X-ray of a knee joint

Helping people with osteoarthritis: improving mobility and reducing pain

Research at UWE Bristol has developed a method that enables people with osteoarthritis to regain their ability to move and reduce their pain. It has been adopted and implemented across the UK, producing better results for patients and reducing costs to the NHS.

What works for patients?

Osteoarthritis (OA) affects 8.5 million people in the UK, and is set to become the fourth most common cause of disability by 2020. The resulting financial burden to society is estimated at around 1% of GNP. People with the condition can suffer from chronic pain, tenderness, stiffness or locking in their joints.

Dr Nicola Walsh, Associate Professor of Musculoskeletal Rehabilitation at UWE Bristol, has led research to tackle the problems that sufferers face. She and her UWE Bristol colleagues, together with collaborators from hospitals and other universities, have built on her earlier work to develop a new intervention – a programme of help for people with OA – called ESCAPE (Enabling Self-management and Coping with Arthritis Pain through Exercise).

It includes group sessions led by a physiotherapist. These consist of discussion, advice and suggestions on simple coping strategies, and also a simple exercise routine tailored to each person’s individual needs.

But does it actually work any better than what was available before? Over the last decade, Walsh and her collaborators have conducted trials that have assessed how the new approach compares with standard care for OA in the knee and also the hip, both in terms of the results for patients and also its cost effectiveness.

They found that it worked well, and that for knee OA there were long-term benefits. ESCAPE gave better results than GP care alone. It was also just as beneficial as standard physiotherapy, but with significant cost savings. The patients themselves were also enthusiastic.

In 2012, Walsh and colleagues followed up with patients 2½ years after they completed the intervention and found that the improvements had lasted.

Implementing a service for patients

The new programme has spread beyond these studies to patient care across the UK.

The UK’s National Institute of Health and Care Excellence (NICE), which sets out guidelines on treatments for use in the NHS, has highlighted ESCAPE on its approved list of healthcare improvements, after evaluation by other experts. This has drawn it to the attention of managers and clinicians across the NHS – and that of commissioners, who are responsible for buying NHS services for patients.

It has already been adopted by physiotherapy services across Kent as the intervention of choice for people suffering from chronic knee pain. By the end of 2013, about 150 patients had experienced long-term relief from their symptoms as a result. The resulting cost savings there have been estimated at about 50%.

In South London, groups of GPs with responsibility for commissioning services are now asking for this treatment for their patients.

Hospitals in Bristol have also implemented ESCAPE as standard care for people with knee OA. They originally rolled it out in 2009, and have now expanded it to include patients with long-term knee pain.

Impressed by how well ESCAPE has been working, the Bristol Royal Infirmary is now delivering another similar programme with the same ethos and approach. This version is for people suffering from a related condition, ankylosing spondylitis, a chronic inflammatory disease that mainly affects the joints of the spine.

The final test of any new treatment is whether it benefits patients. “The exercises were most helpful,” says one, and another adds “I was more mobile and able to walk further and do the stairs with less pain”. The research from UWE Bristol has helped ordinary people in the real world.

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