Co-designing the Early Pain Intervention After Knee Replacement (EPIK) model of care for people with persistent pain after knee replacement

BACKGROUND: Approximately one in five Australians who undergo total knee replacement (TKR) experience persistent postoperative pain. There are currently no known effective and cost-effective multidisciplinary models of care in Australia to address this. We are developing the 'Early Pain Intervention after Knee Replacement' (EPIK) model of care, adapted from 'Support and Treatment After Replacement' (STAR) care pathway. STAR was developed in the United Kingdom (UK) and shown to be effective and cost-effective in the UK context. Extensive consumer and clinician engagement informed the development of the EPIK model of care, tailored to the Australian health system and geographical context to address this critical gap. OBJECTIVE: To co-design the 'Early Pain Intervention after Knee replacement' (EPIK) model of care for people with persistent pain after TKR. METHODS: We used Experience-Based Co-Design (EBCD) methodology to co-design EPIK, a telehealth model of care providing remote care coordination for people with persistent pain after TKR. Three online Zoom workshops were conducted with key stakeholders, including consumers with lived experience, clinicians (orthopaedic surgeons, physiotherapists, general practitioners, psychologists and a rehabilitation physician), and EPIK investigators. Workshop 1 explored consumer perspectives on the EPIK model of care assessment and follow-up. Workshop 2 determined the feasibility and roles of clinicians in the EPIK model of care delivery. Workshop 3 brought together consumers, clinicians, and researchers to refine and finalise the EPIK model of care. Using EBCD methodology and inductive framework analysis, themes were derived iteratively. Across consumer and clinician workshops, consensus was reached through facilitated discussions where stakeholders actively contributed to prioritisation activities and iterative refinement of model components. RESULTS: Twenty-one individuals participated in the workshops, comprising nine consumers and 12 clinicians from the Australian Capital Territory, New South Wales, Tasmania, and Western Australia, alongside five EPIK Investigators. Workshop 1 with consumers highlighted the need for clearer definition of communication processes, patient education and coaching strategies, and the role of the EPIK care coordinator to ensure consistent information and coordinated support throughout the model of care delivery. Workshop 2 with clinicians focused on telehealth assessments, escalation of clinical pathways, referrals, and psychological support. The final workshop reached consensus on its components and delivery, emphasising the importance of patient advocacy, reassurance and continuity of personalised care. CONCLUSION: Through meaningful end-user involvement, co-design informed the development of the EPIK model of care. The effectiveness, cost-effectiveness and safety of EPIK will be evaluated in a randomised controlled trial. PATIENT OR PUBLIC CONTRIBUTION: Two consumer co-authors (T.G. and B.L.) guided the development of the preliminary model of care and trial protocol. Consumers with lived experience of persistent pain after TKR participated throughout the co-design process. TRIAL REGISTRATION: ACTRN12625001029482p (Australian and New Zealand Clinical Trials Registry). Registered on 17 September 2025.