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Healthcare professionals’ views on implementing the STAR care pathway for people with chronic pain after total knee replacement: A qualitative study

For many people with advanced osteoarthritis, total knee replacement is an effective treatment to relieve pain and improve function. However, 10–34% of people experience chronic postsurgical pain in the months and years after total knee replacement. The Support and Treatment After Replacement (STAR)...

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Autores principales: Moore, Andrew J., Wylde, Vikki, Bertram, Wendy, Beswick, Andrew D., Howells, Nick, Gooberman-Hill, Rachael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10146502/
https://www.ncbi.nlm.nih.gov/pubmed/37115771
http://dx.doi.org/10.1371/journal.pone.0284406
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author Moore, Andrew J.
Wylde, Vikki
Bertram, Wendy
Beswick, Andrew D.
Howells, Nick
Gooberman-Hill, Rachael
author_facet Moore, Andrew J.
Wylde, Vikki
Bertram, Wendy
Beswick, Andrew D.
Howells, Nick
Gooberman-Hill, Rachael
author_sort Moore, Andrew J.
collection PubMed
description For many people with advanced osteoarthritis, total knee replacement is an effective treatment to relieve pain and improve function. However, 10–34% of people experience chronic postsurgical pain in the months and years after total knee replacement. The Support and Treatment After Replacement (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. Our objective was to identify factors promoting or inhibiting its implementation, and to inform future training and wider implementation of the pathway. We conducted a prospective process evaluation using qualitative interviews with eight Extended Scope Practitioners and six Principal Investigators from seven trial sites who were involved in delivering the STAR care pathway during the trial. We used Normalization Process Theory as a theoretical framework for qualitative data collection and content analysis. We identified that factors promoting the implementation of the pathway were quick familiarisation with the pathway, valuing patient-centredness, formalising referral processes, and increasing confidence to address neuropathic pain. Challenges to implementation were availability of time and resources, sensitivity in referral process, and ensuring collective understanding of the pathway. These findings have enabled us to make recommendations about the future implementation of the STAR care pathway and will inform the development of a training package, and updated manual for successful delivery in usual care. Furthermore, this model of care has potential value in diverse elective surgeries and pain conditions.
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spelling pubmed-101465022023-04-29 Healthcare professionals’ views on implementing the STAR care pathway for people with chronic pain after total knee replacement: A qualitative study Moore, Andrew J. Wylde, Vikki Bertram, Wendy Beswick, Andrew D. Howells, Nick Gooberman-Hill, Rachael PLoS One Research Article For many people with advanced osteoarthritis, total knee replacement is an effective treatment to relieve pain and improve function. However, 10–34% of people experience chronic postsurgical pain in the months and years after total knee replacement. The Support and Treatment After Replacement (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. Our objective was to identify factors promoting or inhibiting its implementation, and to inform future training and wider implementation of the pathway. We conducted a prospective process evaluation using qualitative interviews with eight Extended Scope Practitioners and six Principal Investigators from seven trial sites who were involved in delivering the STAR care pathway during the trial. We used Normalization Process Theory as a theoretical framework for qualitative data collection and content analysis. We identified that factors promoting the implementation of the pathway were quick familiarisation with the pathway, valuing patient-centredness, formalising referral processes, and increasing confidence to address neuropathic pain. Challenges to implementation were availability of time and resources, sensitivity in referral process, and ensuring collective understanding of the pathway. These findings have enabled us to make recommendations about the future implementation of the STAR care pathway and will inform the development of a training package, and updated manual for successful delivery in usual care. Furthermore, this model of care has potential value in diverse elective surgeries and pain conditions. Public Library of Science 2023-04-28 /pmc/articles/PMC10146502/ /pubmed/37115771 http://dx.doi.org/10.1371/journal.pone.0284406 Text en © 2023 Moore et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Moore, Andrew J.
Wylde, Vikki
Bertram, Wendy
Beswick, Andrew D.
Howells, Nick
Gooberman-Hill, Rachael
Healthcare professionals’ views on implementing the STAR care pathway for people with chronic pain after total knee replacement: A qualitative study
title Healthcare professionals’ views on implementing the STAR care pathway for people with chronic pain after total knee replacement: A qualitative study
title_full Healthcare professionals’ views on implementing the STAR care pathway for people with chronic pain after total knee replacement: A qualitative study
title_fullStr Healthcare professionals’ views on implementing the STAR care pathway for people with chronic pain after total knee replacement: A qualitative study
title_full_unstemmed Healthcare professionals’ views on implementing the STAR care pathway for people with chronic pain after total knee replacement: A qualitative study
title_short Healthcare professionals’ views on implementing the STAR care pathway for people with chronic pain after total knee replacement: A qualitative study
title_sort healthcare professionals’ views on implementing the star care pathway for people with chronic pain after total knee replacement: a qualitative study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10146502/
https://www.ncbi.nlm.nih.gov/pubmed/37115771
http://dx.doi.org/10.1371/journal.pone.0284406
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