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

Treatments & Therapies

by Catherine Holmes, National Service Improvement Manager, Anchor

I was thrilled to read Sue Brown’s (CEO, ARMA) September blog and the proposed plan for an event on physical activity. The importance and benefits of staying active is already widely accepted and understood in terms of maintaining joint movement, bone and muscle strength and this is especially important for residents living in care homes. The challenge for care is to create opportunities for people with a wide variety and often multiple and complex health needs such as musculoskeletal, limited or a lack of mobility and living with dementia to keep engaged and active. I believe the solution may require us to rethink what constitutes activity and movement within the context of the individual and use alternative methods including technology, where appropriate, to create a sense of achievement and wellbeing.

If we do this, we first need to accept that some residents may not feel inclined, able or confident to join in energetic physical exercise sessions to the beat of ‘Tiger Feet’ or that they may feel distressed and anxious being outside of the care home. This in turn should challenge us to look more closely and creatively at what could work, considering musculoskeletal and wider health needs such as individual ability and capacity, together with guidance from healthcare professionals. This may mean that participation in gentle, seated stretching exercises possibly on a one-to-one basis might provide an initial starting point, and the NHS website provides clear guidance. Technology is often perceived as an expensive option, but it certainly has a place in encouraging physical activity, especially where mobility is restricted. In Anchor care homes we are using Memoride  – technology based on google maps where sensors are placed to a fitness device such as foot pedals or rollers to enable residents to move through familiar streets or countryside at their own pace. We’ve also invested in OMI Vista interactive projectors which project onto communal tables, floors or bed trays encouraging residents to stretch and move as they engage with quizzes, games and therapeutic activities; all which link with visually stimulating reminiscence and music.

AgeUK states ‘our bodies were made to move and it’s a myth that getting older means an end to being active,’ which is something I genuinely believe to be true regardless of where or how you live. Whether it’s taking a walk in the garden, reminiscing about the plants and seasons, or creating stimulating environments in hallways which invite and intrigue our residents to keep moving onwards, we should recognise, encourage and celebrate all that is active in whatever context individuals can achieve.

Arthritis Action has launched a new webpage featuring arthritis-friendly exercises using animated images (GIFs). These chair-based strength and conditioning exercises were developed in partnership with wellbeing organisation Oomph!,  mobilising different parts of the body.

The exercises were designed with the aim to recondition and build mobility and confidence in people who have not been keeping active. The can be viewed on the Arthritis Action website.

A new campaign, We are Undefeatable, launched on 2 September from Sport England and associated partners including Versus Arthritis.

The campaign aims to help people with health conditions find ways to get active. With a long term condition you are two times more likely to be inactive. Physical activity plays a powerful role, it can help manage 20 or more conditions and reduce the risk of many health conditions by up to 40%.

Sport England are challenging the existing narrative and working with partners to challenge the status quo. They created a unified physical activity campaign which challenges misconceptions and finds a strong emotional platform to engage and motivate and sustain behaviour change across health conditions.  It’s designed with the perspective and lived experience of people with health conditions.

It’s aimed at an audience from ages 30-64 years old and beyond and at people who are doing a little physical activity, less than 30 minutes, or none. For more information see Twitter @undefeatable or www.weareundefeatable.co.uk

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.