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Published in: Trials 1/2018

Open Access 01-12-2018 | Research

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

Authors: Vikki Wylde, Nicholas Howells, Wendy Bertram, Andrew J. Moore, Julie Bruce, Candy McCabe, Ashley W. Blom, Jane Dennis, Amanda Burston, Rachael Gooberman-Hill

Published in: Trials | Issue 1/2018

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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.
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Metadata
Title
Development of a complex intervention for people with chronic pain after knee replacement: the STAR care pathway
Authors
Vikki Wylde
Nicholas Howells
Wendy Bertram
Andrew J. Moore
Julie Bruce
Candy McCabe
Ashley W. Blom
Jane Dennis
Amanda Burston
Rachael Gooberman-Hill
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Trials / Issue 1/2018
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-017-2391-8

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