Clinical Update: Joint pain - moving ahead

ESCAPE-Pain (Enabling Self-management and Coping with Arthritic Pain using Exercise) is an exercise-based group rehabilitation programme for people aged 45 and over, with chronic joint pain of the hip and knee. It is designed to improve function by integrating exercise, education and self-management strategies to dispel inappropriate health beliefs, alter behaviour and encourage regular physical activity. 

Participants attend 12 supervised group sessions twice a week for six weeks. This includes a facilitated discussion of about 15 minutes to explore different topics each week (such as pain beliefs, mood, diet, relaxation techniques and goal setting), followed by 45 minutes of a simple individualised exercise regimen to address strength, balance, range and coordination. The education component is core to supporting behaviour change through a motivational interviewing approach – ‘a collaborative, person-centred form of guiding to elicit and strengthen motivation for change’ (Rollnick and Miller, 2012). 

The programme can be delivered by physiotherapists or suitably qualified fitness instructors within a range of settings, including hospital sites, leisure centres, and other community venues, for example, in collaboration with the charitable and leisure sectors.

Origins of the programme

ESCAPE-Pain was developed by Professor Mike Hurley, a physiotherapist and clinical researcher who was recently awarded a fellowship (bit.ly/2MIYhMn), joining the prestigious 2017 NHS Innovation Accelerator (NIA) scheme to increase national spread of the ESCAPE-Pain programme. 

The ESCAPE-Pain programme is now led and coordinated by the Health Innovation Network (HIN) in London, where Professor Hurley is clinical director for the musculoskeletal theme. The HIN is one of 15 Academic Health Science Networks (AHSNs) in England.

AHSNs are NHS England-funded organisations that support health improvement and economic growth, through the development and adoption of innovations into the NHS. ESCAPE-Pain is now a national programme as part of the AHSN Network and will be supported as it is rolled out across the country. 

Arthritis Research UK, NHS Right Care and NHS England have funded and supported two early adopter AHSNs in the North East and North Cumbria, and the North West Coast. Also, UKactive supports exercise professionals to play a greater role in delivering medical interventions and health advice in leisure facilities. 

Traditionally, ESCAPE-Pain has been delivered in physiotherapy outpatient departments. However, this limits the number of people who can access and benefit from the programme. The HIN is now working with Sport England and Arthritis Research UK to deliver ESCAPE-Pain to 2,000 inactive older adults with chronic joint pain over the next two years as part of the active ageing project. As part of the project, 51 fitness instructors, therapy assistants and physiotherapists from 18 NHS and leisure sector organisations have been trained to deliver ESCAPE-Pain classes in a variety of community and leisure venues across the UK, increasing the availability and accessibility of ESCAPE-Pain to older people.

Impact

• ESCAPE-Pain has been shown to reduce pain, improve physical function, depression, health beliefs and general wellbeing in a randomised control trial (Hurley et al, 2007a)
• The benefits have been shown to be sustained for up to 30 months (Hurley et al, 2007b)
• Cost savings of £1,417 demonstrated across the health and care system per person, per annum (Jessop et al, 2009)
• Participants reported being less concerned about the perceived dangers of exercise and an increased confidence in their ability to use exercise to manage their condition immediately after completing ESCAPE-pain (Hurley et al, 2010)

Key endorsements

• The programme has been highlighted as a Tier 3 intervention in Arthritis Research UK’s report ‘Providing physical activity
• interventions for people with musculoskeletal conditions’  and British Journal of General Practice (BJGP) editorial.
• Featured within the NICE clinical guideline [CG177] for the management of osteoarthritis bit.ly/1NZe5tH and has been published as a Quality Innovation Productivity and Prevention (QIPP) case study.
• Recommended by Public Health England (PHE) as a preferred intervention for musculoskeletal management - its report, Return on Investment Interventions for the Prevention and Treatment of Musculoskeletal Conditions  shows the programme has a positive financial return on investment of £5.20 for every £1 spent.
• Featured within NHS Right Care Commissioning for Value packs. 

How to get involved

If you would like to know more about ESCAPE-Pain, or to find out if the programme is running in your area, email hello@escape-pain.org. The annual ESCAPE-Pain conference will be held on 12 December. Details here. 

• Dr Rachel Turnbull is project manager, Academic Health Science Network for the North East and North Cumbria

More information

• Free ESCAPE-Pain app.
• Twitter @ESCAPE_pain
• Musculoskeletal Prevalence Calculator (Arthritis Research UK).

The four care components of ESCAPE-Pain

1. Two sessions per week for six weeks, 12 in all
2. Each session includes an exercise and education component
3. Each group of participants begins and ends the programme together
4. Collecting outcome data and share with the Health Innovation Network

Awards

• Best Practice Award in Rheumatology and Musculoskeletal Disorders, British Society for Rheumatology 2016
• Health and Wellbeing Award, Royal Society of Public Health 2015
• Finalist for Patients as Partners Award, AbbVie Sustainable Healthcare: 2016
• Semi-Finalist, Harvard Business School Acceleration Challenge 2016