Evidence map›Paper›PMID 38102656›Full record

Trial reportBMC musculoskeletal disorders2023

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

Wendy Bertram, Vikki Wylde, Nick Howells, Beverly Shirkey, Tim J Peters, Liang Zhu, Sian Noble, Emma Johnson, Andrew D Beswick, Andrew Moore and 4 more

Open access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC musculoskeletal disorders, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 2 pooled it
1.2field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 2 syntheses or guidelines pooled it, 5 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 7 institutions in 1 country.

Wendy BertramBristol Medical School, University of Bristol, Bristol, UK. Wendy.Bertram@bristol.ac.uk.
Vikki WyldeBristol Medical School, University of Bristol, Bristol, UK.
Nick HowellsNorth Bristol NHS Trust, Bristol, UK.
Beverly ShirkeyBristol Trials Centre, University of Bristol, Bristol, UK.
Tim J PetersBristol Medical School, University of Bristol, Bristol, UK.
Liang ZhuBristol Trials Centre, University of Bristol, Bristol, UK.
Sian NobleBristol Medical School, University of Bristol, Bristol, UK.
Emma JohnsonBristol Medical School, University of Bristol, Bristol, UK.
Andrew D BeswickBristol Medical School, University of Bristol, Bristol, UK.
Andrew MooreBristol Medical School, University of Bristol, Bristol, UK.
Julie BruceWarwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Warwick, UK.
David WalshPain Centre, National Institute for Health Research Nottingham Biomedical Research Centre, Versus Arthritis, University of Nottingham and Sherwood Forest Hospitals NHS Foundation Trust, Nottingham, UK.
Christopher EcclestonCentre for Pain Research, The University of Bath, Bath, UK.
Rachael Gooberman-HillBristol Medical School, University of Bristol, Bristol, UK.
University of Bristol · GBUniversity Hospitals Bristol NHS Foundation Trust · GBNorth Bristol NHS Trust · GBNottingham Biomedical Research Centre · GBUniversity of Bath · GBUniversity Of Bristol Dental Hospital · GBUniversity of Warwick · GB

Funding

National Institute for Health and Care Research NIHR202618
6 · The paper itself

Abstract

backgroundThe 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.

methodsParticipants 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.

resultsOverall, 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.

conclusionsThe 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 registrationISRCTN: 92,545,361.

Indexed as

Arthroplasty, Replacement, KneeChronic PainCost-Benefit AnalysisCritical PathwaysFollow-Up StudiesHumansQuality-Adjusted Life YearsQuality of LifeState MedicineTreatment OutcomeCare pathwayChronic post-surgical painOsteoarthritisTotal knee replacement

Identifiers

PMID38102656
PMCPMC10725008
OpenAlexW4389804745

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.