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Publications

Journal Article Ppublish

PubMed: 42675641 DOI: 10.1002/acr2.90139

Stakeholders' Perspectives on the Development of the Early Pain Intervention After Knee Replacement Model of Care: A Qualitative Study.

ACR Open Rheumatol 8(9):e90139

Authors: Navneet Chadha, Joshua R Zadro, Sam Adie, Ian A Harris, Ilana N Ackerman, Deanne E Jenkin, Blake F Dear, Christopher G Maher, Rachelle Buchbinder, Laurent Billot, Ian D Cameron, Bernadette Brady, Alexandra Ortega, Haiwad Rashtia, Tracey Gregson, Brenda Luck, Giovanni E Ferreira

Affiliations

  • Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia. Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
  • Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia.
  • School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
  • Faculty of Medicine & Health, School of Clinical Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
  • St. George and Sutherland Centre for Clinical Orthopaedic Research, Kogarah, New South Wales, Australia.
  • Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.
  • Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
  • School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
  • Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
  • The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  • John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, New South Wales, Australia.
  • The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
  • Physiotherapy Department, Liverpool Hospital, Sydney, New South Wales, Australia.

Abstract

OBJECTIVE

Persistent pain affects around 20% of Australians after total knee replacement (TKR), yet no dedicated Australian model of care exists to address this unmet need. The Early Pain Intervention after Knee replacement (EPIK) model is being developed, informed by the effective and cost-effective UK Support and Treatment After Replacement care pathway and extensive multistakeholder engagement. Before evaluating the EPIK model of care in a randomized controlled trial, it must be adapted for the Australian context. This qualitative study aimed to explore stakeholders' perspectives to inform this adaptation.

METHODS

This qualitative descriptive study, guided by a subtle realist ontologic stance and a pragmatic epistemology, used semistructured interviews with key stakeholders across Australia. A preinterview screening questionnaire captured demographic, clinical, and professional characteristics which informed purposive sampling to ensure diverse views. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive analysis.

RESULTS

Sixty-one participants were interviewed (9 patients, 20 physiotherapists, 15 orthopedic surgeons, 14 general practitioners, 1 nurse, and 2 health fund managers) across all six states and the Australian Capital Territory, with 75% residing in metropolitan areas. We identified four key themes: (1) living with pain after TKR, (2) acceptability and value of EPIK, (3) defining the scope of the EPIK care coordinator, and (4) infrastructure and system-level challenges.

CONCLUSION

The EPIK model was well accepted by stakeholders as the first approach designed to improve care coordination for Australians with persistent pain after TKR, with potential to support a more efficient and patient-centered health care system. These insights will inform the EPIK model, which will be tested in a registry-nested randomized controlled trial.

MeSH

Pain