The STAR care pathway for patients with chronic pain after total knee replacement: four-year follow-up of a randomised controlled trial.

Autor: Bertram W; Bristol Medical School, University of Bristol, Bristol, UK. Wendy.Bertram@bristol.ac.uk.; National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK. Wendy.Bertram@bristol.ac.uk., Wylde V; Bristol Medical School, University of Bristol, Bristol, UK.; National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK., Howells N; North Bristol NHS Trust, Bristol, UK., Shirkey B; Bristol Trials Centre, University of Bristol, Bristol, UK., Peters TJ; Bristol Medical School, University of Bristol, Bristol, UK.; Bristol Dental School, University of Bristol, Bristol, UK., Zhu L; Bristol Trials Centre, University of Bristol, Bristol, UK., Noble S; Bristol Medical School, University of Bristol, Bristol, UK., Johnson E; Bristol Medical School, University of Bristol, Bristol, UK., Beswick AD; Bristol Medical School, University of Bristol, Bristol, UK.; National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK., Moore A; Bristol Medical School, University of Bristol, Bristol, UK., Bruce J; Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Warwick, UK., Walsh D; Pain Centre, National Institute for Health Research Nottingham Biomedical Research Centre, Versus Arthritis, University of Nottingham and Sherwood Forest Hospitals NHS Foundation Trust, Nottingham, UK., Eccleston C; Centre for Pain Research, The University of Bath, Bath, UK., Gooberman-Hill R; Bristol Medical School, University of Bristol, Bristol, UK.; National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.
Jazyk: angličtina
Zdroj: BMC musculoskeletal disorders [BMC Musculoskelet Disord] 2023 Dec 16; Vol. 24 (1), pp. 972. Date of Electronic Publication: 2023 Dec 16.
DOI: 10.1186/s12891-023-07099-x
Abstrakt: Background: The Support and Treatment After Replacement (STAR) care pathway is a clinically important and cost-effective intervention found to improve pain outcomes over one year for people with chronic pain three months after total knee replacement (TKR). We followed up STAR trial participants to evaluate the longer-term clinical- and cost-effectiveness of this care pathway.
Methods: Participants who remained enrolled on the trial at one year were contacted by post at a median of four years after randomisation and invited to complete a questionnaire comprising the same outcomes collected during the trial. We captured pain (co-primary outcome using the Brief Pain Inventory (BPI) pain severity and interference scales; scored 0-10, best to worst), function, neuropathic characteristics, emotional aspects of pain, health-related quality of life, and satisfaction. Electronic hospital informatics data on hospital resource use for the period of one to four years post-randomisation were collected from participating hospital sites. The economic evaluation took an National Health Service (NHS) secondary care perspective, with a four-year time horizon.
Results: Overall, 226/337 (67%) of participants returned completed follow-up questionnaires, yielding adjusted between-group differences in BPI means of -0.42 (95% confidence interval, CI (-1.07, 0.23); p = 0.20) for pain severity and - 0.64 (95% CI -1.41, 0.12); p = 0.10) for pain interference. Analysis using a multiple imputed data set (n = 337) showed an incremental net monetary benefit in favour of the STAR care pathway of £3,525 (95% CI -£990 to £8,039) at a £20,000/QALY willingness-to-pay threshold, leading to a probability that the intervention was cost-effective of 0.94.
Conclusions: The magnitude of the longer-term benefits of the STAR care pathway are uncertain due to attrition of trial participants; however, there is a suggestion of some degree of sustained clinical benefit at four years. The care pathway remained cost-effective at four years.
Trial Registration: ISRCTN: 92,545,361.
(© 2023. The Author(s).)
Databáze: MEDLINE
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