Effectiveness and cost-effectiveness of a group-based pain self-management intervention for patients undergoing total hip replacement: feasibility study for a randomized controlled trial.

Vikki Wylde,Elsa Marques,Rachael Gooberman-Hill,Neil Artz,Ashley Blom

doi:10.1186/1745-6215-15-176

Vikki Wylde, Elsa Marques + Show 3 more

Open Access

https://doi.org/10.1186/1745-6215-15-176

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Abstract

BackgroundTotal hip replacement (THR) is a common elective surgical procedure and can be effective for reducing chronic pain. However, waiting times can be considerable. A pain self-management intervention may provide patients with skills to more effectively manage their pain and its impact during their wait for surgery. This study aimed to evaluate the feasibility of conducting a randomized controlled trial to assess the effectiveness and cost-effectiveness of a group-based pain self-management course for patients undergoing THR.MethodsPatients listed for a THR at one orthopedic center were posted a study invitation pack. Participants were randomized to attend a pain self-management course plus standard care or standard care only. The lay-led course was delivered by Arthritis Care and consisted of two half-day sessions prior to surgery and one full-day session after surgery. Participants provided outcome and resource-use data using a diary and postal questionnaires prior to surgery and one month, three months and six months after surgery. Brief telephone interviews were conducted with non-participants to explore barriers to participation.ResultsInvitations were sent to 385 eligible patients and 88 patients (23%) consented to participate. Interviews with 57 non-participants revealed the most common reasons for non-participation were views about the course and transport difficulties. Of the 43 patients randomized to the intervention group, 28 attended the pre-operative pain self-management sessions and 11 attended the post-operative sessions. Participant satisfaction with the course was high, and feedback highlighted that patients enjoyed the group format. Retention of participants was acceptable (83% of recruited patients completed follow-up) and questionnaire return rates were high (72% to 93%), with the exception of the pre-operative resource-use diary (35% return rate). Resource-use completion rates allowed for an economic evaluation from the health and social care payer perspective.ConclusionsThis study highlights the importance of feasibility work prior to a randomized controlled trial to assess recruitment methods and rates, barriers to participation, logistics of scheduling group-based interventions, acceptability of the intervention and piloting resource use questionnaires to improve data available for economic evaluations. This information is of value to researchers and funders in the design and commissioning of future research.Trial registrationCurrent Controlled Trials ISRCTN52305381.

Highlights

Total hip replacement (THR) is a common elective surgical procedure and can be effective for reducing chronic pain
Recruitment rate and participants Postal invitations were sent to 385 eligible patients and 88 consented to participate, giving a recruitment rate of 23% (Figure 1)
This study looked at the feasibility of an randomized controlled trial (RCT) to evaluate the effectiveness and cost-effectiveness of a group-based pain self-management intervention for patients undergoing THR and the acceptability of this intervention

Summary

Introduction

Total hip replacement (THR) is a common elective surgical procedure and can be effective for reducing chronic pain. Patients often wait months or even years for THR surgery despite targets aimed at reducing National Health Service (NHS) waiting times [3] In this lead up to surgery, patients report high levels of intrusive pain impacting on their lives, lack of information about managing pain, and uncertainty about where to seek advice or support [4,5]. Interventions to support patients with self-management of arthritis can improve pain, self-efficacy, symptom management and psychological well-being [6,7,8,9,10] Trials of these interventions with patients waiting for joint replacement report positive beneficial effects on pain and skills acquisition [11,12] but the effectiveness and cost-effectiveness of a pain self-management intervention has not yet been evaluated [13]. Prior to conducting such an evaluation it is important to conduct feasibility work, because previous studies of self-management programs for patients with arthritis have faced challenges through low recruitment rates, poor uptake of the intervention and high attrition rates [8,14,15,16,17]

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