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Experiences of recovery and a new care pathway for people with pain after total knee replacement : qualitative research embedded in the STAR trial
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Moore, Andrew D. , Wylde, Vikki, Bruce, Julie, Howells, Nicholas, Bertram, Wendy, Eccleston, Christopher and Gooberman-Hill, Rachael (2022) Experiences of recovery and a new care pathway for people with pain after total knee replacement : qualitative research embedded in the STAR trial. BMC Musculoskeletal Disorders, 23 (1). 451. doi:10.1186/s12891-022-05423-5 ISSN 1471-2474.
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WRAP-Experiences-of-recovery-and-a-new-care-pathway-for-people-with-pain-after-total-knee-replacement-Bruce-22.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (874Kb) | Preview |
Official URL: http://dx.doi.org/10.1186/s12891-022-05423-5
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.
| Item Type: | Journal Article | ||||||||
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| Subjects: | 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 |
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| Library of Congress Subject Headings (LCSH): | Total knee replacement, Total knee replacement -- Patients -- Care, Postoperative pain -- Treatment | ||||||||
| Journal or Publication Title: | BMC Musculoskeletal Disorders | ||||||||
| Publisher: | Biomed central | ||||||||
| ISSN: | 1471-2474 | ||||||||
| Official Date: | 13 May 2022 | ||||||||
| Dates: |
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| Volume: | 23 | ||||||||
| Number: | 1 | ||||||||
| Number of Pages: | 11 | ||||||||
| Article Number: | 451 | ||||||||
| DOI: | 10.1186/s12891-022-05423-5 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 4 July 2022 | ||||||||
| Date of first compliant Open Access: | 4 July 2022 | ||||||||
| RIOXX Funder/Project Grant: |
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