Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
AposTherapy can reduce elective care waiting lists and costs significantly, whilst maintaining excellent clinical outcomes and patient satisfaction. For the CCG's/ Trusts with long waiting lists it will be a game changer.
Overview of Innovation:
AposTherapy technology is not new science. AposTherapy incorporates traditional concepts used in physiotherapy and surgery and puts it all into one easy to use device. AposTherapy methodology is based on changing the forces working on the joints and increasing proprioception through controlled instability. By doing this the biomechanics of movement can be changed whilst new/forgotton neuromuscular pathways can be formed.
For example, a patient who has medial knee osteoarthritis is likely to have varus knee alignment, increasing the adductor moment on the knee - therefore increasing pain and difficulty with movement/ weightbearing. AposTherapy can reduce this adductor moment to allow soft tissue around the joint to work in a more efficient way.
Gradually through frequent short daily usage (like slippers) the body will learn better improved movement patterns/ motor pathways, so even when not using AposTherapy the improvements will be maintained. This incorporates functional rehabilitation and self-management techniques.

Compliance to treatment is exceptionally high due to the immediate pain-relieving effects of the device.
The AposTherapy device is a footworn pair of shoes, with convex components in specific positions - depending on the patient’s mobility, irritability and severity of symptoms - so it is completely individual to each patient.

Patients are screened over the phone for suitability, and then fully assessed by a physiotherapist using internationally recognised PROMS, spatio-temporal gait analysis and traditional physiotherapy assessment techniques. If the treatment is a suitable option for the patient then they will enter into an initial year plan, with 5-6 follow ups spread across 12 months to work towards their goals. At each follow up all outcomes and the device are reassessed and progressed as required.

During follow up years we expect patients to receive follow ups for maintenance / continued improvements.

AposTherapy is both a Product and Service - as the device is only fully effective through attendance to follow ups and following a treatment programme. Throughout treatment, patients will receive ongoing advice on pain management and graded exercise.

Intended patient group size is at least 50% of patients who meet criteria for hip/ knee replacement surgery.
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)
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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
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. 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: 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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Innovation 'Elevator Pitch':
Enabling patients to self-rehabilitate with clinically evidenced treatment plans to improve the speed of recovery and enhance patient outcomes. Reducing unnecessary prescription of medicines, scans and surgery; along with GP and Physio workloads.
Overview of Innovation:
Rehab Me offers GP’s a tool to help advise and support their patients without necessarily referring them to a physio for a scan or prescribing pain medication. It provides easy to access evidenced based advice sheets, treatment plans and interactive prompts to support compliance and outcome tracking, as well as signposting patients to further support and prevention pathways.
How it works: A simple digital solution, accesses on-line or via a downloadable all which operates on a stand-alone basis or be integrated into existing GP systems.
Step 1 - patient injury or MSK condition identified by GP who then prints off the relevant advice sheet from the Rehab Me website. This provides evidence-based exercises and advice regulated by standard physiotherapy practice and directs patient to the Rehab Me website for the patient to register.

Step 2 - patient registers on the Rehab Me website and selects the treatment plan advised by the GP. This will then provide scheduled exercises including frequency and number of repetitions across the treatment plan period. This is automatically linked to the patient’s calendar to enable reminders and prompts over the treatment period which can be anywhere between 6-10 weeks.
Step 3 - the patient can access the plan via the website or a downloadable app. The patient will be prompted each day and guided by their virtual physio with the use of easy to follow HD videos and/ or detailed descriptions.  Patients track their own adherence and progress through the website or via the app. They can also record and track pain each day to help assess progress and provide PROM data for their GP.
Step 4 – at any time the GP can view progress and results for a patient on a treatment plan; and if appropriate advice on a new exercise plan virtually so the patient can progress without the need for another appointment.
Step 5 – during or after a course of treatment, Rehab Me can signpost access to other relevant resources to encourage people to adopt exercise into their everyday lives to prevent relapse. This includes a social prescribing section encouraging patients to join gyms, walking clubs etc.
Part of the service provided by Rehab Me includes educational training on MSK issues as part of the process to this new pathway for GP’s to adopt in their practice.

The Rehab Me data platform adheres to appropriate NHS data IG and GDPR requirements, with all data securely stored on a cloud based server.
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)
WMAHSN priorities and themes addressed: 
Wellness and prevention of illness / Digital health / Innovation and adoption
Benefit to NHS:
The Rehab Me solution has been proven to:
  • Reduce unnecessary prescription of medicine
  • Reduce the need for costly scans and potential surgery
  • Reduce demand on physio appointments
  • Improve a GP’s ability to provide relevant MSK advice
  • Improve patient activation and compliance
  • Improve waiting times for specialist physio appointments
  • Support First Contact Practitioners in GP surgeries.
There is further opportunity for Rehab Me to reduce demand through earlier preventative treatment, on-going self-management support and improvement in post-surgery recovery and potential length of stay in hospital.
The results: a structured 18-month proof of concept across five GP practices servicing c70,000 people resulted in 2300 patients being supported, achieving the following key results.
  • 89% of GPs said they are now ‘confident’/ ‘extremely confident’ in managing MSK issues, versus 33% at the start
  • 70.3% of GPs recommended over 50% of patients to Rehab Me rather than referring to a physio.
  • 30.8% of GPs reduced prescribing medication by 50%
  • 25.9% of GPs reduced referral for imaging (XR, USS, MRI)
  • 19.2% reduced prescribing medication by 70% for MSK conditions
  • 50% improvement in patient pain scores, average score of 3/10 to 6/10
  • 66.7% of GPs rated the pilot 10/10 (with 10 = fantastic)
  • Reduced physio waiting times, from over 7 weeks to just 2 weeks for patients
Initial Review Rating
4.80 (2 ratings)
Benefit to WM population:
For Patients
  • Immediate and faster recovery time
  • Improve health, well-being and pain management
  • Increased confidence and empowerment to re-habilitate.
  • Reduced inconvenience and travel time for appointments
  • Avoid risks and side effects of anti-inflammatories, analgesics or other medications    
  • Potential surgery avoidance or painful injections
  • Easy and convenient solution access.
For GP’s
  • Increase knowledge and confidence to support patients with MSK conditions
  • Reduction in prescribed medicines
  • Reduction in physio referrals
  • Reduction in imaging and consultant referrals
  • Reduction in GP appointments
  • Ability to track patient activation and PROMS
  • Increased practice efficiency.
For NHS Physiotherapy clinics and other referral departments
  • Reduced number of referrals
  • Reduced wait times to enhance intervention effectiveness
  • Improved prioritisation of serious patient referrals
  • Enhanced quality of service and care
For Commissioners
  • Better resource utilisation
  • Increased capacity at lower cost
  • Alignment to the GIRFT programme
  • Strong ROI based in increased capacity and reduced medication / scan costs
For the Economy
  • Local employment - potential to build software development team locally
  • Local office - commercial office space
Current and planned activity: 
The Rehab Me solution has been supported By NHS England through its Clinical Entrepreneur programme and identified by Dr. Tony Young, (National Clinical Lead for Innovation) as a lead example of a new and exciting digital solution for scaling across the NHS.
The Rehab Me platform has been developed to Beta release level and is now ready for further development to ensure a robust and scalable software solution which can be easily integrated into other NHS systems.
The next stage requires effective engagement with appropriate PCN or GP Federations or CCG to secure financial commitment to embed the solution, support its development and assist in further case study creation and cost benefit analysis. This will then enable a comprehensive sales and marketing drive across England.
What is the intellectual property status of your innovation?:
Copyright of all content owned by Surrey Physio along with software design
Return on Investment (£ Value): 
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
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Overview summary:
In the UK and Western Europe most individuals with Osteoarthritis (OA) are managed in general practice with OA the second most common reason for consulting a general practitioner (GP).

The aim of JIGSAW-E is to implement a new model of supported self-management into general practice pilot sites in 5 European countries and evaluate the impact of this using local audits of quality care for OA. All innovations are designed for adoption and spread at pace and scale beyond pilot evaluation, and opportunistic adoption in developed sites is encouraged.
Challenge identified and actions taken :
JIGSAW-E supports practices in proactively managing patients with OA. The projects aim is to enhance quality of life for adults 45 years and over with joint pain without reverting to surgical treatment for OA unless all other appropriate options have been explored.

NHS England have recognised that given the significance of MSK (musculoskeletal conditions) to the NHS (£4.57 billion & 30% GP consultations) the recommended actions including pan STP collaboration across the pathway, could make a significant contribution to improving the quality of MSK care. NHS England has established MSK health as one of their key priorities.

JIGSAW-E supports general practice in addressing the following challenges:
  • Reducing clincial variation, through successful implementation of an electronic OA template to guide practice
  • Improve uptake of NICE guidance
  • Improve evidence based practice through supporting self management, train the trainer programme, local champions and training on the OA consultation
  • Improve patient satifsfaction and clinical outcomes through practitioner led long term condition clinics and bespoke patient information (OA guidebook)
  • Improving patient safety - reduced reliance on pharmacological/surgical interventions
  • Care pathway - reducing imaging and referrals to Orthopaedics
  • Improving work absense rates
Impacts / outcomes: 
JIGSAW-E addresses the unmet need in the management of OA across 5 European partners focusing on provision of quality non-pharmacological therapy: written patient information; exercise; physical activity; healthy eating and weight management advice. In 2016/2017 JIGSAW-E introduced a new model of supported self-management in general practice pilot sites and evaluated its impacts using audits of OA Quality Indicators collected using the JIGSAW-E e-template and routinely recorded general practice medical records.

JIGSAW-E supports the self-management of OA, providing a model of quality care incorporating four key primary care innovations:
  1. OA Guidebook - written information authored by patients and health professionals
  2. Model OA consultation for primary care
  3. Training for primary healthcare professionals in delivering high quality OA care
  4. Medical record (using e-template) and patient derivied Quality Indicators of OA care

Through EIT Health funding the project has also impacted on
  • the systematic implementation of international guidelines and NICE quality standards for OA at practice level across 5 European countries
  • Citizen and Industry partnerships supporting the scaling up of the this project across additonal EU partner countries

Highlight outcomes of the project so far
  • International Community of Practice for the project which includes key representation from across the 5 partner countries and the health professional groups of GPs, Practice Nurses, Physiotherapists and Patients
  • JIGSAW-E template embedded into clinical systems within practice within the UK. Translated templates are developed for partner countries as a local IT solution
  • OA Guidebook - translated and adapated across all project partners
  • Bespoke training package for GPs, Nurses, Physiotherapists and non-clincial staff. Training packages have been translated and adapted for use in partner countries and currently being converted into online training programmes
  • JIGSAW-E website providing supporting information for both clinicians and patients. Currently in the testing phase
  • Patient App
  • Strong industry links to be developed further in 2018
  • Business model in development
  • Network of clinical and patient champions supporting the effective roll out of the project
  • World leading patient and public involvement and engagement
Which local or national clinical or policy priorities does this innovation address:
NICE: Osteoarthritis: the care and management of osteoarthritis in adults
Supporting quote for the innovation from key stakeholders:
"The JIGSAW project promotes self management of OA amongst patients which encourages them to take a proactive role, understand the fuller implications of living with OA and to feel more ‘in control’ of their symptoms.

It helps to lessen pressure on secondary care services, and reduce the need for preventable surgery in some cases
I would strongly encourage other surgeries and multidisciplinary teams to embrace the project as its implementation has demonstrated positive outcomes in terms of improved quality of life; appropriate use of primary and secondary care services and satisfaction amongst health care professionals."

Practice Nurse, Portcullis Surgery, Ludlow, Shropshire
Plans for the future:
The project is now in its third year of funding from EIT Health. During the next 12 months the project will have a large focus on evaluation and the capture of key learning from the implementation across the five European partner countries.  Each project partner site will be developed into a beacon site for the project, supporting the scale up and out of the project.  Creating an business model for the project will be a key consideration to continue the growth of the project following the end of the funding period.

Digital innovations will continue to be built on over the next 12 months following the development of a JIGSAW-E website, online training package and patient app. 
The implementation of the project will continue to grow with new partners engaging in Europe and in the UK continuation of the adoption and spread of the project will take place across the West Midlands and beyond.

Opportunities to engage Industry in the project further will be explored.
Tips for adoption:
  • An understanding of Knowledge Mobilisation, theory and practice
  • Strong project management for effective implementation of the project
  • Phased approach to bringing on sites of implementation within an area
  • Recognising the impact of a pilot site to showcase best practice
  • Recognising the innovations may need to be flexible to meet the needs of different practices / organisations
  • The development of communities of practice to support the implementation of the project has been hugely successful
  • Development of a network of clincial and patient champions has been instrumental in the dissemination of information and encoragement of stakeholder uptake
  • Development of a busines model to support scale up and adoption
Contact for further information:
Nicola Evans
Implementation Project Manager, Impact Accerator Unit, Keele University 01782 734868
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