Chronic joint pain, or osteoarthritis, affects one in five of the population over the age of 50, and one in two over 80. This condition causes considerable suffering and distress, and is a life-inhibiting disease.
Only a small proportion (about 5% of the eight to ten million sufferers in the UK) proceed to surgical intervention. Most are managed in the community, usually with painkillers, which are both unpopular with patients and potentially harmful. One in four GP appointments are estimated to be related to joint pain.
Through its member organisations, the Health Innovation Network (AHSN for South London) identified a need to be able to support patients with joint pain to self-manage their conditions in their localities, and provide education and exercise support, as recommended in NICE guidance.
Building on the work of ESCAPE-pain’s originator, Professor Mike Hurley, who is an NHS Innovation Accelerator fellow, the Health Innovation Network is promoting the spread of ESCAPE-pain. This is an evidence-based, group rehabilitation programme for patients with knee and/or hip osteoarthritis. The AHSN provides training on the programme to physiotherapists or exercise professionals, who deliver it with the support of their local clinical commissioning group (CCG), hospital or community provider.
The ESCAPE-pain programme comprises 12 supervised sessions for a group of 10 to 12 participantswho receive education and take partin a tailored exercise programme. The programme measures a range of clinical outcomes, and the participants are signposted to services to help them continue to progress.
The ESCAPE-pain programme is now increasingly being delivered to people in leisure centres and other community venues and even workplaces, offering easier access away from clinical settings.
It is less costly than usual care plans, and generates savings in both primary and secondary care. The robust evidence for ESCAPE-pain shows that people achieve a marked improvement in mobility and pain reduction, and are better able to achieve the activities of everyday life. There is also a marked impact on mood based on anxiety and depression score improvements. Notably, results from the original trial have been replicated in clinical practice, which demonstrates the programme’s efficacy.
ESCAPE-pain has already spread to over 70 sites nationally, benefiting more than 6,000 people. It will continue to spread across the country as the AHSN Network supports its wider spread during 2018-2020.