Introduction
pain
OSTEOARTHRITIS, CHRONIC PAIN
Total knee replacement is a common surgical procedure for treatment of advanced osteoarthritis. Over 100,000 knee replacements were performed annually in the UK’s National Health Service (NHS) before the COVID-19 pandemic [The STAR care pathway is a multifaceted personalised care pathway for people with troublesome pain at three months after total knee replacement [The pathway comprises an assessment clinic appointment with a trained Extended Scope Practitioner (ESP: an allied health-care professional with specialist orthopaedic training), referral to existing services for treatment, and up to 6 follow-up telephone calls over 12 months. ESPs who delivered the pathway received specialised training in the assessment of patients with problematic knee replacements, that included a detailed intervention manual and ongoing support from the research team. The 1-hour assessment aims to identify potential underlying causes for chronic pain and enable timely onward referrals to services for treatment. The clinical and cost-effectiveness of the STAR care pathway was evaluated in a multi-centre randomised controlled trial [As highlighted by David Beard in his commentary on the STAR trial, the design of the trial was a pragmatic, pathway-based design rather than a direct comparison of a highly specific intervention, and “one that usefully accounts for real-world variation in treatment content and fidelity” [This study sought to understand healthcare professionals’ experiences of putting the STAR care pathway into practice in a multi-centre randomised controlled trial. This aimed to identify and describe barriers or facilitators to implementation and to produce recommendations for any delivery of the pathway should providers wish to do so. These recommendations will inform future development of a training package, updated manual and recommendations for delivery in usual care.