Increasing access to rehabilitation for knee and hip osteoarthritis - ESCAPE-pain in leisure/community centres


Enabling Self-management and Coping with Arthritic Pain using Exercise, ESCAPE-pain, is a rehabilitation programme for people with knee and/or hip osteoarthritis (OA) that reduces pain, improves function and reduces healthcare utilisation. The programme is usually delivered in physiotherapy departments. However, constraints in the NHS limit the number of people who can access the programme. Delivering ESCAPE-pain in community venues would increase accessibility and provide better on-going support. We trained exercise professionals to deliver ESCAPE-pain in leisure/community venues, monitored whether it continued to be effective and gathered the experiences of participants, facilitators and organisations.

Before the programme 76% of participants
were classified as “inactive” (doing <30 mins activity/week).
After the programme almost 78% of participants
were classified as fairly/moderately active (>30 mins/week).


369 exercise professionals were trained to deliver ESCAPE-pain in 41 leisure and community centres across the UK. Pain, function and quality of life (using Knee or Hip Osteoarthritis Outcome Score, K/HOOS), and self-reported activity levels (minutes/week) were measured before and after the programme. Programme participant’s and facilitator/organisation’s experiences were evaluated using semi-structured interviews.


Results: 1386 participants were recruited, 72% female, mean age 70 years, 28% were over 57 years old. Before the programme 76% of participants were classified as “inactive” (doing <30 mins activity/week), after the programme almost 78% were classified as fairly/moderately active (>30 mins/week), these activity levels were maintained for up 12 months after completing the programme. Participant enjoyed the programme and reported improvements in pain (10 K/HOOS points; p<0.0001 ), function (9pts; p<0.0001), QoL (10pts; p<0.0001), understanding, exercise self-efficacy (confidence in using exercise to control pain and its impact), mental wellbeing and reduced reliance on healthcare professions, medication and surgery. They were able to walk better, farther, without an aid and returned former activities, felt better in themselves and “the world was a brighter place”. Most people were planning to continue exercising after completing the programme and had joined classes and taken up activities they enjoyed such as swimming, golf, walking, yoga. The exercise professionals enjoyed getting involved in healthcare interventions and offering people an effective intervention. The 17 partner organisations found the programme increased their portfolio of interventions, formed links with the healthcare sector who they saw as important partners in the future. Many organisations planned to expand the number of centres running the programme. To create revenue streams that enabled them to sustain delivery of ESCAPE-pain organisations formed collaborations with clinical departments, contracted by CCGs, charged a nominal amount for the programme or membership for the organisation and are expanding the programme to other centres within their organisation.

Conclusion(s): ESCAPE-pain can be safely delivered by exercise professionals in leisure/community centres, maintains its clinical effectiveness and nurtures habitual exercise. The community-based programme is capable of reaching, helping and giving on-going support to the large and rapidly increasing number of people with OA. ESCAPE-pain is now being delivered in leisure and cimmunity venues across the UK.

Cost and savings

No further data.


ESCAPE-pain can be delivered as a community-based rehabiliation programme, enabling many more people to access the programme and be supported to sustain the benefits - Participants learn to self-manage their problems - Older people experience the wide benefits of exercise - increased mental wellbeing, reduced social isolation

Top three learning points

No further information.

Funding acknowledgements

This work was supported by grants from Sport England, Versus Arthritis and the Health Innovation Network (South London's Academic Health Science Network).