Arthritis and Musculoskeletal Alliance
This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.

Musculoskeletal pain

by Professor Michael Hurley, Clinical Director,
Musculoskeletal Programme, Health Innovation Network South London

Along with many others in the musculoskeletal community, I get a tired of hearing about other long term conditions which continuously feature in the headlines – both in national media and NHS policy. Poor old ‘common’ joint pain is neither sexy nor headline-grabbing, but we all know how much it impairs the quality of life – none more so than the people who suffer it.

In the musculoskeletal programme of the Health Innovation Network (South London’s Academic Health Science Network http://www.hin-southlondon.org/clinical-areas/musculoskeletal) we have been focusing on improving community management of osteoarthritis, or chronic joint pain, for the past couple of years. We have three main projects: the ESCAPE-pain programme, education and training and a new ‘Osteoarthritis Advisor’ role.

ESCAPE-pain stands for Enabling Self-Management and Coping with Arthritic Pain using Exercise (www.escape-pain.org | @escape_pain). It is a group-based, 6-week rehabilitation programme that combines exercise and education. It has now been implemented at 25 sites in England, both in clinical physiotherapy departments, and in leisure centres. Participants learn how to manage chronic joint pain using exercise and coping techniques, and we have seen just how powerful the learning and interactions of the group are in changing health beliefs and increasing physical activity. Don’t just take our word for it; look at what some of the 2000 participants who have undertaken the programme say: https://player.vimeo.com/video/151535343. We also have substantial evidence that it will save the health system money – a lot of money. We are currently finalising an app that will allow many more people to access and benefit from the programme.

vimeo-participantsEarly on, we recognised how important it was to improve the training and education of the whole workforce in primary care. So we delivered a short training programme (devised by the Arthritis Research UK and Royal College of General Practitioners) to more than 200 GPs across 10 South London boroughs. They reported improved confidence in their ability to manage people with OA and less inappropriate referrals. Because it used a “train the trainer” approach, where participants who attend the programme can easily be trained to deliver it, we now have 7 GPs who are keen to continue to run these courses and educate their colleagues.

We also realised that leaving it to poor struggling GPs is not an option. People with benign joint pain get stuck in the bottleneck of primary care; because there’s insufficient manpower to deliver effective care, people receive little useful advice or adequate support, and consequently suffer unnecessarily for many years. So we are training other allied health professionals, health trainers and other disciplines to give more people better advice. In particular, we have also been delighted to observe how the provision of care NICE guidelines – simple advice and education delivered by an “Osteoarthritis Advisor” rather than a GP – can help reduce people’s joint pain, body weight and improve physical activity levels. This approach has huge potential for allied health professionals to elevate the burden on overstretched GPs, simplify over-complicated care pathways and deliver effective evidence-based care to large numbers of people.

HIN-logo-transparentOur projects show consistent improvements in pain, in function, wellbeing, and quality of life, and reduce health and social care costs. We are really excited about working with the health and social care systems across South London to scale-up and develop these projects so that many more people can lead better lives.

For more information contact us at the musculoskeletal clinical area at HIN South London.

phe-logoFrom the Public Health Matters blog, Public Health England
, 11 January 2016 — Health and Wellbeing

Life expectancy in England has risen by more than five years in the past two decades, yet for many people, a longer life will involve more years spent in ill-health.

Earlier this year, The Global Burden of Disease project – an international study ranking the diseases and risk factors that cause death and disability – highlighted the toll that musculoskeletal conditions are taking on people’s health.

2000px-Lumbar_region_in_human_skeleton.svgMusculoskeletal conditions are disorders of the bones, joints, muscles and spine. They can cause pain, stiffness or a loss of mobility and dexterity that can make it difficult to carry out everyday activities.

Low back and neck pain is now the leading cause of disability in England for both men and women combined. Falls, which are often a result of poor musculoskeletal health, also remain in the top ten causes of disability adjusted life years – a combination of the number of years of life lost to disease and the number of years lived with disability as a result of disease.

 

The wider effects

Each year 20% of people in the UK see a doctor about a musculoskeletal problem, and the NHS in England spends £5bn each year treating these conditions.

As well as causing pain and disability, musculoskeletal conditions can affect people’s physical health more generally. For example, people with osteoarthritis have an increased risk of cardiovascular disease, and falls among older adults increase the likelihood of early mortality.

Although many musculoskeletal conditions become more common as we age, they are not limited to older adults. A report published by Arthritis Research UK in 2014 highlighted that, in the past year, one in six adults aged over 25 had reported back pain lasting more than three months. Obesity, physical inactivity and injury are all major risk factors for back pain.

Mental health conditions can also increase the likelihood of developing some musculoskeletal disorders. For example, people with depression are at greater risk of developing back pain. Here lies a vicious cycle, as musculoskeletal conditions can also have a significant impact on mental health. Living with a painful condition can lead to anxiety and depression, and depression is four times more common among people in persistent pain compared with those without pain.

People with musculoskeletal conditions are also less likely to be employed than people in good health, and are more likely to retire early.

DALY

Musculoskeletal health: making a difference

Steps can be taken to improve musculoskeletal health at every stage of life, and tackling a number of risk factors could result in the dramatic improvement in the musculoskeletal health of the public.

Bones, joints and muscles begin to develop before birth, and continue to develop throughout childhood. Women who have a good diet and are physically active have babies that go on to have stronger bones throughout life. Conversely, childhood obesity can put pressure on vulnerable joints, increasing the risk of MSK conditions.

Regular physical activity and exercise at every stage of life can reduce the risk of many musculoskeletal conditions, including arthritis, back pain, neck pain, falls and fractures. Indeed, many of the NICE guidelines on physical activity to prevent disease or improve health are directly relevant to musculoskeletal health. A healthy balanced diet is also important for good bone health, to prevent osteoporosis and falls in later life.

There is also a lot that can be done in the workplace to reduce any threats to musculoskeletal health, including adapting physical environments and work practices, as well as early interventions to identify and address problems.

It’s important to note that, for the three leading musculoskeletal conditions that cause the most DALYs in England, there are evidence-based interventions that work (see table).

msk-interventions

Evidence-based interventions for the musculoskeletal conditions that cause the most DALYs in England, including low back and neck pain, falls and osteoarthritis.

 

At Public Health England, we’re working to reduce the impact of musculoskeletal conditions in a number of different ways:

Data and surveillance resources

The Arthritis Research UK report puts a clear emphasis on the need to urgently improve the extent and quality of clinical data on musculoskeletal health. More work is needed fill these gaps, but two useful weapons in our data arsenal are currently available:

The PHE Global Burden of Disease Compare tool helps local authorities to see the burden of musculoskeletal conditions on their local populations, while the Public Health Outcomes Framework enables us to see which risk indicators for musculoskeletal disorders are high in each local authority area.

 

Programmes for patients and professionals

Moving from evidence into action, PHE is working with partners on a number of prevention programmes and resources for people across all stages of life, as well as initiatives to help commissioners procure services to help prevent musculoskeletal ill-health.

For example, the Every Body Active Every Day framework sets out our vision of everybody being physically active, every day. It details clear steps for local authorities and partner organisations to promote change and encourage active lifestyles.

Our Falls prevention booklet explains how older people at risk of falls can reduce their risk and stay active. We have also developed a Falls and Fragility Fraction Population Healthcare Programme to help local authority public health teams gather and disseminate information about their local FFF system. The programme also supports local FFF initiatives, assesses and tracks performance and enables local partners to learn from best practice.

 

Partnerships and public engagement

Improving musculoskeletal health requires commitment from many different stakeholders, and will benefit patients, the health care system and other groups such as employers. We’re working with several partners to find joined-up ways of improving musculoskeletal health across the life course, such as our Workplace Wellbeing Charter to help employers provide workplace environments that support and encourage a healthy workforce.

We’re also working with Arthritis Research UK to make sure that improving the musculoskeletal health of the population is on the agenda of both the public health community and local and national government. Bedfordshire Clinical Commissioning Group is a great example of how some parts of the NHS are already using an integrated approach to improving MSK services. Last year it commissioned one single provider for its entire MSK programme with responsibility for delivering a service that joins up with other elements of the care pathway and focuses on outcomes for patients.

 

Reducing the burden of disease

As health care professionals, we must work together to promote good musculoskeletal health as a way to address multi-morbidity and protect mental health and wellbeing. At PHE, we are committed to working with partners and academics to identify health interventions that really work, supported by world-class knowledge and data, and to improve the capability and capacity of the NHS and the wider public health workforce to identify and treat MSK conditions, and implement effective and efficient prevention programmes.

The Global Burden of Disease study highlighted the fact that, as a nation, we must do better to reduce the burden of chronic diseases. Tackling musculoskeletal conditions and their wider impacts on health and wellbeing is a crucial step.

mediaplanet-bones-and-jointsARMA is pleased to once again support Mediaplanet on the 2015 Bones and Joints campaign to raise awareness of bone and joint health, from everyday strains to critical musculoskeletal diseases.

The campaign, launching today, features leading editorial from industry experts and insights on what is being done to provide better quality of life for patients with bone and joint problems. First-hand accounts from patients living with osteoporosis can be found on the dedicated campaign site, alongside pieces by Craig Revel Horwood and Greg Retter, Clinical Director at The Royal Ballet, on what we can learn from dancers about bone and joint health.

Mr Tim Wilton, President of the BOA, is leading the campaign with the foreword in the print supplement, with Professor Edward Davis of The Royal Orthopaedic Hospital explaining the different possibilities for patients undergoing surgery. You can pick up a copy of Bones and Joints in The Guardian today, or view it online at www.healthawareness.co.uk/bones-and-joints.

Please share on social media and retweet the tweets!

ADWoolf-x200_nlby Professor Anthony Woolf, Chair of ARMA and Chair of the Bone and Joint Decade: A Global Alliance for Musculoskeletal Health

Musculoskeletal conditions continue to be the greatest cause of disability in the UK according to the Global Burden of Disease study [click for summary], accounting for 30%. Low back pain is the greatest specific cause of disability and osteoarthritis is increasing with ageing of the population and increasing obesity. We, the MSK community, have always known the impact these problems have on people and society but now policy makers cannot escape from the facts and have to come up with policies to prevent and manage them more effectively.

The drivers for political action are not just numbers of years lived with disability due to MSK conditions but the economic impact this has due to loss of work and independence. People are living longer and need to be able to work into older ages and maintain their independence. But with ageing physical function declines and people collect long-term conditions like children collected postage stamps. Society cannot afford to look after them. 

It needs to be recognised that musculoskeletal health is essential to general health and well-being and more invested in maintaining it. Promoting physical activity and ideal body weight is important but the gain for musculoskeletal health needs to be more transparent – people think it the main danger from obesity is diabetes but the risk of OA is just as great. We need other solutions to offer the policy makers to reduce the future burden. We know a lot of the “whats”, like early diagnosis of inflammatory arthritis, but we need more examples of the “how” to demonstrate how it can be achieved in a cost-effective way.

We also have to work as an MSK community as no individual person or group can deal with the spectrum of MSK conditions and deliver the integrated care many need. The burden of disease data along with the current political context gives us a great opportunity to present ourselves as a community with solutions to offer – at last policy makers are asking for this and we have to meet the need.

Findings of the Global Burden of Disease Study 2010, from the Lancet.
More about the Bone and Joint Decade, including recent posts.

HIN-logo-transparentOn the 20th October, the Health Innovation Network’s ESCAPE-pain programme was awarded a two-year Health and Wellbeing Award from the Royal Society of Public Health.

This award recognises the work of the ESCAPE-pain programme in moving outside of traditional NHS environments and into the community (i.e. leisure centres) to improve public health.

You can find more information at @ESCAPE_pain and @HINSouthLondon.

ESCAPE logo 2247x500px

RCC-280x300The Royal College of Chiropractors’ Health Policy Unit has recently published a document outlining the skills and competencies of chiropractors in the management of low back and radicular pain. Download the PDF from the RCC website.

Similar documents addressing other musculoskeletal conditions are under development, as are CPD opportunities to help chiropractors further develop their competencies and skills in key areas.

 

2016 AGM & Conference

Speakers at the RCC’s forthcoming AGM & Conference include Professor Charles Greenough, Chair of the multidisciplinary working group that developed the ‘Pathfinder’ pathway of care for low back and radicular pain. The event takes place in London on Wednesday 27th January 2016.

www.rcc-uk.org
RCC on Facebook

by Dr Wendy Holden, Consultant Rheumatologist

arthritis-action-2015-member-logo

Around one in seven people in the UK currently live with arthritis. This figure is expected to rise to one in four by 2030 [1]. It is the leading cause of pain and disability, costing the NHS a staggering £5 billion a year [2]. One in five of us consult their GP about a musculoskeletal problem like arthritis each year, that’s more than 100,000 consultations for arthritis every day [3].

Around 15,000 children and young people live with the condition [4]. Crucially, arthritis also impacts work performance: almost 31 million working days were lost in 2013 due to sickness absence caused by a musculoskeletal condition [5].

A fortnight ago, we marked National Arthritis Week (12 – 18 October), a critical moment in the history of the condition, which, I hope, will help to focus policymakers’ attention on the plight of millions lacking mobility and experiencing pain as a result.

National Arthritis Week is an initiative of Arthritis Research UK [6], which aims to raise awareness of the burden of arthritis and other musculoskeletal conditions amongst the healthcare community and the impact that it has on people living with the condition.

Across the sector, eminent doctors and health professionals have been calling for musculoskeletal conditions to be seen as a priority for many years. Arthritis Action is adding its voice to those calls.

Whilst a great deal of research goes into the prevalence, treatment and diagnosis of arthritis, it is important to highlight the significant role of self-management in coping with arthritis.

To mark our launch in June, Arthritis Action published new research, showing that people with arthritis feel isolated, scared about the future and don’t want to ask family, friends or doctors for help [7].

The researchers surveyed 777 people living with arthritis (both osteoarthritis and inflammatory arthritis) and held in-depth interviews with GPs and senior public health professionals. Interestingly, around half of our survey respondents felt that they needed to take charge of self-managing their condition because the NHS is over-stretched.

The research also revealed that the care pathway for osteoarthritis is particularly limited. The main gaps are in physical therapies and pain-clinics; with long waiting times often meaning that the patient does not receive the required treatment during a flare-up in their condition.

There is increasing recognition by GPs that mental wellbeing and preventing social isolation is an important part of patients’ management of arthritis, but counselling, therapy and social support services are lacking and need to be better integrated with medical care.

Furthermore, GPs acknowledge that much of osteoarthritis management relies on patients’ self-management of their condition, which only reinforces the very reason Arthritis Action was born: to help people with arthritis better manage their condition and endure less pain.

My message to the healthcare community is to be brave and bold in this period of publicity. It is time for policymakers at all levels to pull their heads from the sand and address arthritis as a priority.

It is time for a step change in the way we view arthritis, time to give people living in pain a voice, and importantly, time to listen to what they have to say.

Dr Wendy Holden is a Consultant Rheumatologist at North Hampshire Hospitals NHS Foundation Trust and UK Charity Arthritis Action’s Medical Advisor.