Purpose
ESCAPE-pain is an empirically-tested group-based behavioural change approach for the support of patients with hip and knee osteoarthritis, and has been identified as a NHS implementation priority. This project aimed to support the roll out of ESCAPE-pain via novel, sustainable and affordable models of delivery in collaboration with community partners in Wolverhampton, UK.
Approach
A physiotherapy clinical OA champion led this implementation project, supported by the Keele Impact Accelerator Unit. Key regional ESCAPE-pain implementation partners were identified including an established physiotherapy Osteoarthritis Community of Practice at Keele University, osteoarthritis patients, Royal Wolverhampton NHS Trust Physiotherapy services, fitness and wellbeing providers (Places for People) and third sector osteoarthritis service providers (local Versus Arthritis and Wolverhampton Rheumatology Support groups).
Following stakeholder engagement, a local Community of Practice was developed and a new ESCAPE-pain service was set up receiving referrals from a local physiotherapy department. An ESCAPE-pain-trained Physiotherapist and a community exercise professional delivered the service in a local leisure centre.
Following the ESCAPE-pain programme, ongoing exercise opportunities and local arthritis group support were developed via newly created collaborative working across the health, leisure and third sector.
Outcomes
The ESCAPE-Pain project was developed with a Community of Practice and piloted with 8 participants. Five participants completed the programme. Of the non-completers, one left to join the gym, one returned to work and was unable to attend and one gave no reason.
Mean Knee injury and osteoarthritis outcome scores (KOOS) improved for pain, activities of daily living and quality of life after the group.
KOOS Scores:
Mean scores pre / post group Stiffness 4/4, Pain 48/58*, ADLs 57/64*, QoL 44/49*
* higher scores indicate improvement
Mean Short Warwick-Edinburgh Mental Wellbeing scale scores (SWEMWBS) improved after the group.
SWEMWBS Score:
Mean scores pre / post group 24 / 28**
**higher score indicates improvement
All the participants found ESCAPE-pain beneficial “…very friendly atmosphere…expert tuition and always able to discuss our problems as a group which was very helpful'. They wanted to continue to exercise and were considering attending the post-programme group, three arranged to meet at the next session. Of the participants completing the programme two joined the gym, three reported they would continue with the newly developed follow-on exercise session based at the leisure centre. All participants said they would recommend the service.
Implications
Physiotherapists in collaboration with leisure and third sector organisations facilitated the set-up and delivery of the ESCAPE-pain programme for the support of patients with hip and knee OA in the community. Participants valued group discussion and peer support and desired the on-going opportunity to continue to exercise and meet.
Further work will explore the delivery of the ESCAPE-pain programme in Occupational health services, retirement villages, places of worship and to non-English speaking populations.
Implementation approaches working with a Community of Practice facilitates novel service delivery for patients with hip and knee OA and offer opportunities for continued support for self-management in the community. Working with community leisure partners provides the opportunity for physiotherapists to utilise valuable gym resources for evidence-based rehabilitation programmes.
Funding acknowledgements
This Community project is funded by the West Midlands Academic Health Science Network. Hadley-Barrows, T is funded by West Midland Academic Health Science Network, NIHR CRN West Midlands and Royal Wolverhampton NHS Trust. Quicke, J. is funded by a NIHR Clinical Research Network West Midlands, Research Scholar Fellowship. Dziedzic, K. is a National Institute for Health Research (NIHR) Senior Investigator.
The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research or the Department of Health and Social Care.
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Additional notes
This work was presented at Physiotherapy UK 2019 |