A qualitative exploration of the barriers and facilitators for engagement with a self-led biopsychosocial support tool, Pain Rehabilitation to Optimize Major Orthopaedic Trauma REcovery (PROMOTE), for patients with complex lower-limb orthopaedic trauma

Journal article

Aims Pain Rehabilitation to Optimize Major Orthopaedic Trauma REcovery (PROMOTE) is a biopsychosocial intervention, delivered via a website format and supported by health professionals, to enhance the recovery of patients with complex lower-limb trauma. This qualitative study was embedded within a feasibility randomized controlled trial to explore experience and engagement. Methods All participants randomized to PROMOTE, and staff delivering the intervention at four NHS major trauma centres, were invited to take part. An experienced qualitative researcher conducted online interviews with participants and focus groups with staff. Data were transcribed, managed in NVivo, and analyzed using framework analysis informed by the capability-opportunity-motivation model of behaviour. Results Ten of 29 participants were interviewed, and 16 staff (four per site) participated in focus groups. Participant engagement ranged from accessing over 700 website pages to no use at all. Three key themes emerged to optimize engagement: 1) timing – delivery should occur after the immediate post-surgical period, when participants are “overwhelmed” but before they return to daily life and become too busy to prioritize their recovery; 2) format – content should be reduced, enhanced with audio and video, and be accessible offline; and 3) identity – PROMOTE should be introduced as a comprehensive recovery tool, not solely for pain or psychological wellbeing. Staff should receive enhanced biopsychosocial training to help them tailor the intervention to participants’ individual motivations. Conclusion PROMOTE has the potential to address currently unmet needs for patients with complex lower-limb trauma; however, adjustments to timing, delivery format, identity, and staff training are required to maximize engagement and effectiveness in future trials. Cite this article: Bone Jt Open  2026;7(6):724–732.

Authors: Fordham, B; Tutton, E; Painton, R; Gould, J; Achten, J

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: British Editorial Society of Bone and Joint Surgery
• Journal: Bone & Joint Open
• Volume: 7
• Issue: 6
• Pages: 724-732
• Publication date: 2026-06-02
• DOI: 10.1302/2633-1462.76.bjo-2025-0395.r1
• EISSN: 2633-1462
• ISSN: 2633-1462
• Language: English
• Keywords: Rehabilitation; Randomized controlled trial; Intervention (counseling); Qualitative research; Biopsychosocial model; Focus group