Study Team Members: Dr Benjamin Smith, Dr Fiona Moffatt, Dr Joanne Stocks, Professor Katie Sheehan
The ReStARt (Reducing STiffness After knee ReplacemenT) study is an NIHR-funded research initiative focused on developing non-surgical, physiotherapy-led interventions for patients suffering from severe stiffness (arthrofibrosis) following total knee replacement. It targets improving mobility through targeted, evidence-based rehabilitation protocols, offering an alternative to surgical manipulation.
Development of an optimal physiotherapy intervention for arthrofibrosis following total knee replacement
Plain English Summary:
Aim: This research aims to develop an optimal physiotherapy intervention for people with arthrofibrosis (stiffness due to scar tissue) after total knee replacement (TKR).
Background: Arthrofibrosis is the second most common reason for hospital readmission following TKR. It limits knee movement, causes pain and interferes with everyday activities. There are no guidelines as to how best to treat this complication. Most people will have additional physiotherapy, but it is not clear exactly what this should involve. People who don’t improve will usually undergo manipulation under anaesthetic (MUA), a procedure where the knee is forcefully flexed to release the stiff joint. People who have an MUA are more likely to have poorer outcomes and long-term are more likely to need a repeat knee replacement, which is distressing for patients and costly to the NHS. An optimal physiotherapy intervention could result in better outcomes for patients and reduce the need for MUA and further surgery.
Methods: We will develop an optimal intervention by conducting:
- A review of the evidence to identify what components could be included in the intervention, how effective they are and what outcomes have been measured by the research.
- Interviews with patients with arthrofibrosis to understand the impact it has on their life and what outcomes are important to them and interviews with healthcare professionals (HCPs) to understand their experiences of treating patients with arthrofibrosis.
- A Delphi study with a larger group of HCPs and patients to reach a consensus on what the optimal intervention should include. This involves a series of anonymous votes on a range of items that have been generated by the group and the results of the evidence review.
- A workshop with patients, HCPs and healthcare commissioners to finalise the intervention. During the workshop, we will present our findings and work in small groups to agree on the intervention.
At the end of this study, we will have an intervention that has been agreed upon by patients and HCPs that can then be tested to see if it can work in practice and if a larger trial can be conducted.
Patient and Public Involvement (PPI): Patients who have had knee arthrofibrosis after TKR have told us this is an important topic to research. They experienced variations in their care and felt that improving treatment for arthrofibrosis would benefit patients and the NHS, particularly if MUA could be prevented. Our PPI members will be actively involved throughout the project to ensure the study remains patient-focused.
Dissemination: We will share the findings of this study with patients, healthcare professionals and healthcare commissioners locally through meetings and magazine/internet articles and more widely by presenting at conferences, publishing in academic journals and on social media.
Start Date: April 2022