain, Surgery -- Complications
Journal or Publication Title: Trials
Publisher: Biomed Central
ISSN: 1745-6215
Official Date: 23 January 2018
Dates:
DateEvent
23 January 2018Published
7 December 2017Accepted
Volume: 19
Number: 1
DOI: 10.1186/s13063-017-2391-8
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Funder: UK Clinical Research Network (UKCRN)
Grant number: RP-PG-0613-200001
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
RP-PG-0613-200001[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
UNSPECIFIEDUniversity of Bristolhttp://dx.doi.org/10.13039/501100000883
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