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Wilson N.1, Rosam A.1, Jordan A.1, Carter A.2, Hurley M.2,3
1King's College Hospital NHS Trust, London, United Kingdom, 2Health Innovation Network South London, London, United Kingdom, 3St George's University of London and Kingston University, London, United Kingdom
Background: The impact of osteoarthritis on individuals living and working in Britain is significant and represents an increasing challenge for the UK's National Health Service. Exercise interventions are effective in improving pain, function and quality of life for people with osteoarthritis but provision is traditionally limited to hospital settings. To address the growing burden-service gap new cost-effective models of supported exercise and self-management are needed. One such model, ESCAPE-pain (Enabling Self-management and Coping with Arthritic Pain using Exercise), is a 12 session (1.5 hours per session) exercise and supported self-management programme for people with knee and or hip osteoarthritis.
Purpose: The study aimed to determine the feasibility, acceptability and effectiveness of delivering ESCAPE-pain in the community.
Methods: Participants with symptoms of osteoarthritis of the knee and or hip pain were recruited into ESCAPE-pain between January and July 2015. The 6 week programme was supervised by two physiotherapists and delivered from three community venues in inner London. Feasibility of the programme was assessed by attendance and the occurrence of any adverse events. Self-reported symptoms, pain, function and quality of life (Knee injury and Hip dysfunction osteoarthritis outcome scores), anxiety and depression (Hospital Anxiety and Depression Scale) and self-efficacy for exercise were measured before and after the programme. Patient experience was collected via a short questionnaire and semi-structured telephone interviews and evaluated using content analysis. A local finance model was developed to evaluate the costs associated with delivering ESCAPE-pain in the community.
Results: 169 people with osteoarthritis of the hip and or knee were recruited into ESCAPE-pain. 14% either cancelled or did not attend the programme. 145 participants completed baseline measures and 124 participants provided follow-up data. 73% of the cohort attended ≥ 8 sessions. There were no adverse events as a result of delivering the programme in the community. Improvements were observed in: symptoms (3.89 [95% CI 1.48, 6.30] p=0.002); pain (7.00 [95% CI 4.57, 9.43] p 0.001); function (7.57 [95% CI 4.48, 10.67] p 0.001); quality of life (6.92 [95% CI 3.95, 9.89] p 0.001); anxiety (1.77 [95% CI 1.06, 2.48] p 0.001) and depression (0.50 [95% CI -0.06, 1.06] p=0.080). Self-efficacy for exercise was 0.17 [95% CI -0.57, 0.91] p=0.649. Participants reported that ESCAPE-pain in the community enhanced function and activity levels and that this model of care was acceptable. Local finance modelling highlighted potential economic savings to Clinical Commissioning Groups and opportunities for acute Trusts to move work into the community.
Conclusion(s): Providing ESCAPE-pain in the community is feasible, effective and safe. It is acceptable to people with osteoarthritis of the hip and or knee. Further research should focus on the minimal important difference in function and mood for cohorts attending the programme and the long-term sustainability and effects of this model of care.
Implications: Delivering ESCAPE-pain in the community at scale in the UK could increase access to out of hospital cost-effective treatment strategies for people with osteoarthritis and reduce the over medicalisation of this common musculoskeletal condition.
Funding acknowledgements: This project was funded by an innovation grant from the South London Membership Council.
Topic: Professional practice: other
Ethics approval: The Health Research Authority in England classified the project as service evaluation. Ethical approval was not therefore required.
All authors, affiliations and abstracts have been published as submitted.
