BLOG: ESCAPE-pain – helping people with hip and knee arthritis

Tim Powell, an advanced practice physiotherapist at the Royal Cornwall Hospitals Trust and clinical advisor to the SW AHSN, shares how a new exercise programme is helping people with joint pain.

Versus Arthritis, the charity that supports people with painful joint conditions, estimates that there are around nine million people in the UK who have sought treatment for osteoarthritic joint pain, with the knee joint being the most commonly affected. This is larger than the entire population of New York.

ESCAPE-Pain or Enabling Self-management and Coping with Arthritic Pain using Exercise is a 12-session exercise-based rehabilitation programme that improves patients’ ability to cope with chronic joint pain from osteoarthritis of the knee and/or hip. The programme was developed by Professor Mike Hurley, Professor of Rehabilitation from St George’s and Kingston University, and is a culmination of an extensive career into researching the role of supporting people with osteoarthritis of the hip and knee. Mike explains more about the programme in this video.

There are approximately 160,000 hip and knee joint replacements performed each year in the UK (National Joint Registry Data). This suggests that the overwhelming majority of people are managing their joint pain with non-surgical input. There is a large body of scientific evidence which has shown that people can manage the symptoms of osteoarthritis effectively with exercise 1,2. The ESCAPE-Pain programme was designed to bring together all of these principles in a standardised intervention. Its success was overwhelming with fewer GP appointments required, less analgesia/painkillers needed and people seeing the benefits of the programme for over 30 months. Published research can be found here.

The NHS now spends £5 billion per annum on muscle and joint conditions 3. An estimated 20% of all primary care/GP consultations are due to chronic joint-related pain, the majority of these being due to osteoarthritis. Many of these patients have other chronic health-related conditions such as cardiac conditions or diabetes. A perfect storm of increasing demand layered on top of limited NHS resources has brought into a sharper focus how and why we need to be more effective in the support we offer to people with osteoarthritis.

Multiple scientific studies have concluded exercise helps the symptoms of osteoarthritis and also improves quality of life and function. This has traditionally been delivered in the NHS, either on a 1-1 basis or in small groups by physiotherapists. The structure and content of these sessions have been dependent on individual clinicians and local resourcing. This variability has made the evaluation of effectiveness challenging for researchers, commissioners, clinicians and patients. This is where the ESCAPE-Pain programme can really fill this void. It allows for standardised, high-value care to implement. To help support the uptake of ESCAPE-Pain, the Academic Health Science Networks (AHSNs) are supporting NHS England with implementing the programme across England, both in NHS departments and leisure centres. They are able to help with identifying solutions to barriers, be they logistical or organisational, and can give support to providers with training and implementation planning. For more information on your local AHSN and ESCAPE-Pain click here.

ESCAPE-pain has been shown to be more effective, both clinically and economically, than usual treatments offered by GPs and physiotherapists. Importantly, it has provided a standardised approach to managing chronic joint pain that can be delivered anywhere and allows for more rigorous evaluation of how we can improve the care for people with chronic joint pain and osteoarthritis. In the next blog, I will provide an insight into how ESCAPE-pain has been implemented in Cornwall and has been embedded as a critical component in the local pathway of hip and knee osteoarthritis.

About Tim

Tim is chartered physiotherapist. He works as an advanced practice physiotherapist at the Royal Cornwall Hospitals Trust in Truro. He has a specialist interest in lower limb conditions, especially around the knee. He is passionate about translating scientific evidence into clinical practice. He is providing clinical support to the South West Academic Health Science Network to support the implementation of the ESCAPE-Pain programme across the South West.

References:

  1. Lange AK, Vanwanseele B, Fiatarone singh MA. Strength training for treatment of osteoarthritis of the knee: A systematic review. Arthritis Care Res. 2008;59(10):1488-1494. doi:10.1002/art.24118.
  2. Fernandes L, Hagen KB, Bijlsma JWJ, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72(7):1125-1135. doi:10.1136/annrheumdis-2012-202745.
  3. Ellis B, Silman A, Loftis T, Boothman L. ARUK MSK Health: A Public Health Approach.; 2014.

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