Support and treatment after joint replacement (STAR): translation into practice and long-term follow up

Background Treatment of osteoarthritis with total knee replacement (TKR) aims to reduce pain, functional limitations and associated disability. Over 100,000 primary TKRs are performed annually by the NHS.

Despite good outcomes for many, about 20% of patients report chronic pain after TKR, defined as pain present for at least three months. To address this, we conducted the STAR research programme from 2015-2020 (RP-PG-0613-20001).

We developed the STAR care pathway in which people with chronic pain after TKR are assessed and referred to appropriate care.

In our multi-centre randomised controlled trial comparing patient outcomes after the STAR care pathway with usual care, there was convincing evidence that this approach was clinically important at one-year follow up and that implementation should be explored.

A programme development grant will enable us to translate the STAR findings into clinical practice through work with stakeholders, including the NHS and patients, and conduct longer-term follow up of trial participants to describe their outcomes and use of secondary healthcare resources.

Aim To improve outcomes for patients with chronic pain after TKR by implementing new research findings into the NHS and understanding long-term outcomes. Objectives: 1.

Mobilise knowledge about the STAR care pathway into practice by collaboration with commissioners and healthcare providers 2.

Assess longer term outcomes and healthcare use after TKR and receipt of the STAR care pathway by following up trial participants at a median of four years after randomisation into the trial Development workplan The development work comprises two workstreams, which map onto the study objectives.

Workstream 1: Work with stakeholders (professionals and patients) to mobilise findings and enable implementation of the STAR care pathway and other aspects of the STAR findings into the NHS. This will deliver a structured package of knowledge mobilisation to embed STAR results into NHS practice.

Workstream 2: Follow-up STAR trial participants at a median of four years after randomisation to collect information about long-term pain and secondary healthcare use.

This will deliver information on the long-term experiences of patients with chronic pain after TKR (STAR care pathway and usual care) and cost-effectiveness of the STAR care pathway Patient involvement will be embedded in the work, through a PPI group and collaboration with Versus Arthritis. Timeline for delivery The development work will last 24 months.

Workstreams 1 and 2 will run in parallel during months 1-24.

Impact and dissemination The work will deliver knowledge mobilisation and translation relating to the STAR pathway which has been shown to be clinically important. We will produce resources and publications for patients and professionals.