Newcastle and Gateshead hip and knee osteoarthritis rehabilitation programme
Wednesday 06 April 2022
Tyneside Integrated Musculoskeletal Service (TIMS) is running a research-evidenced rehabilitation class for osteoarthritis of the hips and knees called ESCAPE-pain. The programme originated in South London’s Health Innovation Network and was nationally adopted to be scaled and spread by the Academic Health Science Network in 2018.
In the North East region in 2012, the number of people aged 45 and over suffering from hip osteoarthritis was 132,156 and those suffering from knee osteoarthritis was 225,415. These figures are compounded by higher-than-average inactivity levels and higher than average obesity.
The ESCAPE-pain programme consists of 10–12-hour long sessions over a five to six week period, combining education and exercise to address all the aspects covered in the NICE guidelines.
‘Life changing’ outcomes
Evaluations demonstrate improved function up to 30 months following the completion of the course, compared to usual care.
Participants who have completed the programme report positive behaviour change and altered perceptions of exercise. They feel more confident to use exercise and the other techniques taught in ESCAPE-pain to control symptoms and dispel the idea that exercise is dangerous when you have osteoarthritis.
As the sessions are delivered in a group format, peer support is very important in the process, building relationships with other osteoarthritis sufferers. This environment evolves better knowledge and understanding about osteoarthritis and treatment options.
Participants in ESCAPE-pain have reduced pain and therefore reduced use of pain killers, and they are empowered to better self-manage their osteoarthritis, delaying the need for surgical intervention.
They report improvement in their function as demonstrated by increased walking, stair climbing, getting out of bed being easier and reduced use of walking aids. The programme has been described by some participants as life changing.
From the research, ESCAPE-pain has been found to be more cost effective than usual primary care and outpatient musculoskeletal physiotherapy, generating substantial savings in health and social care (Hurley 2007b, 2009, 2012).
Public Health England demonstrated that ESCAPE-pain produces £5.20 return on investment for every £1 spent on the intervention.
For every 1,000 participants who undertake ESCAPE-pain there are potential annual savings of:
- £20,280 in medication.
- £59,560 in community-based care (GP consultations, district nurse, social care contact)
- £2.8m in total health care and social care (medication, community care, acute hospital care mainly elective surgical procedures).
A proportion of the savings are cash releasing, but others which are equally importantly save much needed clinical time.
Based on the number of ESCAPE-pain participants between December 2018 and October 2019, TIMS is forecast to save the health and social care sector £98,280 in the 2.5 years following completion of the programme. This is based on an economic evaluation of ESCAPE-pain which was conducted in 2007 (Hurley et al.) The original paper can be accessed here: https://escape-pain.org/aboutus/research
Who can benefit from ESCAPE-pain?
ESCAPE-pain is suitable for patients over 45 years old, who have experienced chronic joint pain for over six months, with a confirmed or likely diagnosis of osteoarthritis or degenerative joint changes, and who would benefit from a supervised exercise programme to gain confidence to self-manage. Participants must be independently mobile; however they can be walking aid users and rely on scooters for long distances.
The programme is not suitable for those who are medically unfit to exercise, or with unstable comorbidities such as type 2 diabetes, cardiovascular or respiratory conditions, communication difficulties or psychiatric conditions that would prevent group participation.
Patients can self-refer into ESCAPE-pain via the TIMS website at: https://www.tims.nhs.uk/escape-pain/ or call the service on 0191 4456319 to speak to one of the team to find out more.