Facilitating translation of trial findings into NHS practice : case study of the Support and Treatment After Replacement (STAR) care pathway.

Aims: The Support and Treatment After Replacement (STAR) care pathway is a clinically important, cost-effective treatment to improve pain outcomes over one year for people with chronic pain three months after total knee arthroplasty. This work describes the implementation of trial findings in practice at one NHS hospital and the further work undertaken to support national implementation. Methods: Trial findings were presented to NHS managers with a business case for a pilot embedded in usual care. Trial documentation was adapted using the capability, opportunity, motivation, and behaviour (COM-B) model for behaviour change and evidence-based approaches to increase questionnaire responses. Trial sites were contacted to understand their capacity to pilot the intervention. Results: The STAR care pathway was successfully implemented into NHS practice with a screening response rate of 89%. It is now permanently part of usual care at North Bristol NHS Trust. Trial centres indicated that lack of trained extended scope practitioners was a barrier to implementation. The trial manual and training sessions were adapted into an online training package. Conclusion: The STAR care pathway has been successfully embedded into NHS care at one hospital. A toolkit and online clinician training package supports wider implementation.