March 2018

CEO's Update - Celebrate the messy and the unpredictable

Celebrate the messy and the unpredictable

Bringing knowledge together, bringing people together: those are the aims of ARMA’s clinical networks project. Bringing them together to improve the lives of people with MSK conditions, of course. That really sums up what ARMA is all about. We are about breaking down silos and professional boundaries, creating services which work in pathways, where multidisciplinary teams ensure people get the right support at the right time. We are about sharing knowledge and good practice so that professionals know what works and can replicate excellence in their local area.

The project is about to move into a new and exciting phase, with the launch of local networks and the on line MSK Knowledge Hub. The knowledge hub will include an online forum where people can share experience and learn from each other. Both this and the networks are a bit of a leap into the unknown. There isn’t a set programme or a set of measurable outputs. The point is to let local people take the lead and respond to their own priorities. We can provide some tools to help, but we can’t control what happens.

As someone who likes project plans, measurable outputs and KPIs, that makes me a bit nervous. But I think it is the right approach. This blog from the Kings Fund talks about change as “a messy, non-linear process. It is unpredictable and difficult to chart in absolutes or step-by-step project plans with a neat beginning, middle and end.” I hope the ARMA project will help those of you involved in the messy, unpredictable process of working to improve services to share ideas and enthusiasm, to find out what has worked elsewhere and why, and to connect with others who know things can be better.

Let’s celebrate the unpredictable, the creative and the messy in the interests of driving positive change. Look out for more details on the network on our website shortly and in the next newsletter.

Get involved: sign up to the network, join the hub and make a difference.

Guest Blog - Yoga for Healthy Lower Backs - A back-care toolkit

Yoga for Healthy Lower Backs - A back-care toolkit

by Alison Trewhela, Director of the Yoga for Healthy Lower Backs Institute

Evidence-based exercise for people restricted by back pain, fearful of movement, in considerable pain, or with other illnesses and injuries, ‘Yoga for Healthy Lower Backs’ (YHLB) is a gentle 12-week mind-body exercise programme offering a potentially life-long solution.

Public Health England has recently included YHLB as one of seven evidence-based MSK options in their PHE MSK ROI Return on Investment Interventions report and online tool. Healthcare and public sector commissioners and well-being providers are hereby more easily able to choose cost-effective innovative interventions. YHLB shows a £10 return on investment for every £1 spent.

The ‘Yoga for Healthy Lower Backs’ programme was born out of a large research collaboration of academics, health economists, yoga teachers and back pain specialists led by The University of York and funded by Arthritis Research UK. The 313-participant randomised control trial compared this yoga programme and usual GP care against usual GP care and evaluated back function at the end of the course as well as 12 months later.

The findings showed that YHLB was effective for chronic low back pain for the long-term (Annals of Int. Med., H. Tilbrook et al, Nov. 2011; Vol 15 No 9).

An economic evaluation showed that YHLB would be cost-effective within the NHS, was a dominant treatment for society, and that it reduced work absenteeism by 70% over the 12 months studied (Spine Journal, 15th Aug 2012, LH Chuang et al).

To share this research and knowledge, as the lead yoga research consultant and designer of the YHLB programme, I have trained over 400 experienced yoga teachers nationwide and, along with others, have set up a social enterprise and training Institute. Teaching teams and regional Hubs are being established to improve ease of access.

Our ‘best practice’ ‘Yoga for Healthy Lower Backs’ structured programme was designed to offer person-centred self-management support and advice. Uniquely, it is unparalleled in its strong evidence-base.

Attendees learn how to use strengthening, mobilising, stretching and pain-relieving poses, relaxation and breathing techniques and postural awareness exercises that aid a return to normal activity levels at work, home and leisure. They gain extra psychological support from group learning and benefit from positive ‘side-effects’, such as reduced time off work and improved mood.

Importantly, this is a specialised yoga course, designed for those with persistent, episodic or recurring back pain. However, it is equally true that if you have a lower back (!) and want it to be healthy, you can attend this gentle yoga course and learn how to help yourself to improved comfort, health and well-being for now and the future.

It is a ‘mind-body package of care’ that can easily be integrated into daily life. Offering a manual, relaxations CD, practice sheets and hand-outs, the 12 classes teach people to self-manage their back pain, whilst encouraging long-term changes in increased physical activity and improved well-being. A recent study showed that YHLB attendees had a 63% improvement in feeling able to manage their back pain by themselves.

Through ARMA, we have been able to connect with many organisations in the musculoskeletal field with which we share similar goals. Through these connections, we are continuing to make progress in taking the results of the research out to those that it would most benefit, i.e. those with back pain, but also health professionals and commissioners.

Amongst other regions, the YHLB programme is being successfully piloted by the NHS in Cornwall, as follows:

• GP surgeries (n=5) subsidizing course costs

• ‘Social prescribing’ scheme

• Subsidised courses for Primary Care staff

• Teaching Team and Regional Hub

The evidence from the research contributed significantly to the evidence NICE evaluated in their Guidance on low back pain and sciatica which mentions mind-body exercise, such as yoga, as a first step to managing low back pain.

In the light of the recent Government Paper Improving Lives, The Future of Work, Health and Disability, a social franchising model to take this successful and evidenced Yoga forward as an early intervention treatment option is being explored. The Government paper states “Early intervention and access to treatment and support were critical to preventing the progression of ill-health and preventing people falling out of work.”

One YHLB course attendee called it “a life-changing experience after years of frustration.”

As a specialist tutor for Yoga and Research at University of Exeter Medical School, I know how hard is has been in the past to find yoga programmes with strong evidence-base, so all this is fantastic news for those with back pain, referrers and commissioners.

Further information at or email

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ARMA Webinar: Focus on Musculoskeletal Health: developing and implementing a JSNA chapter

ARMA Webinar: Focus on musculoskeletal health: developing and implementing a JSNA chapter

The webinar on 6 April 2018 at 1.30pm will outline the development of the JSNA chapter and why this is important for improving the musculoskeletal health of a local population. Ian Bernstein and Rutuja Kulkarni-Johnston will outline the process of developing an MSK JSNA chapter. Kevin Fenton will explore the benefits of this and how it might be used.

The London Borough of Ealing and NHS Ealing CCG published the Joint Strategic Needs Assessment (JSNA) chapter on Musculoskeletal Health in December 2017. The JSNA is a statutory document that describes the health and social care needs of the population, identifies gaps and unmet needs, and makes evidence-based recommendations to health and social care commissioners.

Two versions have been published: a visually appealing ‘Focus on’ Musculoskeletal Health chapter provides a compact, easy-to-navigate review. The full version adopts the life course approach proposed by Arthritis Research UK (ARUK), and includes both national data from the Global Burden of Disease, and local data from the ARUK Musculoskeletal Calculator.

See our post on the update to the Ealing MSK JSNA Chapter.

Who should attend:

Directors of Public Health, senior policy makers, health and social care commissioners, Health and Well-being Boards, providers tendering for services, patient groups.


Ian Bernstein, Clinical Lead for Musculoskeletal Transformation, NHS Ealing CCG and NW London STP
Rutuja Kulkarni-Johnston, Consultant in Public Health, London Borough of Ealing
Professor Kevin Fenton MD PhD FFPH, Director of Health and Wellbeing, Southwark Council

Register in advance for this webinar.


Members' News and

Accolade for ASone website & Axial Spondyloarthritis Seminar

Accolade for ASone website and Axial Spondyloarthritis Seminar

ASone wins European Award

NASS is delighted to announce our ASone website is the inaugural winner of the EULAR Young PARE Youth Award.

In summer 2017, NASS launched ASone, a platform aimed at young people with AS. It's a community where young people can share their thoughts, feelings and experiences. ASone covers a range of issues including studying, relationships, managing AS and exercising.

Read more about ASone from the NASS website.


Axial Spondyloarthritis Seminar

NASS welcomed 40 osteopaths and chiropractors to our inaugural Axial Spondyloarthritis Seminar on 21 February.

Hosted by the Norfolk and Norwich University Hospital, the programme included talks from Dr Karl Gaffney (Consultant Rheumatologist), Mandy Rush and Andrea Lucchetti (Chiropractors), Zoe Clark (Osteopath) and Sally Dickinson from NASS.

All of the talks were met with enthusiasm and Dr Gaffney led a lively discussion around the most recent developments in AS and the issues that the groups of healthcare professionals face in referring people with suspected AS to a rheumatologist.

Read more about the event here.

BOA Congress 2018

BOA Congress 2018

Taking stock: Planning the future
25 - 28 September 2018, ICC Birmingham

Join the British Orthopaedic Association in Birmingham this September to celebrate its 100 year anniversary!

The BOA is delighted to be hosting its Centenary Congress at the ICC Birmingham.

The theme for this year’s Congress is ‘Taking stock: Planning the future’ and they are currently building an exciting programme which will be a dedication to the growth and success of the BOA since 1918.

Registering for BOA membership before 16 March to qualify for free registration to the BOA Congress.
Member registration will open on Monday 2 April and close on Friday 1 June 2018.

Please visit to find out more.

LUPUS UK publish results of their member survey

LUPUS UK publish results of their member survey

The recently published results of a LUPUS UK survey have revealed that lupus patients in the UK experience an average delay of 6.4 years between developing initial symptoms and reaching a diagnosis. In addition, the survey showed no change in this delay to diagnosis over recent decades despite efforts to improve identification and diagnosis of the disease.

The results of this survey, which was a collaboration between Manchester researchers and LUPUS UK, demonstrate that further work is needed to raise awareness of lupus amongst both healthcare professionals and patients in the UK to recognise the early symptoms and signs of the disease.

Almost three-quarters of individuals with lupus experience symptoms that limit their ability to carry out their daily activities, so a delay in diagnosis and treatment are having a significant impact on patients’ long-term physical, emotional, and financial wellbeing. These findings suggest a clear agenda for further patient focused research to increase awareness of lupus, identify better and more effective therapies and improve support for patients and overall quality of life.

Studies have shown that lupus affects approximately 25-96 per 100,000 people in the UK, but it is not known how many more cases of lupus are currently undiagnosed due to poor awareness and a lack of specialist referrals.

A summary of the key findings from the survey can be found on the LUPUS UK website.

MSK Medicine informs Choosing Wisely programme

MSK Medicine informs Choosing Wisely programme

The Faculty of Sport and Exercise Medicine UK will be submitting evidence and information on how Musculoskeletal Medicine and Exercise Medicine can contribute to the Choosing Wisely programme.

Choosing Wisely is a part of a global initiative, launched by the Academy of Medical Royal Colleges, aimed at improving conversations between patients and their doctors and nurses.

The purpose of the programme is to improve conversations between medical staff and patients to deliver enhanced care. The Academy explains; by having discussions that are informed by the doctor, but take into account what’s important to the patient too, both sides can be supported to make better decisions about care. Often, this will help to avoid tests, treatments or procedures that are unlikely to be of benefit.The aim of the programme is to help patients and their clinicians choose care that is:

• Supported by evidence

• Not duplicative of other tests or procedures already received

• Free from harm

• Truly necessary

• Consistent with patients’ values

Further information can be found on the AoMRC website.

The evidence for how effective MSK and Exercise Medicine can be in the NHS can be found in the FSEM (UK) A Fresh Approach in Practice NHS document.

HMSA's February e-news

HMSA's e-news

The HMSA are busy preparing for their 'Taking Action 2018-2022' launch, which aims to guide strategy for the next 5 years. Part of that process is 'The Big Conversation' Members Consultation survey.

You can read about this and more from the February edition of HMSA’s e-news.
Learn more about:

• livestream chats from HMSA's resident occupational therapist;

• the HSD Ambassador and Youth Patron preparing for the Hypermobility Management Workshop;

• a consultation on the Call 111 campaign;

• the helpline;

• and an update from the CEO, Donna Wicks.

PCRS Conference 2018 date announced

PCRS Conference 2018 date announced

The Primary Care Rheumatology Society Annual Conference will take place in November.

Start Time: Thursday, 22 November 2018 - 9:00am
End Time: Saturday, 24 November 2018 - 1:00pm

Venue: Park Inn Hotel, North Street, York, YO1 6JF

More details to follow.



Update on Together for Mental Health in North Wales

Update on:
Together for Mental Health in North Wales

Together for Mental Health in North Wales is an all-ages plan for mental health services in North
Wales covering the period up to 2021.

It has been put together by NHS Wales with partner organisations and with people who have lived experience of mental health issues. The project is supported by Caniad, an organisation created to involve people with lived experience in the design, delivery and evaluation of our mental health services.

The strategy outlines NHS Wales's ambition to offer a comprehensive range of services that:

• Promote health and wellbeing for everyone, focussing on prevention of mental ill health, and early intervention when required;

• Treat common mental health conditions in the community as early as possible;

• Are community-based wherever possible, reducing our reliance on inpatient care;

• Identify and treat serious mental illness as early as possible;

• Manage acute and serious episodes of mental illness safely, compassionately, and effectively;

• Support people to recovery, to regain and learn the skills they need after mental illness; and

• Assess and treat the full range of mental health problems, working alongside services for people with physical health needs.

Open the Together for Mental Health in North Wales strategy update document
In Welsh: Law yn Llaw at Iechyd Meddwl yng Ngogledd Cymru - Chwefror 2018


Spotlight On...


NHSE consultation on conditions for which over-the-counter items should not routinely be prescribed in primary care

NHS England is consulting on proposals that will stop routine prescribing in primary care of over the counter treatments for a number of conditions, including the maintenance use of vitamin D. Receiving adequate vitamin D intake is crucial for current and future bone health and NICE Public Health Guideline 562 (PH56) states that a licensed dose of vitamin D, for prevention of vitamin D deficiency, should be widely available to at-risk groups.

The consultation recognises that vitamin D should continue to be prescribed for patients who are deficient and that it can be prescribed in combination with calcium for osteoporosis. However, vitamin D for maintenance is subject to restrictions, and there is a risk that at-risk patients may not purchase it themselves (due to cost, accessibility or lifestyle reasons) or purchase a product which is inappropriate for their needs (due to ingredients or dosing levels). If you are going to respond to this consultation, consider raising the issue of availability of a licenced dose of vitamin D on prescription among at-risk patients. Let us know if you are responding on

The Pain Alliance Europe 2018 survey

The Pain Alliance Europe 2018 survey

Pain Alliance Europe are asking for responses to the 2018 edition of the Survey on Chronic Pain, which highlights how pain can affect the work-life of pain patients.

The charities who are members of Pain Alliance Europe (PAE) are inviting people with chronic pain or their carers to fill in this short survey on the effect of their chronic pain on their quality of life, their work situation and about any financial help they receive. The survey starts with some basic questions.

This is the second survey that PAE has created on the theme of chronic pain, in a series of annual surveys on the impact of pain. With each survey, PAE will analyse a different aspect of the impact of pain on the quality of life of the chronic pain patients in Europe.

A report will be created at the end of this survey, comparing the pain patients’ experiences in different countries. This report will be publicised by Pain Alliance Europe in order to reinforce their actions and promotions in order to make politicians and policy makers more aware of the important issue of chronic pain.

You can also follow @pain_europe on Twitter and share the poster.

Foot Health Priority Setting Partnership survey

Foot Health Priority Setting Partnership survey

The University of Salford and the James Lind Alliance are leading a Priority Setting Partnership (PSP) which will ensure the perspectives of patients, carers and health care practitioners inform future research priorities for charities and funding agencies (such as NIHR). This PSP is an important step forward in understanding the current foot health research priorities across the UK, bringing patients, their carers and clinicians together to identify and prioritise unanswered questions about the effects of treatments ('treatment uncertainties') in specific conditions or areas of healthcare need.

The Steering Group is hoping ARMA members will participate in this unique exercise.

A PSP allows clinicians and patients to decide what research should be done, rather than researchers. The James Lind Alliance provides a specific methodology to achieve this and has become a trusted partner to many major charities across the UK. The top ten research priorities will inform all future research spending by the William M. Scholl Endowment Trust (who is also funding the PSP) and it is expected that other agencies will also adhere to the outcomes (such as NIHR).

This is therefore an opportunity to help guide how millions of pounds will be spent on research over the next decade. As part of the James Lind Alliance methodology a small (12-15) but influential Steering Group is used and its role is to support the leadership of the PSP. Steering group members with direct relevant experience as patients, carers or health care professionals will be invited to participate in the priority setting exercise.

Where does the ARMA membership come in? Taking part in the PSP, by completing the survey when it has been developed later this year, will be a unique opportunity to help shape and address the focus of future foot health research questions that really matter. This is a chance to ensure that foot health research has direct relevance to those that matter; and that there is a clear, transparent pathway to a lasting impact on the future of foot health management.

On the James Lind Alliance website you can read about the JLA and PSPs past and present to help you understand the process and outcomes of the priority setting agenda in more detail.

The Foot Health PSP web site is here:


ARMA Calendar


Meon Valley Orchestra concert                                                                                      10 Mar 2018
Facebook Livestream Occupational Therapist #HMSALiveOT, 7pm                    15 March 2018
BASEM Spring Conference 2018, Doncaster                                                              22 Mar 2018
Portsmouth Easter Tea Dance, 3pm                                                                             24 Mar 2018
BOA Congress registration opens for members                                                         2 April 2018
North Wales ARMA Network meeting                                                                         17 April 2018
“Back to Back” Conference, Portsmouth                                                                      20 April 2018
World AS Day                                                                                                                     5 May 2018
Fibromyalgia International Awareness Day                                                                12 May 2018
2018 AACP Annual Conference, Reading                                                                    19 May 2018
BASEM Foundation Skills Course 2018, Shropshire                                                 10–13 June 2018
Annual European Congress of Rheumatology, Amsterdam                                     13-16 June 2018
North Wales ARMA Network meeting, 4.30pm                                                         3 Jul 2018
Online registration closes for BOA Congress                                                              3 Sept 2018
BOA Congress, ICC Birmingham                                                                                   25 - 28 Sept 2018
Lupus Awareness Month Begins                                                                                    01 Oct 2018
Institute of Osteopathy Convention, London                                                              12–14 Oct 2018
BMJD World Congress on Controversies, Debates                                                    08-10 Nov 2018
     & Consensus 2018, Bangkok, Thailand
PCR Society Conference, York                                                                                        22-24 Nov 2018


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