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.

Treatments & Therapies

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.

On 8 May, Versus Arthritis published a new policy report looking at the impact of home aids and adaptations for people with arthritis, and the barriers that people face when trying to access them. Read the full report here, which includes powerful stories from people with arthritis who benefit from aids and adaptations.

We found that aids and adaptations – from perching stools and grabbing tools, to grab rails and stair lifts – can help people with arthritis, and related conditions such as back pain, achieve a better quality of life and maintain their independence in the home.

60% of all people with arthritis, across all genders, ages, and severity of condition, used an aid or adaptation. Of those, 95% felt that these products had a positive impact on their lives. However, too few people are aware of the support available to them. 

The report makes recommendations to both local and central government that would help widen access to these vital services.

By Jill Hamilton, Professional Engagement Manager, National Ankylosing Spondylitis Society

Exercise is the single most important thing that anyone with axial SpA (AS) can do to self-manage their condition. It’s not always possible though; if someone is experiencing a flare or has severe physical disability as a result of their condition then exercising on land can be pretty much impossible. Exercising in water however is a lot easier; the warmth and the buoyancy make stretches more effective, it’s less painful, it’s easier to stay upright because the effect of gravity is less, it requires less physical effort and afterwards you usually have a really good night’s sleep!

In my time working at NASS I have had the privilege to see first-hand the benefits that people with axial spondyloarthritis (axial SpA) including ankylosing spondylitis (AS) have from being able to exercise in a hydrotherapy pool. Through our network of branches and local NHS services, people with axial SpA (AS) have been well looked after over the years.

I recall visiting one of our branches a while back and a member walked in whilst I was giving an update on what was happening at NASS. He came in clearly in the middle of a massive flare and looked completely crushed when he saw that we were sitting around talking. ‘Is there no hydrotherapy tonight?’ he asked, barely able to walk as his joints had stiffened up and the pain had taken over his body. At this point I stopped talking and said, ‘OK that’s enough from me, time for hydrotherapy everyone’. I knew from looking at him he couldn’t wait a minute longer – medication was having no effect and hydrotherapy was the only thing that was going to help him, even for just a few hours.

It saddens me that in recent years, the closure of hydrotherapy pools has become more common in NHS settings. Too often they are seen as a waste of money and an easy way for the trust or CCG to save some cash. It is a misunderstood form of treatment – to those who don’t use hydrotherapy it is a luxury; for those who do use it, it is essential to keep mobile and minimise pain.

NASS recently funded some research conducted by Melanie Martin, Advanced Physiotherapy Practitioner at Guy’s Hospital in London and Claire Jeffries, Physiotherapy Manager and Clinical Specialist in Hydrotherapy and Rheumatology at Queen Alexandra Hospital in Portsmouth, which looked at attitudes towards hydrotherapy. On average, people gave 7.7 out of 10 for how much hydrotherapy complemented their care overall.

Some of the recent comments that have been published by NHS trusts have been incredibly short-sighted. It seems that their view is, if it isn’t a cure, it’s not a valid treatment. Surgery and pharmacological interventions just aren’t possible for everyone though and so finding alternative forms of treatment is vital.

For a person who lives with chronic pain, the benefits of any treatment are very important; having those few days where you can feel ‘normal’ and get on with your every-day tasks are priceless. Don’t we all deserve those moments?

NASS is joining forces with other organisations to campaign to save our hydrotherapy pools. If you know of a pool under threat or simply would like to learn more about how to advertise your pool and utilise it to the fullest, get in touch. The hydrotherapy pools that are the most successful and the most protected is where they are used by people with a range of conditions and needs. We need to get the message out there just how important this treatment is, and we need the support of ARMA members to do it.

New product the Keywing is opening the door for millions to use keys with ease, while restoring independence.

Winner of the Design Council Spark Award and a £65,000 investment from charity Versus Arthritis, the Keywing is being released on the 27 March 2019, helping millions with reduced dexterity to open doors and regain independence.

Retailing from £4.99, the Keywing is a simple, innovative and thoughtfully designed product that clips onto keys. Once in place, it creates a larger surface area and longer lever, making keys easier to hold, grasp and turn, and locks much easier to open.

The Keywing has been designed by Australian born, London-based designer Geoff Rolandsen. Geoff witnessed his father living with deteriorating dexterity in Australia and the challenges that it brings to his everyday life. Inspired when his father struggled to unlock his shed, and determined to make a difference to his life, Geoff set out to design a beautiful, desirable product that could help restore independence to his father and the 10 million people in the UK who live with arthritis and reduced dexterity.

“It was incredibly frustrating to know that a task as simple as opening the front door, is such a challenge to so many people” says Rolandsen.

The Keywing design has been tested and refined over the past 18 months with hands on testing undertaken by Versus Arthritis supporters across the UK. It is launching in March 2019 at www.theKeywing.com and on Amazon, and a full national retail launch is under discussion.

User testing responses have been incredible, with 90% of people saying it significantly helped them to use their keys with ease, and would make a welcomed difference to their day-to-day lives.

Sarah Odoi, IP development manager at Versus Arthritis, comments:

“There over 10 million people in the UK living with the pain and fatigue of arthritis. That’s one in six people. Many struggle with everyday activities that we take for granted, like getting dressed in the morning or turning the key in a lock. That’s why products, like the Keywing, are essential in helping people to stay in control of their own lives, without the fear that they can’t unlock the door to their home.

“As a charity we support innovative designers, like Geoff, to make everyday products that not only help people with arthritis to maintain their independence but that are appealing to eye – many people are put off from using clunky ‘aids’. It’s been fantastic to work with Geoff and the Design Council, and help the idea come to life.”

“I’ve been blown away by the feedback from users saying how this product has made such a difference to their lives,” Rolandsen adds. “Enabling them to leave their house with confidence that they won’t struggle to unlock their front door upon return is the biggest reward for me.”

Reduced hand dexterity has a vast range of causes and is impacting a growing portion of society with research from Versus Arthritis showing that nearly half (44%) of sufferers have difficulty moving around independently. Pain and difficulty undertaking daily tasks, such as locking and unlocking doors, is a key contributing factor to this alarming statistic.

Dr Anna Lowe, a chartered physiotherapist, believes The Keywing could play a key role in making these challenges easier to manage for people with reduced dexterity.

“As a physiotherapist I’ve worked with many people with reduced dexterity associated with conditions including arthritis and long-term neurological conditions where keys and locks present a particular challenge because of the manual dexterity and strength required.”

“The Keywing is a neat little device and could help to give individuals and their families and carers confidence and peace of mind and could make the difference between someone needing help to get in or out of their own home and being able to do it independently.”

It is not only arthritis sufferers who will benefit from the Keywing. Feedback shows that it can also make a positive impact for the 17 million people who live with a musculoskeletal condition in the UKref (around 28.9% of the population) and those with deteriorating hand strength caused by ageing.

Visit www.theKeywing.com to get your hands on the Keywing and keep informed of new innovative products being released in the future. Until May 1st, ARMA newsletter readers can receive 20% off any purchase using the code ARMA2019 at the checkout. The Keywing is also eligible for VAT relief to qualifying customers and charities.

by Sarah Duncan, Head of Clinical Policy, NHS England

An interview on the news recently about stem cell research into cartilage replacement for osteoarthritis, made me reflect on the phenomenal pace of change and progress in the relatively short time of my career. As a new physiotherapist in the mid-1980s we used short wave diathermy; long flexible heated tubes wrapped around a patient’s knees, to help with the pain of arthritis. Although patients really enjoyed the heat, it made little difference to their ongoing pain and mobility.

At that time, every orthopaedic ward housed patients on traction for spinal pain. Attached to heavy weights via tape stuck to their legs, patients were on bedrest for 6 weeks. It would be the physio’s job to get them standing up for the first time. Many people would nearly faint as their cardiovascular system tried to cope with being vertical again. I often thought the subsequent manoeuvres to get them flat again must have reversed the alleged benefits of the bedrest. This was a time when there were treatment regimes for everything and the main individualising factor was the surgeon’s preference.

I was working in Somerset when I came across a different approach to chronic pain management, led by Dr Alf Collins, now Personalised Care Group Clinical Director at NHS England. His approach for people living with persistent pain was to help them understand and come to terms with their pain, and adopt strategies which enabled them to lead as fulfilling and independent lives as possible. Physiotherapists ran education and exercise groups, which also enabled people to share their experiences with others who understood and could empathise. This approach really worked for many people, supporting both their mental and physical health, and they were empowered to take control of their condition. I learned that managing pain was less about giving a treatment to a passive recipient and more about collaborating and working with them.

Fast forward 30 years and I’m in a national clinical policy role, which includes the Musculoskeletal (MSK) Conditions programme. Digital technology, genomics, stem cell research, and advances in surgery are all enabling progress to be made, beyond anything imaginable in the ‘80s. This progress also includes the evidence-based personalised care approach that the membership organisations of ARMA have long supported and developed. In partnership with ARMA, NHS England has developed the MSK Knowledge Hub enabling the MSK community to debate innovative ideas, share learning and celebrate success. The NHS Long Term Plan published yesterday, has a whole chapter on personalised care building on the  Five Year Forward View, which recognised the need for better integration of services, and connection with the voluntary sector, to enable a more personalised approach.  The NHS Long Term Plan aspires to a fundamental shift in approach to deliver more person-centred care, including for musculoskeletal conditions.

We must continue to develop the focus on people as individuals amongst the high-tech treatment options, and ensure people are properly listened to. People with MSK conditions should have choice and control over the way their care is planned and delivered, based on what matters to them and not only on what’s the matter with them. I’m encouraged to see that the Long Term Plan for the NHS will build on the evidence and examples to show how personalised care could, and should be, business as usual across the health and care system.

More people, more active, more often: three perspectives on physical activity and musculoskeletal health

21 November 2018

Introduced by Sue Brown ARMA CEO and Liam O’Toole, CEO, Versus Arthritis, who partnered with ARMA for the flagship lecture, the three presenters delivered speeches that did not disappoint the rapt audience of health professionals, commissioners, patients, public and NHS health officials and, of course, parkrunners. The discussion about how to overcome the barriers to activity faced by people with musculoskeletal conditions ranged from big-picture societal issues to practical hows-to. 

Michael Brannan, Physical Activity Programme Manager, Public Health England said that strength, balance and co-ordination were often referred to as the ‘forgotten guidelines’ included in the Chief Medical Office Physical Activity Guidelines. While two-thirds of men and half of women achieve the cardiovascular elements of the CMO guidelines, a much smaller proportion meet the strengthening, balance and coordination elements of the CMO guidelines. 

Claire Harris, Physiotherapist from NASS, spoke of the general and specific barriers people face to activity, such as time, transport – especially for people in rural communities – fatigue, financial problems, family support, pain, stiffness, disability, low self-esteem, disability and co-morbidities and how to overcome these, for example, motivational interviewing. 

Nick Pearson, CEO of the popular weekly parkrun, was thought-provoking and unafraid to challenge the status quo. He said, “Many populations most at risk of life-impacting, disabling health conditions are the populations most likely to be inactive, doubling down on their risk levels and potentially creating a ‘health underclass’; these populations are exposed to the highest environment and social risk factors, cut adrift and deprived of the vast majority of health initiatives and interventions. Parkrun has been able to cut through some of these structural, political, and social challenges.”  

The panel then considered questions such as how some of the success of Parkrun could be imitated, followed by audience questions. 

In case you missed it, or want to see it again, the recording of the event is available here.

Twitter, with vlogs from attendees, was popular at the event, you can see the range of tweets and vlogs on #MSKactivity.

by Dr Hamish Reid, Consultant in Sport and Exercise Medicine, Moving Medicine design and development lead

Moving Medicine is an exciting new initiative by the Faculty of Sport and Exercise Medicine in partnership with Public Health England and Sport England. It is dedicated to spreading best practice, research and advice to clinicians and patients to create a healthier, happier and more active nation. On the 16th October 2018 the initiative was formally launched by the Honourable Matt Hancock, Secretary of State for Health and Social Care, headlining the flagship set of resources to support high quality conversations on physical activity across a broad range of chronic diseases including musculoskeletal pain.

Why is it important?

The UK is currently suffering epidemic levels of physical inactivity in keeping with global trends. This inactivity causes a heavy burden of morbidity and mortality. This burden, In contrast to communicable disease, can be prevented and effectively treated through moving more. In no areas is this more important that musculoskeletal conditions.

At the heart of intervention in healthcare lie conversations between healthcare professionals and members of the public. These conversations provide a unique opportunity to interact with the least active members of society, but many healthcare professionals currently lack the skills, knowledge and systems to deliver impactful conversations on physical activity.

How has it been developed?

The ‘prescribing movement’ resources have been developed by a large team of Sport and Exercise Medicine doctors in consultation with 300 medical specialists, general practitioners, researchers and patients. The foundations of the content lie in robust reviews of the literature on physical activity in specific diseases and differ from other resources summarising the evidence base on physical activity as the structure has been designed by clinicians for clinicians to use in practise. A knowledge into action framework, Delphi study and behavioural change framework have underpinned this iterative development process. The result enables the user to dig as deep as they want to into the evidence base, embedded in a time-based framework to support good quality conversations based on established behavioural change techniques and motivational interviewing theory.

What does this mean for musculoskeletal care?

The Moving Medicine musculoskeletal pain resource has been designed with experts in musculoskeletal care in partnership with many ARMA members. Due to the exceptional input from the ARMA network this resource has been developed to fulfil an unmet need in the excellent resources available. It is a practical resource to support and inform clinical staff in routine practice and has been designed to support conversations.

We encourage everyone to use and share the resources. If you are keen to find out more or contribute to the Moving Medicine to get in touch with us at contactus@movingmedicine.ac.uk, join our Facebook ambassador group or follow us on twitter @movingmedicine – we would love to hear from you.

Visit the website at www.movingmedicine.ac.uk.

Taking place on Wednesday 21 November 2018 at 6pm in London.

Hear and debate three perspectives on physical activity at the Annual ARMA Lecture, this year in partnership with Versus Arthritis. Three outstanding speakers, Nick Pearson, CEO parkrun, Michael Brennan, Physical Activity Programme Manager, Public Health England and Claire Harris, Physiotherapist speak to the theme: More people, more active, more often: three perspectives on physical activity and musculoskeletal health

Physical activity is good for promoting musculoskeletal health and helps alleviate the symptoms of musculoskeletal conditions. Yet nearly a quarter of adults in the UK are physically inactive. Getting people active is an obvious way to reduce the costs of MSK conditions to individuals, the NHS and the economy. If activity brings such benefits, why is this so difficult? How can we overcome the barriers people face in getting more active? And what additional barriers are faced by those who have an MSK condition? How can we harness the powers of statutory, voluntary, private sectors and communities to tackle this?

The evening will begin with a drinks reception and the lecture will conclude with a question and answer session, with questions taken from an audience of leading health and public health professionals, policy makers, commissioners, patients, and representatives of professional bodies.

Tickets are available here