Module 1:  Understanding persistent pain after knee replacement

By the end of this module, the clinician should be able to:

• Clearly state that pain does not equal damage.
• Explain how pain can persist after healing.
• Avoid psychologising language.
• Maintain authority when scans are normal.
• Validate pain without reinforcing structural fear.

Module 2:  Explaining the sensitivity loop

By the end of this module, the clinician should be able to:

• Explain why pain fluctuates.
• Introduce the Sensitivity Loop clearly.
• Integrate sleep and stress without blame.
• Reframe flares as temporary amplification.
• Emphasise that loops can be interrupted.
• Transition confidently toward rehabilitation.

Module 3: Communication under challenge

By the end of this module, the clinician should be able to:

• Remain calm when challenged.
• Avoid defensiveness.
• Avoid over-explaining.
• Validate without reinforcing structural fear.
• Reaffirm healing confidently.
• End with a clear management direction.

Module 4: Rehabilitation as active treatment

By the end of this module, the clinician should be able to:

• Confidently position rehabilitation as treatment.
• Explain how it interrupts the loop.
• Avoid fitness-only explanations.
• Reframe flare-ups as information.
• Maintain authority when rehab is questioned.
• Transition naturally into structured behavioural implementation (Module 5).

Module 5: Behaviour change and structured intervention

By the end of this module, the clinician should be able to:

• Translate explanation into measurable action.
• Apply the pain rule consistently.
• Apply <10% progression confidently.
• Use confidence as a progression marker.
• Implement the 50% flare protocol.
• Prevent avoidance without increasing threat.
• Build self-efficacy through structured success.