This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.
  • The Arthritis and Musculoskeletal Alliance (ARMA) is the umbrella body for the arthritis and musculoskeletal community in the UK, and our mission is to transform the quality of life of people with musculoskeletal conditions. We have 33 member organisations ranging from specialised support groups for rare diseases to major research charities and national professional bodies.

Resources

by Sophia Steinberger, Health Intelligence Analyst and Jonathan Canty, Policy Officer, Versus Arthritis

How many people have musculoskeletal conditions in the UK? How are these conditions affecting their lives? What is the breakdown by age, gender, and condition? What is the impact of MSK conditions on work, health services, and the wider economy?

This month Versus Arthritis published the annual State of Musculoskeletal Health 2019 to help answer these questions and many more. The report presents a collection of the best available data on the prevalence, risk factors, comorbidities, and impact of MSK conditions in the UK, to help further the understanding about the people living with and affected by these conditions.

Musculoskeletal (MSK) conditions such as arthritis and back pain affected an estimated 18.8 million people across the UK in 2017. They accounted for more than 22% of the total burden of ill health (morbidity) in the UK, and low back and neck were the biggest cause of ill health overall across all ages.1 While these conditions are incredibly common, many people affected are still not receiving the recognition and support they deserve and need.

The State of Musculoskeletal Health is a resource for health professionals, policy makers, public health leads and anyone interested in MSK health. We believe that with the best information you can build awareness, make more informed decisions, feel more confident and ultimately help more people with MSK conditions.

Read the full report here, which includes powerful short stories from people with arthritis themselves.

1 Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2017 (GBD 2017) Results. Institute for Health Metrics and Evaluation (IHME), Seattle, 2018.

Public Health England has published two documents related to MSK prevention. The first is a whole-system strategic framework for prevention of musculoskeletal conditions across the life-course. The purpose is to provide stakeholders and system collaborators with a clear statement of PHE, NHS England and Versus Arthritis’ commitments to promote MSK health and to prevent MSK conditions. Each collaborating organisation, including ARMA, has identified what they will be contributing, and in some cases, leading on.

The document contains information about a range of MSK prevention activities and links to resources and tools to help prevention activity.

Alongside this is an MSK prevention logic model which provides an overview of the programme vision: help maintain and improve the musculoskeletal health of the population in England (across the life-course), supporting people to live with good lifelong MSK health and freedom from pain and disability which will be delivered by system partners and collaborators within 5 years.

Case study of improved mobility and independence

Listen to Regina’s story of how she overcame osteoarthritis and difficulties with mobility with the help of the ESCAPE-pain group at her local leisure centre.

The ESCAPE-pain Programme: Helping people with chronic joint paint to self-manage their condition and become more physically active

At 76 years old, Regina had been suffering with osteoarthritis for over ten years and it was having a big impact on her life physically and emotionally. “I was in a bad place; I was in a wheelchair to start with.”

Regina found walking very difficult and a journey that should take five minutes, would take her thirty minutes. “It came to a point where I wouldn’t dare to cross the traffic lights, and my daughter would have to drive me everywhere, because I was so scared. Of course, getting on a bus – that was way beyond me. The furthest I ever went was to church and going to church I had to have a carer because I didn’t have the confidence to go on my own.”

In 2018, Regina signed up to a programme being run by Mytime Active in a local leisure centre for chronic knee and hip pain, called ESCAPE-pain. “ESCAPE-pain has really given me my independence back, more than anything else it has given me my confidence.” From having been too scared to travel alone, Regina’s physical function improved so much so that she felt confident to be able to use buses again and travel independently.

Regina also described how crucial the group aspect of the ESCAPE-pain programme was for her. “They make you feel comfortable even before you go into the class, and once you are there you meet other people who are like you, and you know that you are all in this together and that is what works more than anything else. I have made loads of friends at ESCAPE-pain, and I even go shopping with some of them.”

The programme was also important in helping her to adopt a more physically active lifestyle. “Now, I go to gym classes, I go to Zumba (it’s a dance class), and I go to yoga. I would recommend ESCAPE-pain because it makes you be yourself, I would recommend it to anybody, no matter what your state at the moment is.”

Scale of the problem

Regina’s experience is not uncommon. Osteoarthritis has a major impact on individuals, healthcare services and society. The social and economic burden of osteoarthritis is substantial and results in decreased quality of life, loss of productivity, and increasing costs of healthcare. In 2016, an estimated 30.8 million working days were lost to musculoskeletal pain in the UK, accounting for 22.4% of all sickness absence1. It is estimated that one in three people with osteoarthritis retire early, give up work or reduce the hours they work because of their condition2.

People living with osteoarthritis often believe it is an inescapable consequence of ageing and worsening disability is inevitable. Too few people with osteoarthritis receive core advice and support in line with NICE guidelines for care and management of osteoarthritis (CG177)4, 5, such as increasing physical activity and maintaining a healthy weight.

What is ESCAPE-pain?

ESCAPE-pain is an evidence-based exercise-based group rehabilitation programme for people with chronic knee and/or hip pain, also known as osteoarthritis, designed to improve people’s function by integrating exercise, education, and self-management strategies to dispel inappropriate health beliefs, alter behaviour, and encourage regular physical activity.4,6,7,8

The ESCAPE-pain programme was developed by Professor Mike Hurley and is hosted by the Health Innovation Network and supported by NHS England and Versus Arthritis.

ESCAPE-pain is shown to:

  • Reduce pain, improve physical function and mental wellbeing, and improve health beliefs4.
  • Sustain benefits for up to two and a half years after completing the programme6.
  • Create an estimated £1.5 million total savings in health and social care for every 1,000 participants who undertake ESCAPE-pain6, 7.

Currently, over 170 sites are delivering ESCAPE-pain across the UK in both clinical and non-clinical community sites (e.g. community centres and leisure centres) with more than 11,000 people having successfully completing the programme. As ESCAPE-pain has spread into ‘real world’ settings on-going collection of outcome data from sites demonstrates that participants are benefiting from the programme.

How the programme works

Participants attend 12 sessions twice weekly for six weeks, which is led by a trained facilitator* (i.e. either a clinician or level 3-4 fitness instructor). Each session comprises a 15–20 minutes facilitated discussion on a specific topic relating to the self-management of osteoarthritis. This is followed by a 35–40 minutes individualised exercise regimen. Once participants complete the programme they are signposted to local opportunities to help them maintain their physical activity.

*All ESCAPE-pain facilitators completed an accredited 1-day training course to ensure the quality of the programme.

How to find a local class

The programme is being offered in a variety of venues from hospital physiotherapy departments to leisure centres and gyms, from church halls to community centres. To find a local class either visit the site map on the website or email your postcode to hello@escape-pain.org.

Support tools

We have designed some support tools to help people continue exercising safely in their homes once they have completed the face-to-face ESCAPE-pain programme.

See here for further information about the ESCAPE-pain app and the web-based version of the app, ESCAPE-pain Online. Both are free to access.

For more information email us at hello@escape-pain.org or visit the website escape-pain.org.

References

  1. Sickness absence in the labour market – Office for National Statistics [Internet]. Ons.gov.uk. 2017 [cited 1 May 2018]. Available from: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2016
  2. State of Musculoskeletal Health 2018 | Arthritis Research UK [Internet]. Arthritisresearchuk.org. 2017 [cited 1 May 2018]. Available from: https://www.arthritisresearchuk.org/arthritis-information/data-and-statistics/state-of-musculoskeletal-health.aspx
  3. NHS England: CCG programme budgeting benchmarking tool. [Internet]. NHS England. 2014 [cited 1 May 2018]. Available from: https://www.england.nhs.uk/resources/resources–for–ccgs/prog–budgeting/
  4. Hurley M, Walsh N, Mitchell H, Pimm T, Patel A, Williamson E et al. Clinical effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain: A cluster randomized trial. Arthritis & Rheumatism. 2007;57(7):1211-1219.
  5. National Institute for Health and Care Excellence. Osteoarthritis: care and management. Clinical guideline [CG177]. 2014.
  6. Hurley M, Walsh N, Mitchell H, Pimm T, Williamson E, Jones R et al. Economic evaluation of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain. Arthritis & Rheumatism. 2007;57(7):1220-1229.
  7. Jessep S, Walsh N, Ratcliffe J, Hurley M. Long-term clinical benefits and costs of an integrated rehabilitation programme compared with outpatient physiotherapy for chronic knee pain. Physiotherapy. 2009;95(2):94-102.
  8. Hurley M, Walsh N, Mitchell H, Nicholas J, Patel A. Long-term Outcomes and Costs of an Integrated Rehabilitation Program for Chronic Knee Pain: A Pragmatic, Cluster Randomized, Controlled Trial. Arthritis Care & Research. Vol. 64, No. 2, 2012, 238–247.

Arthur’s Place has created and launched “Project Mum” a support kit for young women with arthritis and related conditions, those who are considering becoming mothers in future, women who are currently pregnant and new mums. There will be advice for Dads-to-be and partners too, with or without arthritis.

Project Mum includes invaluable advice from health professionals, including consultant rheumatologists, nurse specialists, midwives, a physiotherapist, occupational therapist and three clinical psychologists. Arthur’s Place is also tremendously proud to include personal shared tips and advice from more experienced mums at Arthur’s Social: the Facebook community.

At the heart of Project Mum is a series of twelve short videos in which North East consultant rheumatologist Dr Martin Lee answers common questions that young women with arthritis have about conception, pregnancy, birth and early motherhood. Dr Lee covers fertility, medication considerations, symptoms during pregnancy, impact on labour, breastfeeding and more. We believe these videos are the first of their kind, and we hope our friends and HCP colleagues will signpost patients to them.

The hope is that Project Mum will reassure young women that motherhood is possible, and there is support available from others going through similar experiences. We also hope to inspire young women to think ahead about whether they would like children in future and discuss this with their doctor as early as possible in their treatment journey.

A new design and new features for Arthur’s Place

The launch of Project Mum is an opportunity to bring a fresh look to Arthur’s Place. The new design is as contemporary and visually striking as before, but the new layout will greatly improve the user experience on smart phones. Please do take a look.

As well as the new design, the blogs section has been relaunched to allow more young people with arthritis to contribute. It is now possible for everyone to share their story, and to contribute just a single written piece, photograph, piece of audio or short video. The goal is to create the richest and most diverse account of life with arthritis for people aged 18-35yrs, from around the world.

There is also Arthur’s Place TV, the YouTube channel devoted to curating the most relevant and trustworthy videos that we feel could be of benefit. This will also host the unique video content that A.P. plans to create, as and when funding allows.

Finally, the arthritis facts section has been updated to include the latest information and signposting to other services – in particular Versus Arthritis – plus launched a monthly newsletter. Arthur’s Place hopes you will subscribe to help spread the word about the fantastic community support and the range of content and tools available.

NASS was delighted to launch the NASS Allies referral template, in conjunction with the Institute of Osteopathy and Royal College of Chiropractors, at the Primary Care and Public Health Conference on 15 and 16 May. The template was developed to help chiropractors and osteopaths in recommending referral for patients with suspected inflammatory back pain to rheumatology.

The template has been endorsed by the Royal College of GPs and Chartered Society for Physiotherapy. NASS is grateful to both the Institute of Osteopathy and Royal College of Chiropractors for their continued collaboration and wonderfully patient-centred approach.

Save Our Pools

NASS is working with a number of organisations, including several ARMA members, on developing a campaign to sustain and in some cases, save, hydrotherapy pools around the country. If you are interested in being involved, please email jill@nass.co.uk. Please also sign and share the petition to save the pool at Bedford Hospital.

 

The Institute for Voluntary Action Research (IVAR) has developed free support resources for health, care and voluntary sector leaders who want to drive action through partnership working around the NHS Long Term Plan. The resources include online learning, webinars, workshops, coaching and individual support and are aimed at ICS/STP leads, commissioners, clinicians, and professionals from the voluntary sector.

The NHS Long Term Plan commits local healthcare systems to working in a new way, including a focus on prevention and reducing health inequalities. Building relationships – with other health agencies, local government, providers and communities – will be essential for the leaders charged with bringing this ambitious vision to life.

The NHS Long Term Plan recognised the role Voluntary, Community and Social Enterprise (VCSE) organisations could play, in partnership with the NHS, to help deliver its vision. At a strategic level, NHS England is committed to working with VCSEs and establishing models for more equitable partnerships and better integration, and to increase the influence of the voice of patients. More locally, STP’s/ICS’s, as with any relatively new player in a system, are taking time to build consistently high and constructive levels of engagement with VCSE organisations and communities more widely. 

The Building Health Partnerships programme and this wider support offer – Transforming Healthcare Together – have been designed in response to all these challenges, to work intensively with statutory services to test and pilot new approaches to partnership working, and to support the leaders working to bring the NHS Long Term Plan to life.

The free support offer is for health, care and VCSE leaders who want to drive action through partnership working. There is a range of support for different levels, whether you are just getting started or have been working in this way for some time.

The Health Foundation, Kings Fund and Nuffield Trust recently published a report Closing the Gap: key areas for action on the health and care workforce. The report looked at two areas – nursing and general practice, both very relevant to MSK health care. At the moment the future looks bleak, with 41,000 nursing vacancies in the NHS and another 5,000 in social care. There are 2,500 fewer GPs than are needed. The report, however, is optimistic that these shortfalls can be addressed, provided policy changes are made.

On nursing, the recommendations include increased training, international recruitment and a range of measure on pay and career opportunities. There are particular issues for recruitment of specialist nurses, something which ARMA member the Rheumatology Nursing Network is very aware of.

Proposals for general practice chime exactly with the work ARMA members have been doing around First Contact Practitioner. The report recognises the potential for nurses and AHPs to work across traditional boundaries and deliver more patient-focused care, moving from a traditional GP model to multidisciplinary team working. It is important to remember that these changes don’t just help make up the shortfall in GP numbers, they also have the potential to improve patient care.

New online infographic posters summarising the National Institute of Health and Care Excellence (NICE) guidance relevant to allied health professionals are now available online. Produced by the Institute of Osteopathy and endorsed by NICE, these easy to use resources provide a quick reference guide to current NICE guidance which can be printed and displayed in a clinical setting and support CPD.

There are currently three topics available; osteoarthritis, osteoporosis and spondyloarthritis, with plans to develop others in the near future.

The posters translate the NICE guidance into an easy to follow visual format to aid health professionals in primary care to identify and assess for the conditions and provide recommended pathways for care and management.

Matthew Rogers, Professional Development Manager at the Institute of Osteopathy and fellow of NICE, has been leading the project: “As a clinician I am acutely aware of the demands on health professionals to keep up to date with current guidance. As part of my fellowship with NICE I was keen to develop resources that would assist clinicians more easily embed the guidance into practice.”

The infographics are available to download for free from www.iosteopathy.org/for-osteopaths/clinical-guidelines.