Improving care for people with chronic low back pain - ESCAPE-pain for back

Purpose

Chronic low back pain (cLBP) is extremely prevalent, difficult to manage and impinges and all aspects of an individual’s life and its socioeconomic impact is enormous. ESCAPE-pain is an effective rehabilitation programme for knee and hip pain that is now being rolled out across the UK and beyond. We adapted ESCAPE-pain making it relevant to people with cLBP to improve their management. This study evaluated the efficacy of the programme in improving pain, function and mental well-being for people with cLBP.

“⋯I received the knowledge to understand that it is not just rest that I need for my pains...
...but also activity and exercise...”

Approach

Participants attended 12 sessions (2/week over 6 weeks) in groups of ~10. Each session lasted 60-90 minutes, comprised of education and supervised, progressive exercise regimen. It was delivered at by physiotherapists and therapy assistants. Data collected before and after the programme on MSK-HQ, self-reported physical activity (days active for 30 minutes each week) and function (30 second sit-to-stand). Feasibility was established from the number of Trusts willing to deliver the programme, participant recruitment and attendance. Participant and clinician satisfaction with, acceptability and experiences of the programme was gleaned from qualitative feedback from the “friends and family test” and semi-structured interviews. Results presented as pre- and post-values (mean change; 95% confidence intervals (CI))

Outcomes

Results: 286 people (191 women), mean age 54yrs were recruited from 4 Trusts. 74% of participants attended 74% of the programme, 9of the 12 sessions). This uptake and retention is a proxy measure of the acceptability of the programme to providers and participants. Average number of days each week participant’s particpated in >30 mins physical activity increased from 2.5 to 3.6 (1.1; 0.8 to 1.4), number of sit-to-stand participants could perform in 30 seconds increased from 9.1 to 12.6 (3.8; 3.2 to 4.4), and mean MSK-HQ score increased from 25.6 to 34.8 (9.3; 8.1 to 10.4). Participant feedback was very positive: 124/125 participant said they would recommend the programme, typical comments included: "...I gained lots of information to help me manage my pain..." “⋯when I started I could only walk for 10 minutes before the pain started. I can now walk a lot further and I do not need to stop...”, “⋯I received the knowledge to understand that it is not just rest that I need for my pains but also activity and exercise...”, “⋯helped me feel more motivated and confident to exercise⋯”, “⋯it has improved the quality of my life and I feel a whole lot better⋯”

Conclusion(s): ESCAPE-pain for backs was accepted, well liked and improved clinical outcomes. The organisations were planning to expand delivery across other sites within their Trusts. Following wide expressions of interest we are rolling out of ESCAPE-pain for backs in NHS, leisure and community centres across the UK.

Cost and savings

No further data. 

Implications

- ESCAPE-pain for backs can help many more people learn how to self-manage their problem - Management delivered in people's local communities so many more people can easily access effective management and be supported to sustain benefits

Top three learning points

No further data.

Funding acknowledgements

Health Innovation Network