Patient perspectives of pain and function after knee replacement: a systematic review and meta-synthesis of qualitative studies

Taylor, Carrie E V; Murray, Carolyn; Stanton, Tasha R.

doi:10.1097/pr9.0000000000001006

Cited by 10 publications

(9 citation statements)

References 71 publications

(514 reference statements)

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“…Survey-based research has shown postoperative pain (and mobility) to be of the most prominent concerns 32 33. A systematic review and meta-synthesis of 28 qualitative studies demonstrated patients did not understand what the normal resolution of pain should be postoperatively 34. Clinicians should be aware of this, in ensuring effective pain management strategies.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, clinicians should take care to explain and give reasonable expectations for pain and function, in particular mobility. Meta-synthesis of qualitative research has demonstrated that this information is not always conveyed 34. Better communication and individual assessment of needs has been suggested to improve care 11 57.…”

Section: Discussionmentioning

confidence: 99%

“…32 33 A systematic review and meta-synthesis of 28 qualitative studies demonstrated patients did not understand what the normal resolution of pain should be postoperatively. 34 Clinicians should be aware of this, in ensuring effective pain management strategies. This must extend to the immediate postdischarge phase, including strategies to anticipate changing analgesic requirements.…”

Section: Painmentioning

confidence: 99%

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What recovery domains are important following a total knee replacement? A qualitative, interview-based study

Khatri,

Dhaif,

Ellard

et al. 2024

BMJ Open

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ObjectivesTo explore people’s views of recovery from total knee replacement (TKR) and which recovery domains they felt were important.DesignSemi-structured interviews exploring the views of individuals about to undergo or who have undergone TKR. A constant-comparative approach with thematic analysis was used to identify themes. The process of sampling, collecting data and analysis were continuous and iterative throughout the study, with interviews ceasing once thematic saturation was achieved.SettingTertiary care centre.ParticipantsA purposive sample was used to account for variables including pre, early or late postoperative status.Results12 participants were interviewed, 4 who were preoperative, 4 early postoperative and 4 late postoperative. Themes of pain, function, fear of complications, awareness of the artificial knee joint and return to work were identified. Subthemes of balancing acute and chronic pain were identified.ConclusionsThe results of this interview-based study identify pain and function, in particular mobility, that were universally important to those undergoing TKR. Surgeons should consider exploring these domains when taking informed consent to enhance shared decision-making. Researchers should consider these recovery domains when designing interventional studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Painmentioning

confidence: 99%

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What recovery domains are important following a total knee replacement? A qualitative, interview-based study

Khatri,

Dhaif,

Ellard

et al. 2024

BMJ Open

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“…27 Motivating patients in rehabilitation after TKA can be challenging because progress is gradual, variable, and often painful. [6][7][8] Positive reinforcement via the tool may increase patient motivation to participate in rehabilitation and support patients to meet their personal goals after surgery.…”

Section: Discussionmentioning

confidence: 99%

Patient and Clinician Perceptions of a “People-Like-Me” Tool for Personalized Rehabilitation after Total Knee Arthroplasty: A Qualitative Interview Study

Churchill,

Graber,

Mealer

et al. 2023

Preprint

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Objective: We developed a clinical decision support tool to help physical therapists (PTs) address the varied expectations and recoveries of the total knee arthroplasty (TKA) population. The tool uses a ″people-like-me″ algorithm to predict recovery after TKA. The purpose of this study was to explore patients′ and clinicians′ perceptions and experiences with the tool during rehabilitation after TKA. Methods: We piloted the tool in 2 outpatient physical therapy clinics. We conducted in-depth semi-structured interviews with 1) patients who underwent TKA and were exposed to the tool during rehabilitation and 2) clinicians who used the tool with patients after TKA. Two members of the research team coded the interview data using a descriptive content analysis. Results: 16 patients and 10 clinicians were interviewed. We identified 4 common themes: 1) Expectations: most patients and clinicians felt the tool provided patients with valuable feedback for managing recovery expectations; 2) Motivation: patients and clinicians felt the tool motivated patients to participate in rehabilitation by providing positive reinforcement and/or a form of competition; 3) Influence on practice: some patients and clinicians indicated that the tool helped guide treatment decisions or provided opportunities for patient education, but most felt it did not influence clinical decision making; and 4) Clarity and comprehension: the majority of patients understood the tool′s ″take-home″ message, however, some patients and clinicians felt the use of percentiles, line graphs, and medical jargon decreased patients′ clarity and comprehension of the tool. Conclusions: Overall, participants reported that the tool helped to shape patients′ expectations for postoperative recovery and increase patient motivation to participate in rehabilitation. Participants had mixed perceptions on how the tool influenced clinical care. Finally, participants identified some limitations in patient comprehension of the tool, which will inform future revisions to the tool to accommodate varying levels of health literacy.

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“…[22][23][24][25][26][27][28][29][30] Most reviews assess only postoperative outcomes, which may be affected by surgery quality, postoperative complications, pain, mismatch of expectations, and motivation to return to rehabilitation. 31 Prehabilitation varies substantially in content and is currently predominantly home-based. No previous reviews have examined the effects of home-based exercise programmes but include studies with heterogeneous interventions.…”

Section: Table I Continuedmentioning

confidence: 99%

Effects of home-based prehabilitation on pre- and postoperative outcomes following total hip and knee arthroplasty

et al. 2023

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AimsThe aim of this study was to determine the effectiveness of home-based prehabilitation on pre- and postoperative outcomes in participants awaiting total knee (TKA) and hip arthroplasty (THA).MethodsA systematic review with meta-analysis of randomized controlled trials (RCTs) of prehabilitation interventions for TKA and THA. MEDLINE, CINAHL, ProQuest, PubMed, Cochrane Library, and Google Scholar databases were searched from inception to October 2022. Evidence was assessed by the PEDro scale and the Cochrane risk-of-bias (ROB2) tool.ResultsA total of 22 RCTs (1,601 patients) were identified with good overall quality and low risk of bias. Prehabilitation significantly improved pain prior to TKA (mean difference (MD) -1.02: p = 0.001), with non-significant improvements for function before (MD -0.48; p = 0.06) and after TKA (MD -0.69; p = 0.25). Small preoperative improvements were observed for pain (MD -0.02; p = 0.87) and function (MD -0.18; p = 0.16) prior to THA, but no post THA effect was found for pain (MD 0.19; p = 0.44) and function (MD 0.14; p = 0.68). A trend favouring usual care for improving quality of life (QoL) prior to TKA (MD 0.61; p = 0.34), but no effect on QoL prior (MD 0.03; p = 0.87) or post THA (MD -0.05; p = 0.83) was found. Prehabilitation significantly reduced hospital length of stay (LOS) for TKA (MD -0.43 days; p < 0.001) but not for THA (MD, -0.24; p = 0.12). Compliance was only reported in 11 studies and was excellent with a mean value of 90.5% (SD 6.82).ConclusionPrehabilitation interventions improve pain and function prior to TKA and THA and reduce hospital LOS, though it is unclear if these effects enhance outcomes postoperatively.Cite this article: Bone Jt Open 2023;4(5):315–328.

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Patient perspectives of pain and function after knee replacement: a systematic review and meta-synthesis of qualitative studies

Abstract: Supplemental Digital Content is Available in the Text.Patient perspectives highlight the need for presurgical information about expected recovery trajectories after total knee replacement and enhanced postsurgical follow-up with practical support.

Cited by 10 publications

References 71 publications

What recovery domains are important following a total knee replacement? A qualitative, interview-based study

What recovery domains are important following a total knee replacement? A qualitative, interview-based study

Patient and Clinician Perceptions of a “People-Like-Me” Tool for Personalized Rehabilitation after Total Knee Arthroplasty: A Qualitative Interview Study

Effects of home-based prehabilitation on pre- and postoperative outcomes following total hip and knee arthroplasty

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