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Andrew Moore

University of Bristol, Translational Health Sciences, Faculty Member

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I am a qualitative methodologist and Associate Professor in Musculoskeletal Health Services Research, at the Bristol Medical School. My research broadly focuses on the human experience of health and illness. I have an interest in musculoskeletal conditions; orthopaedic outcomes; ageing and physical activity.

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Queen's University Belfast

Christian Munthe

University of Gothenburg

Eric S . Kim (UBC)

University of British Columbia

Ruben López-Cano

Escola Superior de Música de Catalunya

Kansas State University

Fordham University

Adriano Cancellieri

Università degli Studi di Milano-Bicocca

Cleveland Clinic

Johns Hopkins University

Johns Hopkins University

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Papers by Andrew Moore

Clinical and cost effectiveness of single stage compared with two stage revision for hip prosthetic joint infection (INFORM): pragmatic, parallel group, open label, randomised controlled trial

BMJ

Objectives To determine whether patient reported outcomes improve after single stage versus two s... more Objectives To determine whether patient reported outcomes improve after single stage versus two stage revision surgery for prosthetic joint infection of the hip, and to determine the cost effectiveness of these procedures. Design Pragmatic, parallel group, open label, randomised controlled trial. Setting High volume tertiary referral centres or orthopaedic units in the UK (n=12) and in Sweden (n=3), recruiting from 1 March 2015 to 19 December 2018. Participants 140 adults (aged ≥18 years) with a prosthetic joint infection of the hip who required revision (65 randomly assigned to single stage and 75 to two stage revision). Interventions A computer generated 1:1 randomisation list stratified by hospital was used to allocate participants with prosthetic joint infection of the hip to a single stage or a two stage revision procedure. Main outcome measures The primary intention-to-treat outcome was pain, stiffness, and functional limitations 18 months after randomisation, measured by the ...

Healthcare professionals’ views on implementing the STAR care pathway for people with chronic pain after total knee replacement: A qualitative study

PLOS ONE

For many people with advanced osteoarthritis, total knee replacement is an effective treatment to... more For many people with advanced osteoarthritis, total knee replacement is an effective treatment to relieve pain and improve function. However, 10–34% of people experience chronic postsurgical pain in the months and years after total knee replacement. The Support and Treatment After Replacement (STAR) randomised controlled trial (ISCRTN92545361) evaluated the clinical- and cost-effectiveness of a new multifaceted and personalised care pathway, compared with usual care, for people with pain at three months after total knee replacement. Our objective was to identify factors promoting or inhibiting its implementation, and to inform future training and wider implementation of the pathway. We conducted a prospective process evaluation using qualitative interviews with eight Extended Scope Practitioners and six Principal Investigators from seven trial sites who were involved in delivering the STAR care pathway during the trial. We used Normalization Process Theory as a theoretical framework...

Distinctiveness of long-term pain that does not interfere with life: An observational cohort study

European Journal of Pain, 2012

Background: Reporting of pain that does not interfere with life is common in the older population... more Background: Reporting of pain that does not interfere with life is common in the older population but little is known about people with such long-term non-interfering pain. Objectives: To assess whether non-interfering pain can be a long-term state, and to compare this group with those who continuously report no pain, and with those with chronic pain that interferes with life. Methods: This was a prospective general population cohort study set within the North Staffordshire Osteoarthritis Project (NorStOP). People aged 50 plus were sent baseline, 3-year and 6-year questionnaires. Those who reported the same pain status (no pain, non-interfering pain, interfering pain) at each time point were compared on pain intensity, widespread pain and medication, and on sociodemographic and co-morbid characteristics at 6 years. Results: Forty percent of responders reported the same pain status at each time point; 12% reported long-term non-interfering pain. Fifty-nine percent of those with non-interfering pain reported at least one site of high pain intensity, 33% reported widespread pain, and 90% had used pain medication in the past 4 weeks. This group was similar to the no-pain group but distinct on sociodemographic and co-morbid measures from those with pain that interfered. Conclusions: Long-term non-interfering pain is common, but despite often suffering from high pain intensity and widespread pain, those within this group seem to be able to control their pain without allowing it to affect their everyday lives. Future work is needed to assess how people with long-term pain ensure it does not cause interference with life.

Development of evidence-based guidelines for the treatment and management of periprosthetic hip infection

Bone & Joint Open

AimsPeriprosthetic hip-joint infection is a multifaceted and highly detrimental outcome for patie... more AimsPeriprosthetic hip-joint infection is a multifaceted and highly detrimental outcome for patients and clinicians. The incidence of prosthetic joint infection reported within two years of primary hip arthroplasty ranges from 0.8% to 2.1%. Costs of treatment are over five-times greater in people with periprosthetic hip joint infection than in those with no infection. Currently, there are no national evidence-based guidelines for treatment and management of this condition to guide clinical practice or to inform clinical study design. The aim of this study is to develop guidelines based on evidence from the six-year INFection and ORthopaedic Management (INFORM) research programme.MethodsWe used a consensus process consisting of an evidence review to generate items for the guidelines and online consensus questionnaire and virtual face-to-face consensus meeting to draft the guidelines.ResultsThe consensus panel comprised 21 clinical experts in orthopaedics, primary care, rehabilitation...

Living Well With Chronic Pain in Later Life: The Role and Meaning of Activity and Involvement

Activities, Adaptation & Aging, 2015

Living well with chronic pain in later life: the role and meaning of activity and involvement Abs... more Living well with chronic pain in later life: the role and meaning of activity and involvement Abstract Objective: To examine how older people can best be helped to live well with musculoskeletal pain. Methods: A mixed-methods study integrating quantitative analysis of a longitudinal cohort survey with 60 semi-structured interviews. Results: Comparison of 'expected' to 'reported' interference suggested that social activity, physical activity, and 'involvement' were important for participants who reported minimal interference from their pain. Discussion: For many older people with chronic pain, activity and involvement may not simply be outcomes of living with minimal interference from pain, but factors that contribute to this outcome and give meaning to their lives.

Experiences of recovery and a new care pathway for people with pain after total knee replacement: qualitative research embedded in the STAR trial

BMC Musculoskeletal Disorders

Background Approximately 20% of people experience chronic postsurgical pain after total knee repl... more Background Approximately 20% of people experience chronic postsurgical pain after total knee replacement. The STAR randomised controlled trial (ISCRTN92545361) evaluated the clinical- and cost-effectiveness of a new multifaceted and personalised care pathway, compared with usual care, for people with pain at three months after total knee replacement. We report trial participants’ experiences of postoperative pain and the acceptability of the STAR care pathway, which consisted of an assessment clinic at three months, and up to six follow-up telephone calls over 12 months. Methods Semi-structured interviews were conducted with 27 people (10 men, 17 women) between February 2018 and January 2020. Participants were sampled purposively from the care pathway intervention group and interviewed after completion of the final postoperative trial questionnaire at approximately 15 months after knee replacement. Interviews were audio-recorded, transcribed, anonymised and analysed using inductive ...

Expertise and trust a qualitative study of orthopaedic surgeons’ provision of professional care for patients with painful osteoarthritis

“It’s not my knee” – understanding ongoing pain and discomfort after total knee replacement through (re)embodiment

Arthritis Care & Research, 2020

Objective: Up to 20% of people who undergo total knee replacement surgery have ongoing pain and d... more Objective: Up to 20% of people who undergo total knee replacement surgery have ongoing pain and discomfort. The aim of this study was to understand what role the concepts of embodiment (of both having a body and experiencing the world through one's body) and incorporation (integrating something into one's body) might have in understanding experiences of pain and discomfort after total knee replacement. Methods: We conducted semi-structured interviews with 34 people who had received total knee replacement at either of two National Health Service hospitals in the United Kingdom, and who had chronic post-surgical pain (n=34, age 55-93 years). Data were audio-recorded, transcribed and analysed thematically. Results: Two main themes were identified: 1) When describing chronic post-surgical pain, some participants also described sensations of discomfort including heaviness, numbness, pressure and tightness associated with the prosthesis; 2) Participants reported a lack of felt connection with and agency over their replaced knee, often describing it as alien or other, and lacked confidence in the knee. Conclusion: Participants' experiences indicate that some people do not achieve full incorporation

What narrative devices do people with systemic sclerosis use to describe the experience of pain from digital ulcers: a multicentre focus group study at UK scleroderma centres

BMJ Open, 2020

ObjectivesDigital ulcers (DUs) are a common complication in systemic sclerosis (SSc). No existing... more ObjectivesDigital ulcers (DUs) are a common complication in systemic sclerosis (SSc). No existing studies have specifically reported on the qualitative patient experience of DU pain, and our current patient-reported outcome measure (PROM) does not capture the multifaceted painful experience of SSc-DU. Our aim was to examine the patient experience of SSc-DU pain.DesignFocus groups with people diagnosed with SSc who had experienced DUs were conducted using a topic guide developed by people with SSc, experts in SSc and experienced qualitative researchers. Focus groups were continued until data saturation had been reached. The focus groups were audio recorded, transcribed verbatim, anonymised and analysed using inductive thematic analysis. Our current study is an integration of the data from these focus groups to specifically examine the patient experience of DU pain.SettingThree specialist scleroderma units across the UK (Bath, Manchester and London).ParticipantsFour focus groups were ...

Interpreting intracorporeal landscapes: how patients visualize pathophysiology and utilize medical images in their understanding of chronic musculoskeletal illness

Disability and rehabilitation, Jan 26, 2018

Medical science and other sources, such as the media, increasingly inform the general public'... more Medical science and other sources, such as the media, increasingly inform the general public's understanding of disease. There is often discordance between this understanding and the diagnostic interpretations of health care practitioners (HCPs). In this paper - based on a supra-analysis of qualitative interview data from two studies of joint pain, including osteoarthritis - we investigate how people imagine and make sense of the pathophysiology of their illness, and how these understandings may affect self-management behavior. We then explore how HCPs' use of medical images and models can inform patients' understanding. In conceptualizing their illness to make sense of their experience of the disease, individuals often used visualizations of their inner body; these images may arise from their own lay understanding, or may be based on images provided by HCPs. When HCPs used anatomical models or medical images judiciously, patients' orientation to their illness change...

A UK national survey of care pathways and support offered to patients receiving revision surgery for prosthetic joint infection in the highest volume NHS orthopaedic centres

Musculoskeletal care, Dec 23, 2017

Deep prosthetic joint infection (PJI) is a devastating complication of joint replacement surgery.... more Deep prosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. It is difficult to treat, and patients often require multiple major revision surgeries to eradicate the infection. Treatment can have negative and long-term impact on patients' quality of life. Understanding current service provision provides valuable information needed to design and evaluate support interventions for patients. This survey aimed to identify usual care pathways and support in UK National Health Service (NHS) orthopaedic centres for patients receiving revision surgery for PJI after hip or knee replacement. The 20 highest volume NHS orthopaedic centres treating prosthetic joint infection after hip or knee replacement were approached. Consultant orthopaedic surgeons specializing in treating PJI were invited to participate in a telephone or email survey about usual care provision and support for PJI. Sixteen centres completed the survey. Findings showed a high degree of ...

Deep prosthetic joint infection: a qualitative study of the impact on patients and their experiences of revision surgery

BMJ open, Jan 7, 2015

Around 1% of patients who have a hip replacement have deep prosthetic joint infection (PJI) after... more Around 1% of patients who have a hip replacement have deep prosthetic joint infection (PJI) afterwards. PJI is often treated with antibiotics plus a single revision operation (1-stage revision), or antibiotics plus a 2-stage revision process involving more than 1 operation. This study aimed to characterise the impact and experience of PJI and treatment on patients, including comparison of 1-stage with 2-stage revision treatment. Qualitative semistructured interviews with patients who had undergone surgical revision treatment for PJI. Patients were interviewed between 2 weeks and 12 months postdischarge. Data were audio-recorded, transcribed, anonymised and analysed using a thematic approach, with 20% of transcripts double-coded. Patients from 5 National Health Service (NHS) orthopaedic departments treating PJI in England and Wales were interviewed in their homes (n=18) or at hospital (n=1). 19 patients participated (12 men, 7 women, age range 56-88 years, mean age 73.2 years). Parti...

Appropriated landscapes: the intrusion of technology and equipment into the homes and lives of families with a child with complex needs

Journal of Child Health Care, 2010

‘I am closer to this place’—Space, place and notions of home in lived experiences of hospice day care

Health & Place, 2013

In the United Kingdom hospice day care services are the fastest growing yet least researched of t... more In the United Kingdom hospice day care services are the fastest growing yet least researched of the palliative care services. Using photo-elicitation interviews with 11 day care patients attending a specialist hospice day care setting we explored their experiences of the hospice as a place and how these changed over time. Informed by concepts from existential and humanistic geography we propose three existential modes of being -Drifting, Sheltering and Venturing -which characterize the patients' lived experiences of the hospice. Our phenomenological analysis shows that the hospice is (re)constructed purposefully to achieve a sense of 'home' and 'homelikeness', creating an important therapeutic landscape for patients.

Older People’s Perceptions of Remaining Physically Active and Living With Chronic Pain

Qualitative Health Research, 2014

Active aging, using the conventional sense of activity, might be difficult to achieve for people ... more Active aging, using the conventional sense of activity, might be difficult to achieve for people with chronic musculoskeletal pain (CMP). Given that a large number of older people will develop CMP, it is important to consider a broader conceptualization of activity and how this might fit into discourses of aging. We report findings from a study of the experiences of chronic pain in the daily life of 60 older people. In this article we focus on the role and meanings of physical activity for those older people. We develop a typology of styles—deliberate, strategic, and natural—to show how people approached physical activity and how its meaning differed for individuals in different contexts and across their life course. We suggest a more balanced perspective of aging in which “slowing down” might also be a desirable outcome for some older people with CMP but is not incompatible with well-being.

Needs and Support for Patients Undergoing Treatment for Prosthetic Joint Infection following Hip or Knee Arthroplasty: A Systematic

Background Hip and knee arthroplasty are common interventions for the treatment of joint conditio... more Background Hip and knee arthroplasty are common interventions for the treatment of joint conditions, most notably osteoarthritis. Although many patients benefit from surgery, approximately 1% of patients develop infection afterwards known as deep prosthetic joint infection (PJI), which often requires further major surgery. Objective To assess support needs of patients undergoing treatment for PJI following hip or knee arthroplasty and to identify and evaluate what interventions are routinely offered to support such patients. Design Systematic review Data sources MEDLINE, EMBASE, Web of Science, PsycINFO, Cinahl, Social Science Citation Index, The Cochrane Library, and reference lists of relevant studies from January 01, 1980 to October 05, 2016. Selection criteria Observational (prospective or retrospective cohort, nested case-control or case-control) studies, qualitative studies, or clinical trials conducted in patients treated for PJI and/or other major adverse occurrences followi...

What are patients’ preferences for revision surgery after periprosthetic joint infection? A discrete choice experiment

BMJ Open

ObjectivesUnderstanding patients’ preferences for treatment is crucial to provision of good care ... more ObjectivesUnderstanding patients’ preferences for treatment is crucial to provision of good care and shared decisions, especially when more than one treatment option exists for a given condition. One such condition is infection of the area around the prosthesis after hip replacement, which affects between 0.4% and 3% of patients. There is more than one treatment option for this major complication, and our study aimed to assess the value that patients place on aspects of revision surgery for periprosthetic hip infection.DesignWe identified four attributes of revision surgery for periprosthetic hip infection. Using a discrete choice experiment (DCE), we measured the value placed on each attribute by 57 people who had undergone either one-stage or two-stage revision surgery for infection.SettingThe DCE was conducted with participants from nine National Health Service hospitals in the UK.ParticipantsAdults who had undergone revision surgery for periprosthetic hip infection (N=57).Result...

Surgeons are deeply affected when patients are diagnosed with prosthetic joint infection

PLOS ONE

Knee replacement is a common preference sensitive quality-of-life procedure that can reduce pain ... more Knee replacement is a common preference sensitive quality-of-life procedure that can reduce pain and improve function for people with advanced knee arthritis. While most patients improve, knee replacement surgery has the potential for serious complications. Prosthetic knee infection is an uncommon but serious complication. This study explored the impact of cases of prosthetic knee infection on surgeons' personal and professional wellbeing. Qualitative telephone interviews were conducted with consultant orthopaedic surgeons who treated patients for prosthetic knee infection in one of six high-volume NHS orthopaedic departments. Data was audio-recorded, transcribed and analysed thematically. Eleven surgeons took part. Analysis identified three overarching themes: (i) At some point infection is inevitable but surgeons still feel accountable; (ii) A profound emotional impact and (iii) Supporting each other. The occurrence of prosthetic joint infection has a significant emotional impact on surgeons who report a collective sense of devastation and personal ownership, even though prosthetic joint infection cannot be fully controlled for. Surgeons stressed the importance of openly discussing the management of prosthetic joint infection with a supportive multidisciplinary team and this has implications for the ways in which orthopaedic surgeons may be best supported to manage this complication. This article also acknowledges that surgeons are not alone in experiencing personal impact when patients have infection.

Law, ethics and end-of-life care: the policy and practice interface in England

International journal of palliative nursing, Jan 2, 2017

Health Care Needs and Support for Patients Undergoing Treatment for Prosthetic Joint Infection following Hip or Knee Arthroplasty: A Systematic Review

PloS one, 2017

Hip and knee arthroplasty are common interventions for the treatment of joint conditions, most no... more Hip and knee arthroplasty are common interventions for the treatment of joint conditions, most notably osteoarthritis. Although many patients benefit from surgery, approximately 1% of patients develop infection afterwards known as deep prosthetic joint infection (PJI), which often requires further major surgery. To assess support needs of patients undergoing treatment for PJI following hip or knee arthroplasty and to identify and evaluate what interventions are routinely offered to support such patients. Systematic review. MEDLINE, EMBASE, Web of Science, PsycINFO, Cinahl, Social Science Citation Index, The Cochrane Library, and reference lists of relevant studies from January 01, 1980 to October 05, 2016. Observational (prospective or retrospective cohort, nested case-control or case-control) studies, qualitative studies, or clinical trials conducted in patients treated for PJI and/or other major adverse occurrences following hip or knee arthroplasty. Data were extracted by two ind...

Clinical and cost effectiveness of single stage compared with two stage revision for hip prosthetic joint infection (INFORM): pragmatic, parallel group, open label, randomised controlled trial

BMJ

Objectives To determine whether patient reported outcomes improve after single stage versus two s... more Objectives To determine whether patient reported outcomes improve after single stage versus two stage revision surgery for prosthetic joint infection of the hip, and to determine the cost effectiveness of these procedures. Design Pragmatic, parallel group, open label, randomised controlled trial. Setting High volume tertiary referral centres or orthopaedic units in the UK (n=12) and in Sweden (n=3), recruiting from 1 March 2015 to 19 December 2018. Participants 140 adults (aged ≥18 years) with a prosthetic joint infection of the hip who required revision (65 randomly assigned to single stage and 75 to two stage revision). Interventions A computer generated 1:1 randomisation list stratified by hospital was used to allocate participants with prosthetic joint infection of the hip to a single stage or a two stage revision procedure. Main outcome measures The primary intention-to-treat outcome was pain, stiffness, and functional limitations 18 months after randomisation, measured by the ...

Healthcare professionals’ views on implementing the STAR care pathway for people with chronic pain after total knee replacement: A qualitative study

PLOS ONE

For many people with advanced osteoarthritis, total knee replacement is an effective treatment to... more For many people with advanced osteoarthritis, total knee replacement is an effective treatment to relieve pain and improve function. However, 10–34% of people experience chronic postsurgical pain in the months and years after total knee replacement. The Support and Treatment After Replacement (STAR) randomised controlled trial (ISCRTN92545361) evaluated the clinical- and cost-effectiveness of a new multifaceted and personalised care pathway, compared with usual care, for people with pain at three months after total knee replacement. Our objective was to identify factors promoting or inhibiting its implementation, and to inform future training and wider implementation of the pathway. We conducted a prospective process evaluation using qualitative interviews with eight Extended Scope Practitioners and six Principal Investigators from seven trial sites who were involved in delivering the STAR care pathway during the trial. We used Normalization Process Theory as a theoretical framework...

Distinctiveness of long-term pain that does not interfere with life: An observational cohort study

European Journal of Pain, 2012

Background: Reporting of pain that does not interfere with life is common in the older population... more Background: Reporting of pain that does not interfere with life is common in the older population but little is known about people with such long-term non-interfering pain. Objectives: To assess whether non-interfering pain can be a long-term state, and to compare this group with those who continuously report no pain, and with those with chronic pain that interferes with life. Methods: This was a prospective general population cohort study set within the North Staffordshire Osteoarthritis Project (NorStOP). People aged 50 plus were sent baseline, 3-year and 6-year questionnaires. Those who reported the same pain status (no pain, non-interfering pain, interfering pain) at each time point were compared on pain intensity, widespread pain and medication, and on sociodemographic and co-morbid characteristics at 6 years. Results: Forty percent of responders reported the same pain status at each time point; 12% reported long-term non-interfering pain. Fifty-nine percent of those with non-interfering pain reported at least one site of high pain intensity, 33% reported widespread pain, and 90% had used pain medication in the past 4 weeks. This group was similar to the no-pain group but distinct on sociodemographic and co-morbid measures from those with pain that interfered. Conclusions: Long-term non-interfering pain is common, but despite often suffering from high pain intensity and widespread pain, those within this group seem to be able to control their pain without allowing it to affect their everyday lives. Future work is needed to assess how people with long-term pain ensure it does not cause interference with life.

Development of evidence-based guidelines for the treatment and management of periprosthetic hip infection

Bone & Joint Open

AimsPeriprosthetic hip-joint infection is a multifaceted and highly detrimental outcome for patie... more AimsPeriprosthetic hip-joint infection is a multifaceted and highly detrimental outcome for patients and clinicians. The incidence of prosthetic joint infection reported within two years of primary hip arthroplasty ranges from 0.8% to 2.1%. Costs of treatment are over five-times greater in people with periprosthetic hip joint infection than in those with no infection. Currently, there are no national evidence-based guidelines for treatment and management of this condition to guide clinical practice or to inform clinical study design. The aim of this study is to develop guidelines based on evidence from the six-year INFection and ORthopaedic Management (INFORM) research programme.MethodsWe used a consensus process consisting of an evidence review to generate items for the guidelines and online consensus questionnaire and virtual face-to-face consensus meeting to draft the guidelines.ResultsThe consensus panel comprised 21 clinical experts in orthopaedics, primary care, rehabilitation...

Living Well With Chronic Pain in Later Life: The Role and Meaning of Activity and Involvement

Activities, Adaptation & Aging, 2015

Living well with chronic pain in later life: the role and meaning of activity and involvement Abs... more Living well with chronic pain in later life: the role and meaning of activity and involvement Abstract Objective: To examine how older people can best be helped to live well with musculoskeletal pain. Methods: A mixed-methods study integrating quantitative analysis of a longitudinal cohort survey with 60 semi-structured interviews. Results: Comparison of 'expected' to 'reported' interference suggested that social activity, physical activity, and 'involvement' were important for participants who reported minimal interference from their pain. Discussion: For many older people with chronic pain, activity and involvement may not simply be outcomes of living with minimal interference from pain, but factors that contribute to this outcome and give meaning to their lives.

Experiences of recovery and a new care pathway for people with pain after total knee replacement: qualitative research embedded in the STAR trial

BMC Musculoskeletal Disorders

Background Approximately 20% of people experience chronic postsurgical pain after total knee repl... more Background Approximately 20% of people experience chronic postsurgical pain after total knee replacement. The STAR randomised controlled trial (ISCRTN92545361) evaluated the clinical- and cost-effectiveness of a new multifaceted and personalised care pathway, compared with usual care, for people with pain at three months after total knee replacement. We report trial participants’ experiences of postoperative pain and the acceptability of the STAR care pathway, which consisted of an assessment clinic at three months, and up to six follow-up telephone calls over 12 months. Methods Semi-structured interviews were conducted with 27 people (10 men, 17 women) between February 2018 and January 2020. Participants were sampled purposively from the care pathway intervention group and interviewed after completion of the final postoperative trial questionnaire at approximately 15 months after knee replacement. Interviews were audio-recorded, transcribed, anonymised and analysed using inductive ...

Expertise and trust a qualitative study of orthopaedic surgeons’ provision of professional care for patients with painful osteoarthritis

“It’s not my knee” – understanding ongoing pain and discomfort after total knee replacement through (re)embodiment

Arthritis Care & Research, 2020

Objective: Up to 20% of people who undergo total knee replacement surgery have ongoing pain and d... more Objective: Up to 20% of people who undergo total knee replacement surgery have ongoing pain and discomfort. The aim of this study was to understand what role the concepts of embodiment (of both having a body and experiencing the world through one's body) and incorporation (integrating something into one's body) might have in understanding experiences of pain and discomfort after total knee replacement. Methods: We conducted semi-structured interviews with 34 people who had received total knee replacement at either of two National Health Service hospitals in the United Kingdom, and who had chronic post-surgical pain (n=34, age 55-93 years). Data were audio-recorded, transcribed and analysed thematically. Results: Two main themes were identified: 1) When describing chronic post-surgical pain, some participants also described sensations of discomfort including heaviness, numbness, pressure and tightness associated with the prosthesis; 2) Participants reported a lack of felt connection with and agency over their replaced knee, often describing it as alien or other, and lacked confidence in the knee. Conclusion: Participants' experiences indicate that some people do not achieve full incorporation

What narrative devices do people with systemic sclerosis use to describe the experience of pain from digital ulcers: a multicentre focus group study at UK scleroderma centres

BMJ Open, 2020

ObjectivesDigital ulcers (DUs) are a common complication in systemic sclerosis (SSc). No existing... more ObjectivesDigital ulcers (DUs) are a common complication in systemic sclerosis (SSc). No existing studies have specifically reported on the qualitative patient experience of DU pain, and our current patient-reported outcome measure (PROM) does not capture the multifaceted painful experience of SSc-DU. Our aim was to examine the patient experience of SSc-DU pain.DesignFocus groups with people diagnosed with SSc who had experienced DUs were conducted using a topic guide developed by people with SSc, experts in SSc and experienced qualitative researchers. Focus groups were continued until data saturation had been reached. The focus groups were audio recorded, transcribed verbatim, anonymised and analysed using inductive thematic analysis. Our current study is an integration of the data from these focus groups to specifically examine the patient experience of DU pain.SettingThree specialist scleroderma units across the UK (Bath, Manchester and London).ParticipantsFour focus groups were ...

Interpreting intracorporeal landscapes: how patients visualize pathophysiology and utilize medical images in their understanding of chronic musculoskeletal illness

Disability and rehabilitation, Jan 26, 2018

Medical science and other sources, such as the media, increasingly inform the general public'... more Medical science and other sources, such as the media, increasingly inform the general public's understanding of disease. There is often discordance between this understanding and the diagnostic interpretations of health care practitioners (HCPs). In this paper - based on a supra-analysis of qualitative interview data from two studies of joint pain, including osteoarthritis - we investigate how people imagine and make sense of the pathophysiology of their illness, and how these understandings may affect self-management behavior. We then explore how HCPs' use of medical images and models can inform patients' understanding. In conceptualizing their illness to make sense of their experience of the disease, individuals often used visualizations of their inner body; these images may arise from their own lay understanding, or may be based on images provided by HCPs. When HCPs used anatomical models or medical images judiciously, patients' orientation to their illness change...

A UK national survey of care pathways and support offered to patients receiving revision surgery for prosthetic joint infection in the highest volume NHS orthopaedic centres

Musculoskeletal care, Dec 23, 2017

Deep prosthetic joint infection (PJI) is a devastating complication of joint replacement surgery.... more Deep prosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. It is difficult to treat, and patients often require multiple major revision surgeries to eradicate the infection. Treatment can have negative and long-term impact on patients' quality of life. Understanding current service provision provides valuable information needed to design and evaluate support interventions for patients. This survey aimed to identify usual care pathways and support in UK National Health Service (NHS) orthopaedic centres for patients receiving revision surgery for PJI after hip or knee replacement. The 20 highest volume NHS orthopaedic centres treating prosthetic joint infection after hip or knee replacement were approached. Consultant orthopaedic surgeons specializing in treating PJI were invited to participate in a telephone or email survey about usual care provision and support for PJI. Sixteen centres completed the survey. Findings showed a high degree of ...

Deep prosthetic joint infection: a qualitative study of the impact on patients and their experiences of revision surgery

BMJ open, Jan 7, 2015

Around 1% of patients who have a hip replacement have deep prosthetic joint infection (PJI) after... more Around 1% of patients who have a hip replacement have deep prosthetic joint infection (PJI) afterwards. PJI is often treated with antibiotics plus a single revision operation (1-stage revision), or antibiotics plus a 2-stage revision process involving more than 1 operation. This study aimed to characterise the impact and experience of PJI and treatment on patients, including comparison of 1-stage with 2-stage revision treatment. Qualitative semistructured interviews with patients who had undergone surgical revision treatment for PJI. Patients were interviewed between 2 weeks and 12 months postdischarge. Data were audio-recorded, transcribed, anonymised and analysed using a thematic approach, with 20% of transcripts double-coded. Patients from 5 National Health Service (NHS) orthopaedic departments treating PJI in England and Wales were interviewed in their homes (n=18) or at hospital (n=1). 19 patients participated (12 men, 7 women, age range 56-88 years, mean age 73.2 years). Parti...

Appropriated landscapes: the intrusion of technology and equipment into the homes and lives of families with a child with complex needs

Journal of Child Health Care, 2010

‘I am closer to this place’—Space, place and notions of home in lived experiences of hospice day care

Health & Place, 2013

In the United Kingdom hospice day care services are the fastest growing yet least researched of t... more In the United Kingdom hospice day care services are the fastest growing yet least researched of the palliative care services. Using photo-elicitation interviews with 11 day care patients attending a specialist hospice day care setting we explored their experiences of the hospice as a place and how these changed over time. Informed by concepts from existential and humanistic geography we propose three existential modes of being -Drifting, Sheltering and Venturing -which characterize the patients' lived experiences of the hospice. Our phenomenological analysis shows that the hospice is (re)constructed purposefully to achieve a sense of 'home' and 'homelikeness', creating an important therapeutic landscape for patients.

Older People’s Perceptions of Remaining Physically Active and Living With Chronic Pain

Qualitative Health Research, 2014

Active aging, using the conventional sense of activity, might be difficult to achieve for people ... more Active aging, using the conventional sense of activity, might be difficult to achieve for people with chronic musculoskeletal pain (CMP). Given that a large number of older people will develop CMP, it is important to consider a broader conceptualization of activity and how this might fit into discourses of aging. We report findings from a study of the experiences of chronic pain in the daily life of 60 older people. In this article we focus on the role and meanings of physical activity for those older people. We develop a typology of styles—deliberate, strategic, and natural—to show how people approached physical activity and how its meaning differed for individuals in different contexts and across their life course. We suggest a more balanced perspective of aging in which “slowing down” might also be a desirable outcome for some older people with CMP but is not incompatible with well-being.

Needs and Support for Patients Undergoing Treatment for Prosthetic Joint Infection following Hip or Knee Arthroplasty: A Systematic

Background Hip and knee arthroplasty are common interventions for the treatment of joint conditio... more Background Hip and knee arthroplasty are common interventions for the treatment of joint conditions, most notably osteoarthritis. Although many patients benefit from surgery, approximately 1% of patients develop infection afterwards known as deep prosthetic joint infection (PJI), which often requires further major surgery. Objective To assess support needs of patients undergoing treatment for PJI following hip or knee arthroplasty and to identify and evaluate what interventions are routinely offered to support such patients. Design Systematic review Data sources MEDLINE, EMBASE, Web of Science, PsycINFO, Cinahl, Social Science Citation Index, The Cochrane Library, and reference lists of relevant studies from January 01, 1980 to October 05, 2016. Selection criteria Observational (prospective or retrospective cohort, nested case-control or case-control) studies, qualitative studies, or clinical trials conducted in patients treated for PJI and/or other major adverse occurrences followi...

What are patients’ preferences for revision surgery after periprosthetic joint infection? A discrete choice experiment

BMJ Open

ObjectivesUnderstanding patients’ preferences for treatment is crucial to provision of good care ... more ObjectivesUnderstanding patients’ preferences for treatment is crucial to provision of good care and shared decisions, especially when more than one treatment option exists for a given condition. One such condition is infection of the area around the prosthesis after hip replacement, which affects between 0.4% and 3% of patients. There is more than one treatment option for this major complication, and our study aimed to assess the value that patients place on aspects of revision surgery for periprosthetic hip infection.DesignWe identified four attributes of revision surgery for periprosthetic hip infection. Using a discrete choice experiment (DCE), we measured the value placed on each attribute by 57 people who had undergone either one-stage or two-stage revision surgery for infection.SettingThe DCE was conducted with participants from nine National Health Service hospitals in the UK.ParticipantsAdults who had undergone revision surgery for periprosthetic hip infection (N=57).Result...

Surgeons are deeply affected when patients are diagnosed with prosthetic joint infection

PLOS ONE

Knee replacement is a common preference sensitive quality-of-life procedure that can reduce pain ... more Knee replacement is a common preference sensitive quality-of-life procedure that can reduce pain and improve function for people with advanced knee arthritis. While most patients improve, knee replacement surgery has the potential for serious complications. Prosthetic knee infection is an uncommon but serious complication. This study explored the impact of cases of prosthetic knee infection on surgeons' personal and professional wellbeing. Qualitative telephone interviews were conducted with consultant orthopaedic surgeons who treated patients for prosthetic knee infection in one of six high-volume NHS orthopaedic departments. Data was audio-recorded, transcribed and analysed thematically. Eleven surgeons took part. Analysis identified three overarching themes: (i) At some point infection is inevitable but surgeons still feel accountable; (ii) A profound emotional impact and (iii) Supporting each other. The occurrence of prosthetic joint infection has a significant emotional impact on surgeons who report a collective sense of devastation and personal ownership, even though prosthetic joint infection cannot be fully controlled for. Surgeons stressed the importance of openly discussing the management of prosthetic joint infection with a supportive multidisciplinary team and this has implications for the ways in which orthopaedic surgeons may be best supported to manage this complication. This article also acknowledges that surgeons are not alone in experiencing personal impact when patients have infection.

Law, ethics and end-of-life care: the policy and practice interface in England

International journal of palliative nursing, Jan 2, 2017

Health Care Needs and Support for Patients Undergoing Treatment for Prosthetic Joint Infection following Hip or Knee Arthroplasty: A Systematic Review

PloS one, 2017

Hip and knee arthroplasty are common interventions for the treatment of joint conditions, most no... more Hip and knee arthroplasty are common interventions for the treatment of joint conditions, most notably osteoarthritis. Although many patients benefit from surgery, approximately 1% of patients develop infection afterwards known as deep prosthetic joint infection (PJI), which often requires further major surgery. To assess support needs of patients undergoing treatment for PJI following hip or knee arthroplasty and to identify and evaluate what interventions are routinely offered to support such patients. Systematic review. MEDLINE, EMBASE, Web of Science, PsycINFO, Cinahl, Social Science Citation Index, The Cochrane Library, and reference lists of relevant studies from January 01, 1980 to October 05, 2016. Observational (prospective or retrospective cohort, nested case-control or case-control) studies, qualitative studies, or clinical trials conducted in patients treated for PJI and/or other major adverse occurrences following hip or knee arthroplasty. Data were extracted by two ind...