Keep moving to manage pain

Clinician working with woman with back pain

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Musculoskeletal (MSK) conditions such as osteoarthritis and chronic low back pain affect over 18 million people across the UK. These conditions can cause pain and functional limitations, as well as impact on our mental health, which can make ordinary, everyday activities a struggle and prevent us from being able to work or remain independent. Sally Irwin, a Project Manager for the Joint Pain Advice service in the Health Innovation Network, considers the benefits of simple self-management strategies, such as being active, in preventing and managing what can be a life-changing condition.

People often have the view that they can’t do much about the symptoms of osteoarthritis and chronic low back pain. However, there are tools and techniques that people can use to help manage pain and reduce the impact that these conditions can have, and resources available on how to do this. Keeping moving, a healthy lifestyle and self-management strategies such as learning how to pace yourself by planning and prioritising activities are all helpful.

Those with osteoarthritis and chronic back pain often worry being active will increase their pain and may cause more damage. Conversely, keeping moving can help to manage pain, improve mobility and strengthen muscles and bones. Remaining active can bring many benefits, but we know that putting this into practice and changing our habits and behaviours is not easy. It takes time and effort to do and maintain.

Unfortunately, the current Covid -19 pandemic means many people have less opportunity to be active and socialise as they spend more time at home. Similarly, changes to work environments, such as working from home, may be affecting MSK health.

Many MSK organisations have provided useful web-based information and support, including helplines, online groups and peer support. But for some, all of this information can be overwhelming. It can be difficult to know where to start, how to navigate the options available and how to make them relevant to their lives and what matters to them.

One option to support individuals experiencing hip or knee osteoarthritis or chronic low back pain is Joint Pain Advice (JPA). JPA is a service that provides people with an opportunity to have a conversation about their experience and how it impacts them, as well as relevant self-management options.

The Joint Pain Advice (JPA) model of care was developed by the Health Innovation Network as a result of an identified need for accessible, personalised and understandable information, and practical advice and support about how to self-manage the impact of chronic knee and hip pain (often labelled osteoarthritis) and chronic low back pain.

JPA supports individuals to understand and better self-manage their chronic knee and hip and low back pain.

It puts the National Institute for Health and Care Excellence (NICE) guidelines for the management of osteoarthritis and low back pain into practice, using education and self-management strategies for a patient-centred, holistic approach and focusing on increased physical activity and managing weight where appropriate.

The model can easily be incorporated into existing services with minimal disruption and adapted to local contexts. Its flexibility means it can be delivered by a wide range of healthcare and non-healthcare professionals, and it sits comfortably within community, clinical and workplace settings.

The HIN co-ordinates and delivers training for professionals wanting to deliver Joint Pain Advice, which is offered nationally but with a focus on south London. This evaluation shows improvements in pain, physical function, physical activity and mental wellbeing through JPA. Whilst this is based on face-to-face appointments, the approach can easily be delivered virtually where this is not possible.

JPA is a simple and effective way to support individuals experiencing knee and hip osteoarthritis and chronic low back pain to manage the impact that the condition can have on their lives.

If you are interested in finding out more information about Joint Pain Advice, please email hin.jointpainadvice@nhs.net. The JPA training is delivered free of charge to south London organisations.

Sally Irwin is a Project Manager for the Joint Pain Advice service in the Health Innovation Network.

Joint pain programme ESCAPE-pain and young people’s Type 1 diabetes initiative win awards

Trainer helps woman exercise

A national programme to tackle chronic joint pain and a local initiative supporting young people with Type 1 Diabetes have won at the prestigious Health Service Journal Value Awards.

Chronic joint pain programme ESCAPE-pain and the Youth Empowerment Service (YES) that supports 14-19 year olds with Type 1 diabetes, have won prizes at the Health Service Journal Value Awards.

ESCAPE-pain won the MSK Care Initiative of the Year. Since being on the programme , Ann, 68, is no longer in constant pain. She said: “Osteoarthritis was really impacting on my daily life as I had to ask for help to do everyday tasks around the home. My life has significantly changed since I completed the course and I’ve continued to do the exercises and now I no longer have any pain and I live a very active life.”

ESCAPE-pain (Enabling Self-management and Coping with Arthritic Pain using Exercise) is a national programme offering face-to-face and online exercises to help people suffering from chronic joint pain. Driven by the NHS’s Health Innovation Network, in south London, and backed by Sport England and in association with Versus Arthritis, roll-out of the programme has been supported by the national Academic Health Science Network. Prior to Covid-19, the programme was running in 295 sites and has helped 19,300 participants since it started.

ESCAPE-pain programme originator Professor Mike Hurley said:

“The judges were clearly impressed with the general ethos of the programme about self-management, its effectiveness and benefits that it brings to individuals and the healthcare system as a whole. We hope the award gives a boost to ESCAPE-pain that we believe can make a major contribution to the post-Covid-19 NHS ‘reset’.

Guy’s and St Thomas’ Youth Empowerment Skills (YES) programme, which is supported by the HIN, runs vital programmes for 14-19 years-olds with Type 1 Diabetes. It won the HSJ Diabetes Care Initiative of the Year.

YES programme Lead Dr Dulmini Kariyawasam, consultant at Guy’s and St.Thomas’ Foundation Trust , said:

“We are absolutely delighted to have been named as the winners in the Diabetes Care Initiative of the Year 2020! The positive impact of this award will help to create a long-lasting legacy and bolster our efforts to expand the YES programme across London giving every young person living with Type 1 diabetes in London access to the programme.”

“The HIN seeks to speed up the spread and adoption of evidence-based innovation in health and care so both these award-winning projects highlight the value of our work to improve lives. A huge well done to both teams. ”Health Innovation Network Chief Executive Zoe Lelliott

The Health Innovation Network’s Diabetes team Project Manager, Ellen Pirie, said:

“Young people suffering with Type 1 Diabetes face many challenges and the YES programme offers them practical support on issues such as food, sexual health and handling a diabetic seizure. There are also opportunities to go on social outings and try out new skills such as driving and rock-climbing and it’s this peer support network building that I know participants really benefit from.”

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ESCAPE-pain programme reaches 200 sites

ESCAPE-pain programme reaches 200 UK sites

This month the ESCAPE-pain programme launched its 200th site in the UK. It now operates in every region in England, with sites also operating in Wales and Northern Ireland. Over 13,000 people have attended the programme to date.

Originally rolled out by physiotherapists in hospitals, ESCAPE-pain is now also offered to people in leisure centres and gyms, church halls and community centres.

ESCAPE-pain is an evidence-based rehabilitation programme for people with chronic knee and/or hip pain, also known as osteoarthritis. It integrates exercise, education, and self-management strategies to help people live more active lives and manage their pain better. It offers an opportunity to reduce the number of GP consultations for knee and hip pain and reduces prescriptions of painkillers for these people.

The programme was developed by Professor Mike Hurley and is hosted by the Health Innovation Network. Nationwide scale-up is currently being supported by NHS England and Versus Arthritis.

ESCAPE-pain has been shown to:

  • Reduce pain, improve physical function and mental wellbeing.
  • Sustain benefits for up to two and a half years after completing the programme.
  • Reduce healthcare utilisation (medication, GP appointments, secondary care) equating to an estimated £1.5 million total savings in health and social care for every 1,000 participants who undertake ESCAPE-pain.

You can find your nearest ESCAPE-pain programme here.

How to find out more and hear personal real-life experiences here.

To find out more about ESCAPE-pain visit their website or follow them on Twitter @escape_pain

 

Award-winning ESCAPE-pain programme now online

Award-winning ESCAPE-pain programme now online

The award-winning ESCAPE-pain programme for the management of chronic joint pain is now available online to help ease the suffering of thousands of people across the country.

Chronic joint pain, or osteoarthritis, affects over 8.75 million people in the UK, including half the population over the age of 75, and one in five of the population over 45. A small proportion proceeds to surgical intervention while the vast majority are managed in the community with painkillers.

GPs typically spend around a day a week on appointments related to joint pain; by helping those people with joint pain undertake regular exercises evidenced to improve mobility and reduce pain, a large number of GP appointments can be freed for other people to be seen more quickly.

The new online version of ESCAPE-pain (Enabling Self-management and Coping with Arthritic Pain through Exercise), is a digital version of the well-established, face-to-face group programme that is now delivered in over 80 sites across the UK and is already being used to improve the lives of over 7,000 people with chronic joint pain.

Under the new digital programme, people can choose from 16 high-quality exercise videos to help improve joint pain including engaging animations and education videos to learn to manage their condition better. They can feel more in control of their pain through this free NHS resource developed by the South London-based Health Innovation Network which works to innovate health and care in the NHS.

Professor Mike Hurley, originator of the ESCAPE-pain programme, said:
“Thanks to ESCAPE-pain Online anybody with chronic knee or hip pain can now access the ESCAPE-pain programme regardless of where they live. ESCAPE-pain Online isn’t a replacement for attending the face-to-face programme, as that’s the most effective way to experience its benefits but it will support people to exercise safely and regularly in their own homes. People who are unable to attend a face-to-face programme or those who don’t have access to a smartphone can use ESCAPE-pain Online.”

Health Innovation Network Chief Executive Tara Donnelly said:
“ESCAPE-pain is a proven rehabilitation programme with a strong evidence base approved by NICE that is helping thousands of people who have been suffering in pain. By making use of digital technology and extending the programme through offering videos online, we are rolling out the potential benefit of this programme to many more people experiencing chronic joint pain; currently affecting one in five of the population over 45.”

ESCAPE-pain has been recognised with awards from both the Royal Society for Public Health (RSPH) and the British Society for Rheumatology, and is cited in the NICE clinical guidelines for osteoarthritis. More recently, ESCAPE-pain has been recommended as a preferred intervention for musculoskeletal conditions by Public Health England, which showed a positive Return on Investment of £5.20 for every £1 spent.

ESCAPE-pain Online is a free resource produced in the NHS by the Health Innovation Network and Salaso Solution Ltd. It is best viewed on a computer and is accessed via the ESCAPE-pain website homepage. For more information please visit escape-pain.org or email hello@escape-pain.org. Watch a film about ESCAPE-pain here.

Community health trainers are tackling high cost of chronic joint pain in innovative new programme

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New study shows community health trainers are tackling high cost of chronic joint pain

New study shows NICE approved new chronic joint pain intervention could be rolled out across the country through community health trainers.

An intervention that relieves chronic joint pain, called Joint Pain Advisor, has been successfully piloted with community health trainers in south London in a project that reduces pressure on GPs and has the potential to improve the lives of millions of people living in pain.

Musculoskeletal (MSK) pain, which includes chronic knee, hip and back pain, has a major impact on individuals and society. It is the second most common reason for GP visits, accounts for around 25% of all GP consultations and is estimated that 9.3 million working days are lost in the UK to MSK problems.

The Joint Pain Advisor model of care is a safe and cost effective alternative to GP consultations. Involving a series of face-to-face consultations, advisors work collaboratively with people with hip and/or knee osteoarthritis and/or back pain, focusing on supporting self-management. This model has been previously delivered by physiotherapists as Advisors but this new, small-scale study trained health trainers to deliver the advice in the community.

The study has shown that using community health trainers to deliver the Joint Pain Advisor model is effective. Many participants of the study said that their pain was dramatically reduced and movement had returned. They reported taking fewer pain-killers as well as increased mobility and weight loss.

The finding is significant because extending the model to community health trainers could result in much faster growth and mean that many more people can benefit from the service. There are around 3,000 community health trainers at present, who currently provide lifestyle advice on issues such as smoking cessation, weight management and healthy eating. Extending the programme to these trainers could mean that thousands more people are able to live in less pain.

Health Innovation Network Clinical Director Professor Mike Hurley said:
“The Joint Pain Advisor approach allows many more people with joint pain to benefit from NICE advice. Our service enables patients to help themselves live better lives – in less pain, able to do more, with a better quality of life.
This new study is small scale but extremely promising. Not only do we know that the Joint Pain Advisor service works to empower people to manage their pain, but through using the thousands of community health trainers up and down the country we can spread this innovation rapidly and help many more people.

With GPs under so much pressure and the countless working days lost to chronic joint pain, our programme could provide both economic and health and care benefits to the NHS.”

To date over 500 patients have used the service with physiotherapists in a previous pilot in Lewisham, south London, and they reported less pain, better function and higher activity levels. A high satisfaction rate was achieved which included reduced BMI, body weight and waist circumference and has led to fewer GP consultations, investigations and onward referrals. For every £1 spent on the programme there is a saving to the health and social care system of up to £4, according a Social Return on Investment (SROI) analysis.
The programme consists of up to four 30-minute face-to-face consultations between the advisors and people with hip or knee osteoarthritis (OA) or back pain. Patients attend an assessment where they discuss their lifestyle, challenges and personal goals and then jointly develop a personalised care plan that gives tailored advice and support based on National Institute for Health and Care Excellence (NICE) guidelines for the management of OA. They are then invited to attend reviews after three weeks, six weeks and six months to access further tailored support and advice.

Patients involved in the pilot said:
“Before I came, I used to have a lot of pain. Now I can do more walking. It’s helped me.”
“The pains eased, because I’ve strengthened my knees.”
“I’ve stopped taking painkillers because my hip has stopped hurting.”

In the latest study, 10 health trainers were trained as Joint Pain Advisors (JPAs) by the Health Innovation Network and offered the service across six community sites across Greenwich. It involved 85 participants between March 2017 and January this year.

Joint Pain Advisors are currently available in Shropshire and Merton, with plans for Croydon, Bromley and Cornwall to launch Summer 2018.

Download full report Joint Pain Advisor – Greenwich