BackgroundEnabling 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.ObjectivesThis study wanted to establish if delivering ESCAPE-pain in community leisure centres was feasible, effective, acceptable and sustainable.MethodsThe programme (described in detail at 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.Results136 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...”ConclusionsDelivering 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.ReferencesHurley, M et al. Arth Care Res (2012) 64:238–247Jessep et al Physiotherapy (2009) 95;94–102Hur...

BackgroundPrimary care management of osteoarthritis (OA)is often sub-optimal1 because physicians feel overwhelmed by patient numbers and don't have time or skills to deliver lifestyle advice effectively – information, self-management, physical activity, weight control2. Allied healthcare professionals (AHPs) are better skilled in delivering lifestyle coaching. Although AHP-led care is common in many chronic conditions, it is still uncommon in primary care management of OA.ObjectivesWe placed an AHP in the primary care pathway to improve access of more people, and to assess if AHP-led primary care was feasible, safe, effective and valued.MethodsIn February 2015 a physiotherapist began running clinics for people with knee/hip OA in a primary care surgery.At an initial assessment (∼30 minutes) the Advisor;assessed their pain and function, physical activity level, waist circumference, body masstaught the effective self-management strategies - weight control, exercise, pain managementused behavioural change techniques - motivational interviewing, set SMART goals, action/coping plans, monitoring, feedbackhelp construct personalised care plansidentified people's physical activity preferences (swimming, walking) and identified local availabilityreferred to relevant agencies (dietician) if necessaryPatients were invited to return for review (30 mins) 6 weeks later when the Advisor;repeated the outcome measuresfeedback progress and successreinforced health messagesoffered on-going support, reassurance and encouragementQualitative interviews assessed people's opinions of the effectiveness and value.Results117 patients were recruited.Initially people were not receiving recommended advice and support. Between the initial assessment and the 6-week follow-up improvements were seen across all outcomes:- Knee/Hip Osteoarthritis Outcome Score improved - pain 16%; function 17%; quality of life 15%waist circumference decreased by 1.8cmweight decreased by 0.8kgphysical activity increased by 2.1 days walking 20min per weekpatients were able to do on average 5.6 more “sit-to-stands” in 30 secondsPatient satisfaction was very high. they valued advice tailored to their individual needs, appreciated easier access to care, the convenience and familiarity of the service being in their local GP surgery. This translated into self-reported improvements;“…it worked…I got a big improvement…”“…from February to April I wasn't walking, now I can…”“…I was 10 stone and went down to 9 stone…”Staff satisfaction was also very positive and interest from neighbouring practices meant the role was adopted by 4 other surgeries.ConclusionsAHP-led care of people with knee/hip OA is feasible, safe, quickly accepted and implements evidence-based guidelines care management recommendations that improves important clinical outcomes. Patients, GPs and other practice staff liked and wanted the service.ReferencesGanz, et al. Arthritis Rheum (2006) 55:241–7.Cottrell et al. BMC Family Practice (2010) 11:4.AcknowledgementThe project was funded by the Health Innovation Net...