Assessment of chronic post‐surgical pain after knee replacement: Development of a core outcome set

Abstract

BackgroundApproximately 20% of patients experience chronic post-surgical pain (CPSP) after total knee replacement (TKR). There is scope to improve assessment of CPSP after TKR, and this study aimed to develop a core outcome set.MethodsEighty patients and 43 clinicians were recruited into a three-round modified Delphi study. In Round 1, participants were presented with 56 pain features identified from a systematic review, structured interviews with patients and focus groups with clinicians. Participants assigned importance ratings, using a 1–9 scale, to individual pain features; those features rated as most important were retained in subsequent rounds. Consensus that a pain feature should be included in the core outcome set was defined as the feature having a rating of 7–9 by ≥70% of both panels (patients and clinicians) and 1–3 by ≤15% of both panels or rated as 7–9 by ≥90% of one panel.ResultsRound 1 was completed by 71 patients and 39 clinicians, and Round 3 by 62 patients and 33 clinicians. The final consensus was that 33 pain features were important. These were grouped into an 8-item core outcome set comprising: pain intensity, pain interference with daily living, pain and physical functioning, temporal aspects of pain, pain description, emotional aspects of pain, use of pain medication, and improvement and satisfaction with pain relief.ConclusionsThis core outcome set serves to guide assessment of CPSP after TKR. Consistency in assessment can promote standardized reporting and facilitate comparability between studies that address a common but understudied type of CPSP.

Central sensitization as a determinant of patients’ benefit from total hip and knee replacement

“…Also we did not collect information on the treatments that participants received after joint replacement, which could have influenced pain outcomes at 12 months. Our outcome of interest was pain severity, and while we used a validated tool to assess this, pain severity is only one dimension of the patients’ experience of pain and it is important to acknowledge that there are many other important pain outcomes, such as pain‐related distress and pain interference (Wylde et al., 2015b). Similarly, the assessment of PPTs is only one method by which to measure changes in central pain modulation, and research assessing parameters such as temporal summation or conditioned pain modulation may further add to the knowledge of pain mechanisms in the context of OA and joint replacement (Yarnitsky et al., 2008; Petersen et al., 2015).…”

Pathways Through Care for Long‐Term Pain After Knee Replacement: A Qualitative Study With Healthcare Professionals

“…The study aimed to elicit their experiences of the delivery of patient care, including opinions about service organization. In addition, healthcare professionals were asked to identify pain domains that they thought were important in assessing chronic post‐surgical pain for incorporation into a Delphi study, reported elsewhere (Wylde et al, In press). The present study was most closely aligned with a ‘subtle realist’ approach (e.g.…”

Completeness of Outcomes Description Reported in Low Back Pain Rehabilitation Interventions: A Survey of 185 Randomized Trials

“…28 The most successful example of COS is arthritis trials using Outcome Measures in Rheumatology (OMERACT) initiatives. 20,29 Other examples of its use in fields close to rehabilitation are chronic post-surgical pain after knee replacement 30 and hip fracture. 31 …”