Enabling Self-management and Coping with Arthritic Pain using Exercise - a group rehabilitation programme

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Case Study Summary
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Overview summary:
ESCAPE-pain is an evidence-based, NICE-recommended group rehabilitation programme appropriate for people with osteoarthritis, commonly called chronic joint pain, in their knee and/or hip.
Challenge identified and actions taken :
The probability of having hip replacement is 2.87 times higher in people receiving usual care (for e.g. GP care) compared to those who have participated in individually tailored exercise programmes such as ESCAPE-pain.

What is ESCAPE-pain?

ESCAPE-pain is a group rehabilitation programme for people with chronic joint pain in their knee and/or hip. Participants attend facilitated sessions twice a week for 6 weeks. Each session involves education and exercise components which are individualised for each patient. The Programme is both clinically and cost effective, producing measurable improvements in physical and mental health. It delivers the core NICE recommendations for the management of osteoarthritis in adults.

Research papers show it has wide health benefits and reduces healthcare utilisation. It is cited as a case study in the NHS /Rightcare QIPPseries.

Delivering ESCAPE-pain typically involves implementing changes to current service provision coupled with a commitment from the CCG and Provider organisation to ‘invest to save,’ using the ‘evidence-base’ of ESCAPE-pain to ensure that a minimum of 10 (and ideally 12 sessions) are offered to participants, for longer-term benefit.
Impacts / outcomes:
  • Clinical outcome measures - KOOS (Knee osteoarthritis outcome score), HOOS (Hip osteoarthritis outcome score) and HADS (Hospital anxiety and depression scale) assess pain, function, activities of daily living and quality of life.
  • Data from live sites demonstrates improvements in pain, function, and the ability to carry out activities of daily living; as well as improvements in mental health for participants completing the programme.
  • Staff and participant satisfaction: scores in both domains are consistently very positive.
  • Capacity benefits: grouping participants into cohorts for ESCAPE-pain reduces wait time for 1:1 physio.
  • Savings: research evidence showing a reduction in overall healthcare utilisation following the programme can be easily extrapolated to the local MSK prevalence using the MSK calculator (Arthritis Research UK).
  • From a baseline of 2 sites (2014), ESCAPE-pain is now delivered at >80 sites in England/Wales, including leisure centres as well as clinical departments - over 7000 participants to date.
  • Physiotherapy savings: extrapolation of research findings suggests physiotherapy savings of £82 per person, i.e. £574,000 total national savings to date. In practice this will have meant capacity release, as disinvestment in physiotherapy services is unlikely to have occurred.
  • Overall health and social care utilisation per patient: extrapolation of research findings suggests reductions achievement of overall health and social care utilisation of £1,511 per person per programme i.e. £10.6 million total national savings to date
Awards and endorsements
Supporting quote for the innovation from key stakeholders:
The ESCAPE-pain website is a project supported by the Health Innovation Network. Founded by NHS England, the Health Innovation Network is the Academic Health Science Network (AHSN) for South London. Their objective is to deliver service improvement and sustainable change, through collaborating with partners from the NHS, universities, local government, industry, the third sector, and prioritising involvement from service users and the public, to drive innovation and best practice across South London.
Which local or national clinical or policy priorities does this innovation address:
Health and Wellbeing
Plans for the future:
  • Approximately 1 in 5 of the adult population over the age of 50 have osteoarthritis. Access to ESCAPE-pain need not be limited to clinical environments. ESCAPE-pain is currently being offered in hospitals, physiotherapy departments, gyms, local leisure centres, and community halls etc. One of the aims is to grow the number of leisure sector providers offering the programme and also providers based out in the community.
  • The programme has been selected by the AHSN Network for national adoption and spread during 2018-2020.
  • The free ESCAPE-pain app is available on both iOS and Android devices. It contains 16 high-quality exercise videos and engaging animations and videos to help people learn how to manage their condition better and feel more in control of their pain.
  • An additional digital tool has been launched to further support the ESCAPE-pain programme. ESCAPE-pain Online is a web-based version of the app which replicates the same education and exercise videos. It allows people who don’t have smart phones to continue exercising safely in their own homes. ESCAPE-pain Online has been designed to be accessed from a computer.
Tips for adoption:
  • Facilitators must attend a one-day training course to become an ESCAPE-pain facilitator covering key areas such as the content of all 12 sessions, the evidence-base, Motivational Interviewing, the importance of collecting the clinical outcomes etc.
  • Initial support and mentoring to ESCAPE-pain facilitators (typically physiotherapists and fitness instructors) to set up the Programme.
  • Describing aligned incentives – delivering ESCAPE-pain in groups releases capacity in physiotherapy services, and is cheaper for CCGs, as well as delivering participant benefits.
  • Influencing commissioners through existing fora/more detailed discussions where CCGs are re-procuring MSK services.
  • For National Programme spread monthly webinars are scheduled to bring together ESCAPE-pain project/programme managers with those who have experience in delivering the programme. Each webinar covers key topics and provides an opportunity for sharing best practice and discussing challenges. Face-to-face events are planned as well.
  • Ongoing use and promotion of the ESCAPE-pain website to demonstrate digitally and succinctly how to deliver the Programme; the website also provides research evidence/financial data for commissioners.
  • Ongoing use and promotion of the free ESCAPE-pain app which is available on iOS and Android devices, and ESCAPE-pain Online.
  • Distributed leadership: clinical champions and champion sites regularly showcase the Programme.
  • Annual event to bring together sites delivering the Programme to learn from each other.
www.escape-pain.org gives all the materials required to commission the Programme and provides information on how to access the training.
Contact for further information:
Andrea Carter
E: andrea.carter@nhs.net
www.escape-pain.org: website for healthcare professionals and commissioners, showing videos of the Programme, full evidence-base, educational information for patients etc. Register for free to access the education and exercise videos.
Metrics: outcome data can be provided
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