• Mirella Keast, Anastasia F Hutchinson, Damien Khaw, and Joanne McDonall.
• Deakin University Geelong, School of Nursing and Midwifery, Burwood, Australia.
• Pain Manag Nurs. 2022 Aug 1; 23 (4): 541-547.

BackgroundPatient participation in care is key to optimising postsurgical outcomes and the quality of acute care delivery.AimsThis study explored patient perceptions of the impact of pain on acute recovery following Total Knee Arthroplasty (TKA), and barriers and facilitators to participating in pain management.DesignAn exploratory-descriptive qualitative study involving semi-structured interviews.SettingsA private-sector health service.Participants/SubjectsParticipants were adults undergoing TKA allocated to the control ward of a cluster randomised controlled trial who received standard care.MethodsTo allow adequate opportunity for participation in their care, interview and pain data were collected on postoperative Day 3. Acute pain was assessed using an 11-point Numerical Rating Scale (NRS). Interviews were analysed using combined qualitative thematic analysis and quantitative content analysis.ResultsOverall, 120 patients, 69 females (50.4%) and 68 males, were interviewed (mean age = 66.8 years, stadard deviation [SD] = 8.5). Most reported severe (NRS 7-10), day 3 pain (n = 76, 63.3%). Two themes emerged from interviews: (1) participants' postoperative pain experience; and (2) participation in postoperative pain management was limited. Pain experience was characterised by variation in pain and its qualities, having uncontrolled pain and distress, and influence from preoperative expectations. Patient participation was characterized by reliance upon prior staff instruction, barriers from limited knowledge, inconsistent promotion of non-pharmacologic strategies, and suboptimal clinician-patient communication. Regular analgesia was identified to facilitate participation.ConclusionsDespite the known benefits of patient participation in pain management, gaps remain in providing patients with the knowledge and opportunity to take an active role in their recovery. Interventions to overcome identified barriers need to be developed and evaluated.Copyright © 2021 Elsevier Ltd. All rights reserved.

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