Background 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). It delivers guideline core recommendations (information, self-management advice, exercise) that reduce pain, improve function, is cheaper and more cost-effective than usual care1,2 and participants value its benefits3.
The programme is usually delivered in physiotherapy departments. However, financial and logistical constraints limit the number of people able to access the programme. Delivering ESCAPE-pain in community centres would increase accessibility, “reach” and provide better on-going support, and many more people would benefit.
Objectives This study wanted to establish if delivering ESCAPE-pain in community leisure centres was feasible, effective, acceptable and sustainable.
Methods The programme (described in detail at http://www.escape-pain.org/)was supervised by 2 physiotherapists in 3 Inner London leisure centres. Briefly, participants attended 12 sessions (2 sessions/week for 6 weeks) each comprised of a 25-minute education component and 45-minute exercise component. The education is a supervisor-guided theme discussions giving information, self-management and coping advice and incorporates behavioural change techniques. The exercise is an individualised, progressive regimen circuit that helps participants come to appreciate exercise is a safe, effective self-management strategy that reduces the impact of OA.
Pain, function and quality of life (Knee Osteoarthritis Outcome Score), anxiety and depression (Hospital Anxiety and Depression Scale) were measured before and after the programme. Participant experiences were evaluated using semi-structured interviews.
Results 136 people with knee OA were recruited, mean age 63 years old.
Before (n-136) After (n=117)
KOOS-pain 46 (±20) 54 (±18; p<0.0001)
KOOS-ADL 48 (±22) 56 (±20; p<0.0001)
KOOS-QoL 31 (±23) 39 (±21; p<0.0001)
HADS-depression 7.5 (±4.1) 6.2 (±4.3; p<0.016)
HADS-anxiety 8.3 (±4.5) 7.0 (±4.5; p<0.016)
Attendance was good 64% of people attended ≥9 sessions. Participant were very satisfied with the programme and its outcomes, not only describing improvements in knowledge and symptoms, but also their confidence and attitude to exercise and understanding of the role of exercise in the management of OA. A large majority (80%) planned to continue exercising at leisure centres after completing the programme. The leisure centres decided to run the programme permanently.
“...I now have more movement and less pain...”
“...it has helped me get back into regular exercise...”
“...I have gained more confidence and knowledge about my arthritis...”
Conclusions Delivering ESCAPE-pain in community settings is feasible, safe, improves clinical outcomes, acceptable, sustainable and nurtures an exercise habit. It is a community-based programme capable of caring for the large and rapidly increasing number of people with chronic joint pain.
Hurley, M et al. Arth Care Res (2012) 64:238–247
Jessep et al Physiotherapy (2009) 95;94–102
Hurley, M et al. BMC Musculoskel Dis (2010) 11:31
Acknowledgement Fusion Lifestyle hosted the programme.
Disclosure of Interest None declared