ESCAPE-pain is an award-winning programme for people with chronic joint pain. It achieves fantastic results and saves NHS resources.
ESCAPE-pain changed Arlene Rowe’s life. She was in terrible pain because of Osteoarthritis before taking up the six-week programme. She says:
“Since being on the ESCAPE-pain programme, my life has changed massively. My first goal was just to stand straight. Now, I’m not hunched over, and I’m beginning to walk properly.
‘I’m still stiff, I’ve still got arthritis, but what I don’t have is the pain. Occasionally I get twinges, but nothing that makes me miserable. Being able to sleep at night is wonderful. I’m not afraid to go out, I’m not afraid to cross the road, I can get on and off the bus okay, and I can get on the train.”
Arlene Rowe, participant
What was the problem?
Chronic joint pain, or osteoarthritis, affects one in five of the population over the age of 50, and one in two of the population over the age of 80. This condition causes considerable suffering and distress, and is a life-inhibiting disease.
A small proportion (about 5% of the eight to ten million sufferers in the UK) proceed to surgical intervention; the vast majority are managed in the community, usually with painkillers – which are both unpopular with patients, and potentially harmful. Roughly 1 in 4 GP appointments are estimated to be related to joint pain.
The Health Innovation Network’s members expressed the need for support to enable their patients with joint pain to self-manage their conditions in their localities, and provide education and exercise support, as recommended in NICE guidance.
What we did and why
Building on the work of ESCAPE-pain’s originator, Professor Mike Hurley, the HIN actively promotes the spread of ESCAPE-pain; an evidence-based, group rehabilitation programme for patients with knee and/or hip osteoarthritis. We provide training on the programme to physiotherapists or exercise professionals, who deliver it with the support of their local CCG, hospital or community provider.
The ESCAPE-pain programme comprises 12 supervised sessions for a group of 10 to 12 participants who receive education and take part in a tailored exercise programme. Sessions are twice-weekly for six weeks, and the trained supervisor is typically (but not necessarily) a physiotherapist or exercise professional. The programme measures a range of clinical outcomes, and at the end of the programme, participants are signposted to services to help them continue to progress.
The ESCAPE-pain programme is now increasingly being delivered to people in leisure centres and other community venues, offering easier access away from clinical settings. The programme has also been delivered in workplaces, direct to staff who have chronic joint pain.
Which national priorities does this work address?
- Patient activation and greater self care
- Providing care in community settings rather than hospital
- Reducing GP workload
- Musculoskeletal health
ESCAPE-pain was adopted as a case study in NICE’s Quality, Innovation, Productivity and Prevention programme  and delivers the NICE core recommendations of exercise and education for the management of osteoarthritis.
The robust evidence for this programme shows that people achieve a marked improvement in mobility and pain reduction, and are better able to achieve the activities of everyday life. There is also a marked impact on mood based on anxiety and depression score improvements after the programme compared to before. Notably, results from the original trial have been replicated in clinical practice which demonstrates the programme’ s efficacy.
It is less costly than usual care plans, and generates savings in both primary and secondary care.
ESCAPE-pain has now spread to over 70 sites nationally, benefitting more than 6,000 people, and continues to spread across the UK.
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 in a Return on Investment tool which showed a positive ROI of £5.20 for every £1 spent.
Professor Mike Hurley has recently been awarded the NHS Innovation Accelerator Fellowship 2017/18.
“[We were] greatly impressed by the innovative approach taken by this initiative in combining exercise, education, self-management and coping advice in a programme centred upon the individual needs of people with chronic joint pain. The panel felt that this was a mature initiative that presented strong evidence of improvement in clinical, financial and patient reported outcomes.”
Dr Peter Lanyon, President of the British Society for Rheumatology
Tips for implementation
A one day training programme has been designed for clinicians and exercise professionals keen to implement the programme in their locality which provides participants which technical competencies and the ethos underpinning the programme to successfully deliver and implement ESCAPE-pain. Post training, participants are provided with a comprehensive online resource pack to begin delivery of the programme.
Next steps and spread
We continue to spread the programme widely in south London and nationally, working with a range of health and leisure organisations, and continue our partnership working with Arthritis Research UK.
In October 2017 we were awarded a National Lottery funded grant of £392,000 by Sport England to spread ESCAPE-pain into the community as part of their Active Ageing project ,with a focus on getting older adults more active.
We have launched a patient app, freely available on Android and Apple devices, so that people are able to access the programme content digitally even if they are not able to access an ESCAPE-pain programme in person. It is useful as an aide-memoire to help people who have already completed the programme to continue to manage their condition.
We are in the final testing stages of launching our web app which will replicate the content of the programme for desktop computer users, more information on this will be released in summer 2018.
Find out more
For more information please visit the ESCAPE-pain website.
Visit the Health Innovation Network website.
Contact for help and advice
Andrea Carter, MSK Programme Director, Health Innovation Network
Programme duration: April 2014 – present