The effectiveness of a multi-disciplinary designed intervention to promote self-management of joint pain performed by non-clinicians

Purpose

Nuffield Health is the UK's largest not for profit healthcare organisation. As a trading charity, re-investment of profits allows Nuffield Health to sustain free programmes for those living by lower resources.

The Nuffield Health Joint Pain Programme provides a self-referral scheme for members of the public suffering from hip/knee osteoarthritis to assist them with self-managing a long-term condition. It is delivered by non-clinicians who have been trained by clinical subject matter experts and provides an opportunity to deliver the content via resource efficient means.

The purpose of this service evaluation was to review the effectiveness of the Joint Pain Program delivered by non-clinical staff from a health and fitness background

 

Approach

Nuffield Health's Joint Pain program consists of 12-weeks supervised bespoke exercise and group education. Candidates self-refer to this program and are accepted subject to inclusion criteria of;

1. Being above 45 years old, and 2. Had a diagnosis of joint pain or experienced joint pain longer than 6 months. Individuals were excluded from taking part if they reported joint locking.


Participants received a one hour 'Health MOT' at the start and end of the program which included measurement of blood pressure, BMI, Waist to Hip Ratio, Resting Heart Rate, Blood Glucose, and Timed Up and Go. Attendance of one-hour sessions, twice per week, for a total of 12 weeks was mandatory.

Syllabus of education included a variety of topics including pain physiology, pathology of OA, pacing and goal setting, sleep, weight management, and emotional wellbeing.

Exercise sessions consisted of progressive exercise programming which included Circuit Training, Yoga, Tai Chi, water-based therapy, and strength training.

Participants had unlimited access to a health and wellbeing centre between sessions for the duration of the 12-week programme.


Data was reviewed and evaluated for participants that completed the program between September and November 2019 across 4 Fitness and Wellbeing sites across the UK (Plymouth, Chester, Nottingham, Kingston).

Outcomes

55 participants who completed the program were included for review. The average age of the participants was 6 ±6.6 years).


From the baseline readings, statistically significant improvements were observed in the Timed Up and Go Test (11.01±5.47 to 6.66±2.53 secs, p< 0.001), and systolic blood pressure (142.60±17.7 mmHg to 138.27±14.44 mmHg, p< 0.05).

No further changes were observed for BMI, Waist-to-Hip Ratio, Diastolic Blood Pressure, Fasting Blood Glucose, or Resting Heart Rate.

Approaches to treating degenerative joint pain with exercise forms part of NICE guidelines for Osteoarthritis: Care and Management (2014).

This service evaluation has concluded that utilising non clinical staff trained by SME's is an effective and sustainable model for delivery stretched beyond studio-based exercise only. This programme will be rolled out nationally and further long-term reviews are planned to ascertain the benefit provided at both an individual and societal level.

Implications

The Nuffield Health Joint Pain Program provides an evidence-based approach to the management of degenerative joint pain. As this program was delivered by non-clinicians at utilised wider health and fitness environments, it proposes a more economic and sustainable approach to healthcare delivery for long-term diseases.

Funding acknowledgements

There was no funding received for this service evaluation.

Additional notes

This work was presented at Physiotherapy UK 2019