Development of a biopsychosocial hybrid intervention to support patients following a complex lower-limb trauma
Beth Fordham, Louise M. Quarmby, Emma Evans, Jonathon Merrill, Duncan Appelbe, Jenny Gould, Dominic Burton, Julie Wright, Jane Quinlan, Juul Achten, Elizabeth Tutton, Matthew L. Costa, David J. KeeneAims
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.
Cite this article: Bone Jt Open 2026;7(11):1398–1409.