STarT Back: implementing stratified care for low back pain – tools and innovations for primary care (#1875)

Creation
Draft
Initial
Detailed
Accepted
Adoption
Idea Description
Supplementary Information
Detailed Submission Data
Innovation 'Elevator Pitch':
STarT Back utilises an innovative tool to screen patients according to their risk of persistent lower back pain disability. Ensuring their management is supported in primary care offering more effective and targeted physiotherapy treatment. 
Overview of Innovation:
STarT Back provides:
  • A simple prognostic screening tool used in primary care settings (GP / Community Physiotherapy) allocates patients to 3 risk groups (low, medium or high risk of persistent disabling problems)
  • Matched treatment pathways according to prognosis
    • Low risk treatment  - evidence-based consultation, simple messages about pain relief, exercises, written and verbal information – discharged after 1 session
    • Medium risk treatment – evidence based physiotherapy to reduce pain/disability, supporting patients to stay at or return to work – 4/5  physiotherapy sessions
    • High risk treatment – psychologically informed rehabilitation delivered by trained physiotherapists aimed at pain management, reducing disability and distress – up to 6 sessions
  • Improved clinical outcomes, patient satisfaction, reduced time off work
  • Reduced health care and societal costs
  • Prognostic screening tool guides clinical decision making – available in electronic and paper format
  • Training packages for primary / community and secondary care health practitioners to deliver targeted treatment
  • Resources available via website to support implementation – commissioners, clinicians and researchers (see website: http://www.keele.ac.uk/sbst/)
  • Supports review of clinical pathways for the management of back pain
In addition the following resources are readily available to any team wishing to implement stratified care for low back pain:
  • Established training course for physiotherapists in matched treatments
  • STarT Back website providing adoption and spread information on the roll out of the project across the West Midlands region and nationally through AHSN to AHSN working
  • Web resources supporting business case development, training, audit
  • Patient satisfaction audits
  • Audit of clinical pathways
  • Integrated IT platform for STarT Back within GP clinical systems
  • System to support automated referral to physiotherapy for medium/high risk material
  • High quality patient information to support self-management
  • GP resources to support consultations in primary care – available via website and patient.co.uk
  • Validated musculoskeletal patient reported outcome measure (MSK PROM)
Target groups are: general practitioners, physiotherapists, patients, commissioners, providers of musculoskeletal services.
 
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
Similar Content3
Innovation 'Elevator Pitch':
Spring Active has developed an integrated digital and physical back pain coaching approach for the management of back pain.  We will drive improved efficiency of care for providers whilst reducing costs of delivery.
Overview of Innovation:
Spring Active has developed an integrated digital and physical back pain coaching approach for the management of back pain. Our treatment combines evidence-based clinical approaches with innovative internet and mobile platforms. This early intervention approach will result in reduced waiting times for patients, and enable patients to be in control of their care, having immediate access to self-management leading to improved compliance and improved outcomes. In turn, we will drive improved efficiency of care for providers whilst reducing costs of delivery.

HealthyBack Coach™ is a digital and physical “virtual” service that combines digital screening, HealthyBack™ workbook and remote video consultations with a qualified physiotherapist (Spring Active Back Coach).
 
Here’s how it works:
  • Following referral, Spring Active contact the patient immediately to arrange delivery of materials and consultations – All materials are provided digitally and all consultations are via remote video link.
  • A member of our Clinical Team (Physiotherapist) carries out the remote video assessment & consultations each week for 3 weeks.
  • By week 3 the patient has a recovery plan that’s right for them and the tools to ensure a full recovery.
  • All referrals are registered on digital outcomes in order to record and monitor their improvement over 5 years
This service is designed to improve access at scale, reduce waiting times and reduce costs for healthcare providers, by providing instant access to the expert help & advice needed for an efficient recovery from an episode of back pain.

The Spring Active programmes involve exercise and educational sessions, with an emphasis on working towards purposeful individualised goals and developing skills to improve back pain in the long term. In order to support long lasting improvements and functional gains the patient will also go through digital outcomes measures for 5 years.
 
Our programmes focus on self-management improvements through identifying unhelpful pain beliefs and behaviours, providing tailored exercises to improve movement and body awareness, psychological support and practical coping and problem-solving strategies.

Our programmes have been developed in line with Spinal Taskforce and NICE guidelines.
 
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
WMAHSN priorities and themes addressed: 
Wellness and prevention of illness / Digital health / Person centred care
Benefit to NHS:
Back pain is reported to be the largest cause of disability in the world. This has a huge impact, both on the economy with lost working days, and on the health systems trying to cope with demand leading to long waiting lists and high healthcare costs. Although the web is often the first port of call for people, with “back pain” the number one searched for complaint, web advice is patchy and often not evidence-based. It is estimated that those in chronic back pain consult their doctor up to five times more frequently than others according to the National Office of Statistics and that those with back pain have health care expenditures approximately 60% higher than individuals who do not suffer from back pain.

Our treatment combines evidence-based clinical approaches with innovative internet and mobile platforms. This will result in reduced waiting times and enable you to be in control of your care. Having immediate access to self-management leads to improved outcomes.
  • No waiting times – the patient has immediate access to evidence-based treatment.
  • An integrated digital and physical back pain coaching approach for the management of back pain – the flexibility of a digital format with the reassurance of a real professional healthcare provider.
  • Allows the patient to be in control of their care with a self-management approach.
  • Immediate access to self-management leading to improved compliance and improved outcomes.
  • Improved efficiency of care for providers whilst reducing costs of delivery.
Initial Review Rating
4.60 (1 ratings)
Online Discussion Rating
5.25 (4 ratings)
Benefit to WM population:
As a West Midlands based SME, adoption of the HealthyBack Coach within the region would allow the company to grow and take on additional specialist staff. Our current forecast suggests the creation of 45 jobs over the next 5 years in software engineering, e-commerce agencies, HealthyBack physiotherapists and sales and marketing.

Reduction in travel for patients (reduces pressure on the region’s transport infrastructure) a reduction in pressure to the primary Care system.
Current and planned activity: 
Due to lack of progress within the NHS Spring Active is currently trialling and developing the HealthyBack Coach in 2 areas;
  1. Direct to consumer trial – this is providing the opportunity to gather user feedback and develop the approach to suit the patient
  2. Trials with large insurance companies to provide HealthyBack Coach direct to client company employees
Procurement / Adoption of: - Require assistance with marketing to CCGs and commissioners.   
Spring Active is keen to work with NHS to develop case studies in order to demonstrate financial benefits specific to the NHS and support the develop of care pathways for the management of back pain.
 
 
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
N/A
Ease of scalability: 
2
Read more
Hide details
Innovation 'Elevator Pitch':
Spring Active has developed an integrated digital and physical back pain coaching approach for the management of back pain.  We will drive improved efficiency of care for providers whilst reducing costs of delivery.
Overview of Innovation:
Spring Active has developed an integrated digital and physical back pain coaching approach for the management of back pain. Our treatment combines evidence-based clinical approaches with innovative internet and mobile platforms. This early intervention approach will result in reduced waiting times for patients, and enable patients to be in control of their care, having immediate access to self-management leading to improved compliance and improved outcomes. In turn, we will drive improved efficiency of care for providers whilst reducing costs of delivery.

HealthyBack Coach™ is a digital and physical “virtual” service that combines digital screening, HealthyBack™ workbook and remote video consultations with a qualified physiotherapist (Spring Active Back Coach).
 
Here’s how it works:
  • Following referral, Spring Active contact the patient immediately to arrange delivery of materials and consultations – All materials are provided digitally and all consultations are via remote video link.
  • A member of our Clinical Team (Physiotherapist) carries out the remote video assessment & consultations each week for 3 weeks.
  • By week 3 the patient has a recovery plan that’s right for them and the tools to ensure a full recovery.
  • All referrals are registered on digital outcomes in order to record and monitor their improvement over 5 years
This service is designed to improve access at scale, reduce waiting times and reduce costs for healthcare providers, by providing instant access to the expert help & advice needed for an efficient recovery from an episode of back pain.

The Spring Active programmes involve exercise and educational sessions, with an emphasis on working towards purposeful individualised goals and developing skills to improve back pain in the long term. In order to support long lasting improvements and functional gains the patient will also go through digital outcomes measures for 5 years.
 
Our programmes focus on self-management improvements through identifying unhelpful pain beliefs and behaviours, providing tailored exercises to improve movement and body awareness, psychological support and practical coping and problem-solving strategies.

Our programmes have been developed in line with Spinal Taskforce and NICE guidelines.
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health
Benefit to NHS:
Back pain is reported to be the largest cause of disability in the world. This has a huge impact, both on the economy with lost working days, and on the health systems trying to cope with demand leading to long waiting lists and high healthcare costs. Although the web is often the first port of call for people, with “back pain” the number one searched for complaint, web advice is patchy and often not evidence-based. It is estimated that those in chronic back pain consult their doctor up to five times more frequently than others according to the National Office of Statistics and that those with back pain have health care expenditures approximately 60% higher than individuals who do not suffer from back pain.

Our treatment combines evidence-based clinical approaches with innovative internet and mobile platforms. This will result in reduced waiting times and enable you to be in control of your care. Having immediate access to self-management leads to improved outcomes.
  • No waiting times – the patient has immediate access to evidence-based treatment.
  • An integrated digital and physical back pain coaching approach for the management of back pain – the flexibility of a digital format with the reassurance of a real professional healthcare provider.
  • Allows the patient to be in control of their care with a self-management approach.
  • Immediate access to self-management leading to improved compliance and improved outcomes.
  • Improved efficiency of care for providers whilst reducing costs of delivery.
Initial Review Rating
3.80 (1 ratings)
Online Discussion Rating
5.00 (5 ratings)
Benefit to WM population:
As a West Midlands based SME, adoption of the HealthyBack Coach within the region would allow the company to grow and take on additional specialist staff. Our current forecast suggests the creation of 45 jobs over the next 5 years in software engineering, e-commerce agencies, HealthyBack physiotherapists and sales and marketing.

Reduction in travel for patients (reduces pressure on the region’s transport infrastructure) a reduction in pressure to the primary Care system.
Current and planned activity: 
Due to lack of progress within the NHS Spring Active is currently trialling and developing the HealthyBack Coach in 2 areas;
1.     Direct to consumer trial – this is providing the opportunity to gather user feedback and develop the approach to suit the patient
2.     Trials with large insurance companies to provide HealthyBack Coach direct to client company employees

Spring Active is keen to work with NHS to develop case studies in order to demonstrate financial benefits specific to the NHS and support the develop of care pathways for the management of back pain.
 
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
N/A
Ease of scalability: 
2
Read more
Hide details
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
Which local or national clinical or policy priorities does this innovation address:
Health and Wellbeing
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.
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
Read more
Hide details
0
0
Votes

4.8 5
Votings

Created by

Share and Follow