Background Total hip arthroplasty (THA) is a highly effective procedure for improving pain and function in patients with advanced joint degeneration; however, revision surgery may be required because of complications or implant wear. Revision THA (rTHA) has a higher in-hospital mortality rate, longer hospital length of stay, are at higher risk of re-revision surgery and have worse physical and mental health outcome measures compared with primary THAs. The introduction of specialist revision hubs also means that patients frequently travel further for surgery. No specific guidelines have been established for rehabilitation after rTHA, leading to large variations in practice and potentially inadequate provision. We hypothesise that delivering a tailored physiotherapy intervention will improve and sustain greater functional outcomes and health-related quality of life compared with standard protocols currently in place. The aim of this study is to determine the feasibility and explore the acceptability of a trial investigating the effectiveness of a tailored physiotherapy intervention after rTHA.Methods and analysis Multicentre, parallel two-arm feasibility randomised controlled trial with an embedded qualitative study. A total of 60 participants will be recruited from at least four UK NHS secondary care hospitals and randomly allocated (1:1 ratio) to either the tailored physiotherapy rehabilitation (THRIVE) programme or a standardised usual care arm. Eligible adults will be undergoing a single or final stage rTHA and participating in outpatient physiotherapy. Feasibility outcomes include recruitment rate, retention rate, adherence rate, intervention fidelity, outcome measure completion and acceptability of the intervention. Research assessments consisting of patient-reported and performance-based measures will occur preoperatively (baseline), with follow-ups at 4 and 8 months postoperatively. Feasibility data will be analysed using descriptive statistics. The embedded qualitative study will include trial participants and physiotherapists from the THRIVE arm to explore their experience of the trial and understand measures to improve the delivery of a future trial.Ethics and dissemination The study has received ethical approval (West of Scotland REC 25/WS/0080), and all participants will provide informed consent. It will assess trial feasibility while exploring operational and safety challenges, including recruitment barriers and the potential value of a hub-and-spoke model for delivering physiotherapy. Findings will be disseminated through trial registry reporting, peer-reviewed open-access publication, conference presentations and participant summaries, with reporting aligned to CONSORT guidelines for pilot and feasibility trials.Trial registration number ISRCTN10649335.

BACKGROUND:Urinary tract infections (UTIs) are common in primary care. Qualitative studies suggest that the way primary care practitioners (PCPs) manage UTIs may be influenced by a complex interplay of factors. AIM:To explore views, perceptions, and experiences of PCPs in the management of UTIs. DESIGN AND SETTING:Qualitative evidence synthesis of studies set in general practice. METHODS:We systematically searched four databases from inception to June 28th, 2024 and performed forward citation searching of included studies. We synthesised findings using Braun and Clarke's reflexive thematic analysis and applied the Critical Appraisal Skills Programme (CASP) to assess the quality of studies. RESULTS:We identified 3,956 records and reviewed 190 reports in full. We included 32 qualitative studies reporting on 690 PCPs, generating the following themes: (1) I am confident, (2) …until patient X presents, (3) I am a victim of an overstretched healthcare system, (4) I must weigh up benefits and impact of antibiotic treatment, (5) It all comes down to our relationship. Using the CASP checklist, we rated the quality of research as high. CONCLUSION:PCPs felt confident in managing UTIs but uncertainty arose when patient X (children, males, older patients, recurrent UTIs) presented, and PCPs perceived consultations as more complex. Our analysis highlights the persistent and complex clinical challenge of assessing the risks and benefits of prescribing antibiotics. Chronic underfunding, staff shortages, and conflicting provider-patient expectations further complicated care, particularly when patients fall outside the ordinary (patient X).

Objective To explore the characteristics of symptom flares, individual experiences and behaviours during flares in people with endometriosis.Design Online questionnaire shared on patient support sites.Setting People with a confirmed or working diagnosis of endometriosis (a working diagnosis is given by clinicians based on symptoms/history; individuals may or may not go on to have further imaging/surgical investigations).Population or Sample A total of 236 responses were collected.Methods Descriptive and comparative analysis of quantitative data, and thematic analysis of qualitative data.Main Outcome Measures The characteristics, triggers, treatments and strategies for symptom flares together with perceived predictability and self-efficacy in relation to flares, healthcare access during flare, advice received and overall endometriosis-related quality-of-life.Results We identified a wide variation in the characteristics and treatments/strategies. 31.2% stated that they were 'not at all' confident coping with long flares, and around 1/3 of participants found flares 'not at all' predictable. Only 35.3% reported receiving advice from a healthcare provider about flares. We developed 5 themes to suggest why participants did not contact healthcare providers: 'what can they do?', 'I can cope, it will end', 'broken healthcare system', 'perceived dismissal and gaslighting' and 'symptoms stop me'.Conclusions Flares have a large impact on quality-of-life and are clinically very important. Individuals do not commonly receive advice from healthcare providers or contact healthcare providers during a flare. More research, in a more diverse sample, is needed to identify mechanisms underlying flares, as well as developing and disseminating management tools to prevent, manage and treat flares.

Although most UK National Health Service (NHS) consultations take place in primary care, healthcare research is dominated by secondary care and higher education institutions. The Royal College of General Practitioners has called for increased academic activity by developing research capability in General Practice. However, little is known about the challenges for GPs involved in research. We aimed to explore general practitioners’ (GPs) experiences of using a screening tool embedded in a research study. We recruited GPs from three practises participating in the study. An independent researcher interviewed GPs virtually. The interviews were recorded, transcribed verbatim, checked against recordings, and de-identified. We used Reflexive Thematic Analysis to develop essential themes. We developed four themes giving insight into barriers to research activity: (1) it’s rare that things are black or white, (2) it’s a clinical tool, not a clinician, (3) it’s about balancing valuable time, (4) we don’t see every patient face-to-face anymore. Quantitative research design, underpinned by positivist epistemology does not always align with primary care practice. Our findings highlight competing epistemologies that can make it challenging for GPs to complete standardised measures in a primary care setting. General practice involves a complex reasoning process grounded on interpretive knowledge. Closed questioning does not always comfortably align with a primary care setting where “a simple answer” is rare. Compatibility with primary care should be considered in all research design.

Aims:The aim of the present study was to understand the experience of surgeons treating patients with unexplained pain after knee arthroplasty and the role they considered revision surgery to have in the management of this condition. Methods:Semi-structured interviews were performed with seven consultant knee surgeons in the NHS. Interviews were audio-recorded, transcribed verbatim, and de-identified before analysis using reflexive thematic analysis. Results:Six themes were developed: 1) I need to understand a patient's journey and their expectations; 2) A difficult consultation; 3) I'm the 'fixer'; 4) It's complicated asking for help; 5) I'm uncomfortable operating for truly unexplained pain; and 6) It's a wound I carry with me. Conclusion:This study has improved our understanding of the important considerations for surgeons when managing patients with unexplained pain after knee arthroplasty. Our study calls for a holistic approach to care that considers patients' experiences, embraces modern pain theory, and fosters collaboration among healthcare providers.

Exploring the emotional impact of pain on children and adolescents: a meta-ethnographic poetic synthesis Pain in early life can go unreported and untreated. We use poems to portray findings from a systematic review of qualitative research. The overall aim of the review was to distil essential experiences across pain conditions and contexts. This report, focusing on the emotional impact of pain, is one of a series of three analyses from one systematic review of qualitative research. We used meta-ethnography to synthesise research. We identified studies in English that explored acute and/or chronic child and/or adolescent pain experience. Findings were distilled into themes and poems co-created in English and Spanish. We included 189 reports (177 unique studies) incorporating 5875 people (at least 3484 reported as female). Most studies (93%) included participants aged 11-20 years (range 2-38). The studies explored acute (24% studies), chronic (75%), and acute/chronic (1%). We report seven themes: (1) Pain can be hard to bear; (2) Pain is scary; (3) Pain is constantly at the back of my mind: (4) Pain makes me feel like I am outside alone; (5) Pain makes school a hard fit; (6) Pain can hurt me deep inside; (7) Pain has changed me. Our themes highlight the emotional impact of pain across conditions and contexts. Art and science are both integral to leaps in understanding. The contribution of the Arts is their unique ability to reach audiences on an affective level, giving the potential to underpin compassionate care and policy. We invite readers to utilise these poems to start a conversation about young people’s pain experiences.This systematic review was registered on the PROSPERO database (CRD42023429027). Ethical permissions are not required for an evidence synthesis. Perspective The voices of young people in pain are not always heard. This article presents themes, in poetic form, from a synthesis of 189 qualitative studies. Science and art are integral to leaps in understanding and inclusive arts-based research methods have the potential to underpin compassionate pain care for young people.

Aim To develop consensus on a core set of standardized outcome measures to be applied to each domain of the previously developed core outcome set for lower limb orthopaedic surgery for ambulant children with cerebral palsy (CP).Method This work consisted of the following three steps: (1) a scoping review of the literature to identify previously used outcome measures to assess lower limb orthopaedic surgery of ambulant children with CP; (2) searching the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) and PubMed databases to assess the quality of the psychometric properties of outcome measures and feasibility criteria; and (3) a consensus meeting with seven healthcare professionals with expertise in CP research and in the assessment of outcome measure psychometric properties was held in September 2021. Consensus on the outcome measures core set was developed through presentation of the evidence and whole-group discussions.Results A combination of clinician-driven and patient-reported outcome measures was considered the most appropriate way to assess the outcome of orthopaedic surgical interventions. Agreement was reached on seven core outcome measures: three-dimensional gait analysis, Edinburgh Visual Gait Scale, Gross Motor Function Measure, Gait Outcome Assessment List, Gillette Functional Assessment Questionnaire, Patient-Reported Outcome Measure Instrument System (pain interference, and fatigue), and Cerebral Palsy Quality of Life for Children questionnaire.Interpretation This study recommends a set of core outcome measures for use in research on lower limb orthopaedic surgery for ambulant children with CP. Consistent use of this core set would enhance validity and comparability of future research.

Objectives Early MRI use varies in the management of acute wrist injuries in the UK, with only a minority of National Health Service (NHS) centres being able to offer this to patients. In this study, we aim to explore the perspectives of staff and patients on the use of early MRI in the management of wrist injuries.Design This is a cross-sectional qualitative study using semistructured, face-to-face and remote interviews. Interviews were audio recorded, transcribed verbatim and analysed using thematic analysis.Setting 10 NHS Trusts in the UK.Participants We interviewed a sample consisting of 37 NHS staff members and 21 patients.Results We analysed the data into three overarching themes. The first theme described the negative impact of wrist injuries on both staff and patients. Staff reported an uncomfortable feeling that they had ‘short-changed’ patients with older non-MRI based pathways, and that the consequences of missing a scaphoid fracture could be a ‘horrible thing’ for patients. The second theme described how early MRI was perceived as a ‘win for everyone’. For patients, the win encompassed the relief of a speedy diagnosis which helped them to get better. Staff saw early MRI as a win because it ‘revolutionised care’ and ‘reduced the clinic footprint’. The final theme defined the key ingredients of delivering an early MRI pathway: a simple pathway with clear accountability, timely access to MRI and prompt reporting of results, a safe pathway with safety nets to avoid patients being lost, data and audit of the time to MRI and definitive treatment, bottom-up engagement, clear communication and looking after your team.Conclusions Our findings contribute to a better understanding of stakeholders’ perspectives on wrist injury pathways in the UK NHS.

Osteoporosis is a global health concern that is likely to increase with a rapidly ageing world population. It affects one in three women and one in five men over the age of 50. Although there is a large body of qualitative research exploring the experience of living with osteoporosis, far fewer studies have focused on men. We aimed to explore the experiences of men with osteoporotic vertebral fracture. We interviewed 13 White British men aged 63 to 94 with an osteoporotic vertebral fracture. We used the six stages of reflexive thematic analysis: familiarisation with the data; coding; generating initial themes; developing and reviewing themes through discussion; refining and naming themes; writing up. We developed six themes giving insight into the existential losses of men with osteoporosis: I have felt a step change coming; I regret that I am no longer the person I once was; it is demeaning (but others are worse off than me); I need to know where I am heading; I need to understand why me; I need to feel like I am in someone’s hands. We describe moral narratives used in defence of self. Our findings highlight the challenge of deciphering the symptoms of osteoporosis and age-related changes. We also see the impact on self and a struggle to repair self. Healthcare providers are in a unique and privileged position to accompany their patients at points of existential crisis. As such, they attend to the repair of both identity and body. This comes with an ethical responsibility and has implications for clinical education. Health professionals should feel equipped to be alongside people facing existential losses. Qualitative research can give valuable insight into the phenomenology of illness and contribute to improvements in care pathways.

BackgroundAccess to pain relief is a fundamental human right, yet child and adolescent pain can remain unheard and untreated . We aimed to understand and testify to young people's pain experiences.MethodsThis is the first systematic review of qualitative research to present findings as poetry. We followed stages of meta-ethnography, using verbatim poetry to express the findings.ResultsWe included 189 studies incorporating 6072 young people with pain across a range of conditions and contexts. Our findings highlight the ambiguity of pain . This ambiguity is exacerbated by unpredictability, absence of diagnosis, and a tangle of bio-psycho-social factors.ConclusionsVerbatim poetry can help us to imagine what it is like to live in someone else' shoes. Poetry can therefore contribute to compassionate and high-quality care. Future research might explore the role of poetry inmore inclusive research.

OBJECTIVES:The aim of this study was to explore the experiences of people with Vertebral Fragility Fracture (VFF) due to osteoporosis and the impact of the physical changes resulting from their condition. DESIGN:Interpretive qualitative research using semi-structured individual interviews PARTICIPANTS: Eighteen people with VFF were interviewed; nine men and nine women. Participants ranged in age from 55 to 92 years and had between 1 and 10 previous vertebral fragility fractures. SETTING:Interviews were offered in participants own homes, at the hospital or by Microsoft TEAMS or telephone. These were audio-recorded, transcribed verbatim, and analysed through reflexive thematic analysis. RESULTS:Results are presented within four themes: loss of height; finding spinal curvature upsetting, the impact on looking good and whether having a stoop was inevitable or could be prevented by active engagement. CONCLUSION:The findings show the negative impact on self-image caused by the physical manifestations of a VFF and that these can be as significant and distressing as pain and functional limitations. This information is useful for physiotherapists treating people with vertebral fragility fractures offering insight into the patients' experiences of these physical changes. CONTRIBUTION OF THE PAPER.

The aim of the present study was to understand the experience of surgeons treating patients with unexplained pain after knee arthroplasty and the role they considered revision surgery to have in the management of this condition. Semi-structured interviews were performed with seven consultant knee surgeons in the NHS. Interviews were audio-recorded, transcribed verbatim, and de-identified before analysis using reflexive thematic analysis. Six themes were developed: 1) I need to understand a patient’s journey and their expectations; 2) A difficult consultation; 3) I’m the ‘fixer’; 4) It’s complicated asking for help; 5) I’m uncomfortable operating for truly unexplained pain; and 6) It’s a wound I carry with me. This study has improved our understanding of the important considerations for surgeons when managing patients with unexplained pain after knee arthroplasty. Our study calls for a holistic approach to care that considers patients’ experiences, embraces modern pain theory, and fosters collaboration among healthcare providers. Cite this article: Bone Jt Open 2025;6(9):1115–1121.

BACKGROUND:Endometriosis affects approximately 10% of those assigned female at birth. Diagnostic journeys can be complex. The average 8-9 years between presenting symptoms and diagnosis has not changed significantly despite guidance. AIM:To explore primary care clinicians' diagnostic considerations in the context of symptoms that suggest possible endometriosis. DESIGN AND SETTING:Qualitative semi-structured interviews with general practice clinicians working in England. METHOD:We report a further analysis of 56 interviews from two inter-linked datasets with GPs and primary care clinicians about supporting patients with symptoms aligned with endometriosis. Analysis was informed by sociologies of diagnosis and ambivalence. RESULTS:Clinicians valued the importance of diagnoses to patients. Diagnoses support longitudinal care throughout episodes of intermittent specialist input, anticipating and responding to current and future health needs, and delivering evidence-based (biomedical) medicine. Diagnoses help clinicians feel more confident and comfortable, and may confer protection from medicolegal risk. Clinicians balanced these considerations against known uncertainties, including recognition that diagnosis might not change the treatment offered, may not be accessible if empirical trials of treatment relieve symptoms, and that an endometriosis diagnosis may not enable individualised advice or risk prediction. Potential advantages were balanced against diagnostic test risks and system pressures. Recognising that patient care remains with them, GPs anticipate and actively ensure ongoing relationships and care, whatever the outcome of tests. Holding these opposing role- based priorities and expectations in parallel creates tensions, which can be characterised through the concept of sociological ambivalence. CONCLUSION:Diagnostic considerations are complex. Educational interventions that do not recognise this may be ineffective in improving or enabling endometriosis diagnostic care journeys.

Aim: To synthesise primary qualitative studies reporting experiences of post-hospital recovery for critical care survivors, their family and the healthcare professionals supporting them with a particular focus on physical impairment. Design: The review was conducted through a meta-ethnography using the seven stages of Noblit and Hare. Methods: Qualitative studies or mixed-method studies which included qualitative research were included if they were based on the phenomenon of interest. Study quality was assessed using the Critical Appraisal Skills Programme checklist and confidence in the findings with the GRADE CERQual framework. Data Sources: Five electronic databases (PubMed, EMBASE, CINAHL, AMED and PEDro) were searched from inception to February 2022 and updated in November 2024. Grey literature for primary qualitative studies was also searched. Results: A total of 26,249 studies were initially screened, and 38 eligible studies were analysed. Four themes were distilled describing the experiences of critical care survivors, their family members and staff involved in their care: 'I survived, but I didn't thrive', 'Healthcare was there to save my life, but not for my long-term recovery', 'I am a burden on my family, and they feel the weight of carrying me' and 'My body still doesn't work like it used to'. Conclusion: This meta-ethnography is unique in bringing together the experiences of patients recovering from critical illness, their families, and the staff who support them after hospital discharge. Ongoing diverse physical impairments prevented patients from thriving, significantly impacting family members. All groups clearly identified unmet rehabilitation needs following critical illness.

Abstract A recent Lancet Commission raised concerns about the management of child and adolescent pain. We aimed to undertake a comprehensive review of qualitative research to understand children and adolescent pain experiences across contexts. We used the 7 stages of meta-ethnography to synthesise findings. We combined the strengths of arts-based methods, translating themes into poems in a range of languages. We screened 7471 titles, 464 abstracts, and 302 full texts, including 189 reports (177 unique samples) incorporating 5875 young people. Age range across studies was 2 to 38 years, with 93% including those between the age of 11 and 20 years old. Studies spanned 30 years (1993-2023) with 121 (64%) published in the last 10 years. Almost all (93%) were set-in high-income countries. We report 6 themes focusing on transition to adulthood: (1) I want to stay within the safety of home; (2) don't exclude me from my own care; (3) it might hurt but it's for my own good; (4) I rely on others but I want some independence; (5) I am no longer a child but I am not an adult yet; and (6) I wasn't prepared for the transfer to adult health care. Our findings focus on the complex transition into adulthood and the importance of creating a genuine healthcare partnership with young people by acknowledging their perspectives, creating a safe and supportive environment, and preparing them for the transition to adult pain care. Arts-based methods have the potential to make findings from qualitative evidence syntheses accessible and impactful for compassionate health care.

Background There is an intricate relationship between the mind and the body in experiences of health and wellbeing. This can result in complexity of both symptom presentation and experience. Although the contribution of life trauma to illness experience is well described, this is not always fully recognised or addressed in healthcare encounters. Negotiating effective and acceptable trauma-informed conversations can be difficult for clinicians and patients. Aim To explore the experience of primary care practitioners caring for women through a trauma-informed care lens. Design and setting Qualitative study in the general practice setting of England, with reflections from representatives of a group with lived experience of trauma. Method This was a secondary thematic analysis of 46 qualitative interviews conducted online/by telephone to explore primary care practitioners' experiences of supporting women's health needs in general practice, alongside consultation with representatives of a lived-experience group to contextualise the findings. Results Four themes were constructed: 'you prioritise physical symptoms because you don't want to miss something'; you do not want to alienate people by saying the wrong thing; the system needs to support trauma-informed care; and delivering trauma-informed care takes work that can have an impact on practitioners. Conclusion Primary care practitioners are aware of the difficulties in discussing the interface between trauma and illness with patients, and request support and guidance in how to negotiate this supportively. Lack of support for practitioners moves the focus of trauma-informed care from a whole- systems approach towards individual clinician-patient interactions.

The Vfrac clinical screening tool was developed to help primary care healthcare practitioners decide if an older woman with back pain is at high risk of a vertebral fragility fracture (VFF) and requires a spinal radiograph to confirm diagnosis. The Vfrac tool developmental work was carried out in women because of the higher background prevalence of VFF. We now wish to assess Vfrac in men. Purpose To understand and characterise pain symptoms of men with VFF, to evaluate the wording of the Vfrac tool from men's perspective, and to establish if a gender-specific version of the Vfrac tool was needed. Methods Individual interviews were conducted with 15 men using an interview topic guide based on the original Vfrac topic guide with the addition of a 'think aloud' section to discuss the wording of the current questions within the Vfrac tool. Thematic analysis was conducted by two researchers. Results Seven themes highlight that physical measurements can be potentially upsetting for those being measured ('Weighed, measured and found wanting'), that closed questions cannot capture the complexity of experience (there is no room on the paper; pain is dynamic, not static; walking can make it better or worse; well, it depends on which chair), and that gendered roles are varied and dynamic (I try to do my share of domestic work; no more do-it-yourself). Conclusions This research has allowed the male perspective of osteoporosis to be heard and importantly identified that the Vfrac tool had no gender-specific barriers.

BackgroundAround 6,000 revision knee replacement procedures are performed in the United Kingdom each year. Three-quarters of procedures are for aseptic, elective reasons, such as progressive osteoarthritis, prosthesis loosening/wear, or instability. Our understanding of how we can best support these patients undergoing revision knee replacement procedures is limited. This study aimed to explore patients' experiences of having a problematic knee replacement and the impact of undergoing knee revision surgery for aseptic, elective reasons.MethodsQualitative semi structured interviews with 15 patients (8 women, 7 men; mean age 70 years: range 54-81) who had undergone revision knee surgery for a range of aseptic, elective indications in the last 12 months at an NHS Major Revision Knee Centre. Interviews were audio-recorded, transcribed, de-identified and analysed using reflexive thematic analysis.ResultsWe developed six themes: Soldiering on; The challenge of navigating the health system; I am the expert in my own knee; Shift in what I expected from surgery; I am not the person I used to be; Lingering uncertainty.ConclusionsLiving with a problematic knee replacement and undergoing knee revision surgery has significant impact on all aspects of patients' lives. Our findings highlight the need for patients with problematic knee replacements to be supported to access care and assessment, and for long-term psychological and rehabilitation support before and after revision surgery.