Development of a biopsychosocial hybrid intervention to support patients following a complex lower-limb trauma : the PROMOTE study
7 affiliations
- 1Kadoorie Institute of Trauma, Emergency & Critical Care, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- 2Oxford Major Trauma Centre, Oxford University John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- 3Oxford Major Trauma Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- 4NDORMS Patient and Public Involvement and Engagement group, Oxford, UK.
- 5Trauma and Major Trauma Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
- 6Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- 7University of Oxford, Oxford, UK.
Abstract
Aims
Complex lower-limb trauma is associated with substantial long-term physical and psychological morbidity. Access to integrated psychological support remains inconsistent. This study describes the development of Pain Rehabilitation to Optimize Major Orthopaedic Trauma REcovery (PROMOTE), a theory-based, hybrid (website plus one-to-one support) biopsychosocial intervention.Methods
Development followed the Medical Research Council framework for complex interventions and is reported in accordance with the GUIDance for the rEporting of intervention Development (GUIDED) checklist. This included: 1) an evidence review to identify modifiable psychosocial risk factors and theoretical models; 2) content coproduction with an expert advisory group including multidisciplinary clinicians and patient representatives, alongside independent patient interviews; and 3) iterative development and user testing of a low-intensity, scalable intervention. The intervention integrates the Common-Sense Model of Self-Regulation with cognitive behavioural therapy.Results
PROMOTE comprises four brief healthcare professional contact sessions delivered over eight weeks and an interactive, personalized website. The website is structured into five sections: 1) psychoeducation about the injury, pain, stress, and recovery; 2) cognitive behavioural techniques; 3) coping strategies; 4) recovery planning; and 5) a personalized profile. Content includes multimedia resources, interactive exercises, and personalized feedback. Iterative feedback from patients and clinicians led to improvements in navigation, language, pacing, and engagement.Conclusion
PROMOTE is a coproduced, theory-informed, scalable biopsychosocial intervention designed to address unmet psychological needs following complex lower-limb trauma. The intervention was evaluated in a feasibility randomized controlled trial to assess acceptability and engagement.
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BibTeX
@article{fordham2026development,
title = {{Development of a biopsychosocial hybrid intervention to support patients following a complex lower-limb trauma : the PROMOTE study}},
author = {Beth Fordham and Louise M Quarmby and Emma Evans and Jonathon Merrill and Duncan Appelbe and Jenny Gould and Dominic Burton and Julie Wright and Jane Quinlan and Juul Achten and Elizabeth Tutton and Matthew L Costa and David J Keene},
journal = {Bone \& joint open},
year = {2026},
month = nov,
doi = {10.1302/2633-1462.711.bjo-2026-0153.r1},
url = {https://europepmc.org/article/PMC/PMC13727322},
note = {CC BY},
}
RIS
TY - JOUR
TI - Development of a biopsychosocial hybrid intervention to support patients following a complex lower-limb trauma : the PROMOTE study
AU - Beth Fordham
AU - Louise M Quarmby
AU - Emma Evans
AU - Jonathon Merrill
AU - Duncan Appelbe
AU - Jenny Gould
AU - Dominic Burton
AU - Julie Wright
AU - Jane Quinlan
AU - Juul Achten
AU - Elizabeth Tutton
AU - Matthew L Costa
AU - David J Keene
PY - 2026
DA - 2026/11/01
JO - Bone & joint open
DO - 10.1302/2633-1462.711.bjo-2026-0153.r1
UR - https://europepmc.org/article/PMC/PMC13727322
AB - Aims Complex lower-limb trauma is associated with substantial long-term physical and psychological morbidity. Access to integrated psychological support remains inconsistent. This study describes the development of Pain Rehabilitation to Optimize Major Orthopaedic Trauma REcovery (PROMOTE), a theory-based, hybrid (website plus one-to-one support) biopsychosocial intervention.Methods Development followed the Medical Research Council framework for complex interventions and is reported in accordance with the GUIDance for the rEporting of intervention Development (GUIDED) checklist. This included: 1) an evidence review to identify modifiable psychosocial risk factors and theoretical models; 2) content coproduction with an expert advisory group including multidisciplinary clinicians and patient representatives, alongside independent patient interviews; and 3) iterative development and user testing of a low-intensity, scalable intervention. The intervention integrates the Common-Sense Model of Self-Regulation with cognitive behavioural therapy.Results PROMOTE comprises four brief healthcare professional contact sessions delivered over eight weeks and an interactive, personalized website. The website is structured into five sections: 1) psychoeducation about the injury, pain, stress, and recovery; 2) cognitive behavioural techniques; 3) coping strategies; 4) recovery planning; and 5) a personalized profile. Content includes multimedia resources, interactive exercises, and personalized feedback. Iterative feedback from patients and clinicians led to improvements in navigation, language, pacing, and engagement.Conclusion PROMOTE is a coproduced, theory-informed, scalable biopsychosocial intervention designed to address unmet psychological needs following complex lower-limb trauma. The intervention was evaluated in a feasibility randomized controlled trial to assess acceptability and engagement.
SN - 2633-1462
ER -