ESCAPE-pain is a NICE approved, award-winning programme for people with chronic joint pain. It achieves fantastic results and saves NHS resources.

Screen Shot 2016-09-07 at 8.59.49 am“I was having a lot of knee pain and my mobility wasn’t good, so I went to my GP as I thought I needed a knee replacement. I began the exercises which I thought were really simple at first – in fact too easy – but soon realised they were working and being simple, they were so easy to do. After a few weeks on the programme, I noticed a huge improvement and I’m not even thinking about a knee replacement now. I’m not only far less tired from the pain but can walk so much better. I can do 10,000 steps a day without thinking about it – my wife even bought me a ‘Fitbit’ to record my activity level.”

Meir Kattan, 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. It is estimated that a day a week of GP’s time (20%) is spent helping people manage their joint pain.

The Health Innovation Network’s provider members told us that they needed support to enable their patients with joint pain to self-manage their conditions, and provide education and exercise support, as recommended in NICE guidance.

What we did and why

ESCAPE-4We created and promoted the spread of ESCAPE-pain, an evidence-based, group rehabilitation programme for patients with knee osteoarthritis. We provide training on the programme to physiotherapists or exercise professionals, who run it with the support of their local CCG, hospital or community provider.

The ESCAPE-pain programme involves 12 supervised sessions for a group of eight to ten participants to receive education and take part in a tailored exercise programme. Sessions are twice-weekly for six weeks, and the supervisor is typically (but not necessarily) a physiotherapist. The programme measures a range of 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 centres, 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
  • Efficiency
  • Musculoskeletal health

Results

The programme is NICE approved and there is significant evidence that it works and achieves a reduction in the NHS burden of participants.

The 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.

ESCAPE-pain map

It is less costly than usual care plans, and generates savings in both primary and secondarESCAPE PAINy care.

ESCAPE-pain has now spread to 30 sites, benefitting more than 3,000 people, and continues to spread across the UK.

ESCAPE-pain has been recognised with awards from both the Royal Society for Public Health and the British Society for Rheumatology, and is cited by the ‘NHS Choices’ patient website and by NHS RightCare Commissioning for Value programme (self care).

“[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

  • We are happy to provide advice to areas keen to implement the programme locally.
  • Capturing the data is really important before and after the programme.
  • The resources we have developed on the website are designed to support other centres to run 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 Arthritis Research UK.

We have launched a patient app, so that people are able to access the programme digitally even if they are not able to access an ESCAPE-pain site. It is useful as an aide-memoire to help people who have already completed the programme to continue to manage their condition.

Find out more

For more information please visit the ESCAPE-pain website.

Learn more about the ESCAPE-pain programme from our new infographics here and here.

Visit the Health Innovation Network website.

Contact for help and advice

Andrea Carter, MSK Programme Director, Health Innovation Network
andrea.carter@nhs.net

Programme duration: April 2014 – present