Research at The Rehabilitation Medicine Group
Research underpins how programs at The Rehabilitation Medicine Group are designed, evaluated and refined.
Our work focuses on understanding why pain persists after surgery and how rehabilitation can be redesigned to better support recovery when standard pathways have not succeeded.
Why Research Matters Here
Persistent pain after surgery is common and complex, yet comparatively little research has focused on how rehabilitation can be redesigned to better support people when recovery does not follow a straightforward path.
Research at The Rehabilitation Medicine Group is conducted to:
– better understand the lived experience of persistent post-surgical pain
– identify gaps in existing rehabilitation pathways
– develop and test practical, accessible rehabilitation strategies
This research-led approach ensures that programs such as Kneed are grounded in evidence, clinically coherent and ethically delivered.
Doctoral Research
As part of a Doctor of Philosophy completed at Monash University in 2025, Dr Nathan Johns investigated how rehabilitation could be redesigned to better treat persistent post-surgical pain.
The research was supervised through the Epworth Monash Rehabilitation Medicine Unit and supported by competitive research grants.
This body of work examined pain outcomes after knee replacement, limitations of existing rehabilitation models and the feasibility of delivering rehabilitation through an online self-management program.
The Kneed Research Study
What was studied
A pilot randomised controlled trial evaluated the feasibility and acceptability of Kneed, an online pain rehabilitation self-management program, compared with usual care for people with persistent pain after knee replacement.
What the study showed
The study demonstrated that it is feasible to recruit and retain people with persistent post-surgical pain into an unsupervised digital rehabilitation program.
Participants using Kneed reported high satisfaction and found the program helpful for managing pain and function compared with usual care.
As a pilot study, the trial was not designed to provide definitive evidence of effectiveness, but to inform future research and program development.
Related peer-reviewed publications
Additional publications from this research program explore pain outcomes after knee replacement and the limitations of existing rehabilitation pathways.
Pain outcomes after total knee replacement in Australian adults
(Published 2022)
This study examined pain outcomes in 1,064 Australian adults following total knee replacement for osteoarthritis, with a focus on whether inpatient rehabilitation influenced pain severity at three months after surgery.
The findings showed that inpatient rehabilitation did not predict lower pain severity. Instead, severe pain before surgery, the presence of other pain conditions, post-operative complications and a younger age were stronger predictors of ongoing pain.
These results highlight that a significant subgroup of people continue to experience pain despite standard rehabilitation pathways, indicating a need for alternative approaches when pain persists.
Pain trajectories and long-term outcomes after knee replacement
(Published 2024)
This longitudinal study followed 718 people for up to three years after total knee replacement to examine how pain, function, and quality of life changed over time.
The study found that pain trajectories were variable and often persistent. While many people improved, a meaningful proportion experienced severe pain at one or more time points and early severe pain strongly predicted pain at later stages.
People with persistent severe pain had significantly poorer function and quality of life, reinforcing that pain after knee replacement is not always self-limiting and may require targeted rehabilitation strategies.
Rehabilitation interventions for persistent pain after knee replacement: a systematic review
(Published 2024)
This systematic review investigated whether randomised controlled trials had evaluated rehabilitation interventions specifically aimed at reducing persistent pain after knee replacement.
Only one eligible trial was identified. That study compared exercise combined with pain neuroscience education to pain education alone and found no significant differences in pain or function outcomes.
The review highlighted a major gap in rehabilitation research for persistent post-surgical pain and underscored the need for new, well-designed rehabilitation approaches to support people whose pain does not resolve with standard care.
How this research informs The RMG programs
Research at The Rehabilitation Medicine Group is not conducted in isolation. Findings from this work directly inform how rehabilitation programs are designed, structured and delivered.
This includes:
– focusing on education and understanding as foundations for recovery
– recognising persistent pain as a complex condition influenced by nervous system adaptation
– prioritising self-management skills that support long-term function and confidence
– avoiding unsupported claims or one-size-fits-all rehabilitation approaches
Programs such as Kneed translate this research into accessible, evidence-informed rehabilitation that people can engage with safely at home.
For those who are unsure whether a rehabilitation approach is right for them, Free Kneed provides a short educational introduction to understanding why pain can persist after knee replacement.
