title: Pathways Through Care for Long-Term Pain After Knee Replacement: A Qualitative Study With Healthcare Professionals.
abstract: BACKGROUND
  Chronic pain after total knee replacement is experienced by around 20% of patients in the UK. Ensuring that services are designed to best meet the needs of patients requires a foundation of empirical work. The present study sought to describe healthcare professionals' experiences and views on the assessment and care of patients with chronic pain after total knee replacement.
  
  
  METHODS
  We undertook a qualitative focus group study with healthcare professionals at a large acute NHS hospital trust, all of whom came into contact with patients experiencing chronic pain after total knee replacement. Snowball sampling was used to recruit participants to four focus groups. Transcripts of the audio-recorded groups were analysed thematically.
  
  
  RESULTS
  Eighteen healthcare professionals from a range of disciplines took part. Participants found it difficult to conceptualize chronic pain; its character varied between patients, and its origins and progress were often ambiguous. In the first of two superordinate themes, participants recognized chronic pain as a possible outcome of total knee replacement, but felt that patients may be unprepared for this. In the second superordinate theme, apparent complexities in assessing and managing patients with chronic pain after total knee replacement and a lack of explicit access points meant that healthcare professionals often saw no clear way to help patients. Participants agreed that a multidisciplinary approach that adapts to individual patient context was an ideal approach.
  
  
  CONCLUSIONS
  The present study illustrated potential obstacles to 'best practice' in the management of chronic pain after total knee replacement, identified through research with healthcare professionals. There is a need to improve access to services and develop well-defined and flexible care pathways that can accommodate complexities inherent to chronic pain, such as an unpredictable course. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: F
authors.initials: F
authors.lastname: MacKichan
authors.affiliation: Musculoloskeletal Research Unit, University of Bristol, Bristol, UK.
authors.forename: V
authors.initials: V
authors.lastname: Wylde
authors.affiliation: Musculoloskeletal Research Unit, University of Bristol, Bristol, UK.
authors.forename: R
authors.initials: R
authors.lastname: Gooberman-Hill
keywords: Total knee replacement; care pathway; chronic pain; qualitative