Bridging the Gap between Secondary Care Pain Service and Community Services: How to promote living well beyond a pain service

Purpose

The protective effect of physical activity (PA) on long term conditions is strongly evidence based. As health care professionals we are encouraged to consider how PA is promoted within our pain services to improve pain, physical function and quality of life. Chronic pain SIGN guidelines list“supervised exercise sessions” as an approach to increase adherence to exercise. This is an approach that can be facilitated within a pain service. Beyond this, consideration needs to be given as to how we encourage a transition between secondary care pain services and community services. The aim of which, to promote longer term uptake of PA in local communities and reduce reliance upon health care services.

25.4%
mean increase in the 5MTW
28.2 %
increase in number of days active

Approach

Service evaluation and improvement project.

• Phase 1: We established a 6 week supported gym programme. This consisted of a once weekly, one hour open gym session facilitated by a pain specialist physiotherapist. The sessions provided an experiential learning environment to put into practice skills introducedby the pain physiotherapy team. Outcome measures selected were the 5 minute timed walk (5 MTW) and one minute timed sit to stand (1min STS). Physical activity levels and barriers to PA were documented.

• Phase 2: We collaborated with our local communityexercise scheme, Live Active, a programme that provides support to individuals who want to be more active. Through meeting with the coordinators we were able to provide education on chronic pain and PA as well as provide a question and answer session to address any individual concerns.

Outcomes

Results: • Phase 1: 27 participants completed the initial six sessions (73%). 10 participants failed to complete. There was a mean increase of 25.4% in the 5MTW, 35.4% increase in 1min STS and 28.2 % increase in number of days active. The qualitative feedback highlighted that participants felt more confident to be physically active as well as valuing the support from the group. Participants no longer reported fear of pain as a barrier to activity. • Phase 2: Our aim is to evaluate longer term uptake of PAin individuals who began their journey in the supported gym sessions. A focus group of Live Active co-coordinators will consider the impact of our training on management of individuals with chronic pain in the community.

Conclusion(s): Results show an improvement in function and confidence to be physically active post supported exercise group. This, combined with ongoing community support, has the potential to improve adherence to exercise in the longer term and providean important self management tool in chronic pain.

Cost and savings

Increased productivity

Implications

The supported gym sessions are now an integral part of our pain service. Anecdotal evidence suggests that community teams feel more confident with their management of individuals with complex pain conditions. This in turn could reduce referrals back into specialist Pain Services, target co-morbidities and reduce the burden on other healthcare resources.

Top three learning points

No further data 

Funding acknowledgements

No funding was required for this project.