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

Treatments & Therapies

The London Choosing Wisely programme is a clinically-led review of evidence for a set of surgical procedures. It looks to ensure they are used consistently across London and their use follows a criteria that ultimately improves the health of patients.

Aim of the review
To make sure people with an equal need, wherever they live in London, have equal access to treatments. A standard approach across London means people will achieve better healthcare and doctors will have better guidance on what should be offered to patients.

Procedures that are being reviewed
Eight procedures will be reviewed by primary and secondary care clinicians, patient representatives, equality and diversity leads and public health experts:

  • Surgical removal of benign skin lesions (abnormal growth or abnormal appearance of skin)
  • Hip arthroplasty (replacement)
  • Knee arthroplasty (replacement)
  • Knee arthroscopy (keyhole surgery)
  • Interventional treatments for back pain
  • Varicose vein procedures
  • Shoulder decompression (removing bone spurs and soft tissue through keyhole surgery)
  • Cataract surgery (replacing a clouded eye lens with an artificial lens)

Read more – and check back for updates – on the www.healthylondon.org website.
Further information will be published in the resources section as the programme develops.

The Hypermobility Syndromes Association, in partnership with Stickman Communications, hosted a Hypermobility Management Workshop on Saturday 25 February, with sections on exercise, pacing, flare-up plans, pain, and communicating about hidden disabilities.
The lecture-format sessions were in Hannah Ensor’s typical style – straightforward, with a dose of humour. The group discussions then provided a valuable opportunity to discuss and apply the information to daily life, sharing and exploring different solutions to the challenges we face.

Of course, being about pacing, what better opportunity to practice what we preach? Each ‘lecture’ was a maximum of 30 minutes, with wiggle breaks in between, and it was great to see the ‘beanbag corner’ being used as well as people standing up, moving and stretching when they needed to.

We asked Hannah Ensor, what was her favourite part of the day?

“Well, first I apologise for forgetting to put out plates with the snacks! But for me, there were two stand-out highlights: First, it was being reminded how incredibly useful discussing solutions with other bendies can be. During a discussion someone shared how their health care professional had recommended that they ‘pace’ their nutrition – so they don’t end up constantly having to rest after full meals, and instead eat little and often, which enabled them to avoid the post-meal crash. I am definitely going to look at whether this will help me too!

The second highlight was that every single person who handed in a completed feedback forms said they felt the workshop had improved their understanding of how to manage a hypermobility syndrome, and would be making changes as a result of the workshop. Which is totally awesome!”

Here are a few comments from the delegates:

  • “The formal sessions were excellent, but the opportunity to talk to others was the icing on the cake.”
  • “The session was fantastic, so useful and funny too! I learned so much.”
  • “[The most useful part was] the pacing info and being able to talk to others with HMS.”
  • “Very well presented in manageable chunks, delivered in a way that was very listenable to and easy to understand.”

The Faculty of Sport and Exercise Medicine UK has responded to this Public Health England consultation with a focus on MSK services in the NHS.

The Faculty’s response emphasises that specialist clinicians are needed who understand the cause of MSK problems and are able to provide focused treatments as well as lifestyle interventions to manage and prevent MSK disorders. If the NHS could create MSK medicine consultants to lead services together with physiotherapy practitioners and GPs with a special interest, it would do a great service to the millions of patients that suffer from MSK disorders.

NHS trusts should invest in those services, not to take away from orthopaedic surgeons or rheumatologist, but to allow both MSK physicians, surgeons and rheumatologist to see the patients they have been trained to help.

Business in the Community in association with Public Health England has published the sixth toolkit in the series “taking a whole-person approach to wellbeing“.

A lack of physical activity and poor eating habits leads to an unhealthy workforce. Around a third of adults in England are damaging their health through a lack of physical activity. In fact, one in four women and one in five men in England are defined as inactive, doing less than 30 minutes of moderate physical activity each week. This is costing the UK taxpayer over £60 billion per year. Employers have a responsibility to provide safe workplaces that do not damage an employee’s health and environments that support healthier lifestyle choices.

Working in partnership with employees, employers can take a positive, pro-active approach to healthier workplaces.

Open and download the toolkit.

A new guide has been published to showcase the extensive range of programmes being delivered by the AHSN Network to improve clinical services in the areas of musculoskeletal (MSK), falls, fractures and frailty, all key priorities for the NHS.

Collectively, MSK, falls, fractures and frailty have a major detrimental impact on patients, families and carers, and are a major cost to the NHS.

With a growing and ageing population, health and social care services need to be proactive in their response to this challenge. Whilst many different clinical pathways and services are provided to manage these four problems, there are clear links between them.

Across the 15 Academic Health Science Networks (AHSNs) there is a wealth of experience and practical skills in working with NHS organisations to improve clinical services in these clinical pathways, with service evaluation projects that have been shown to improve patient outcomes and deliver more efficient use of resources.

Compiled by Alison Gowdy, Clinical Innovation Adoption Manager at Oxford AHSN, with input from all 15 AHSNs, this new guide provides a useful overview of these projects.

It is hoped the guide will help shape discussions with Sustainability and Transformation Partnerships (STPs), commissioners and providers regarding future work to improve services and patient outcomes in these areas, while enabling others to share in learning to help implement and / or build on an existing, proven concept.

Download the guide here.

Happiness in elder rehab facility. Retired successful people

 

Guest blog 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 www.yogaforbacks.co.uk or email YHLBInstitute@gmail.com

Flare Roller Coaster for People Living with Arthritis and Connective Tissue Diseases

The Next Rheumatology Flare Roller Coaster workshop will be held on Saturday 3rd February 2018, from 09:30 -13:00.
Venue: Fracture Clinic – C Level, Queen Alexandra Hospital, Cosham PO6 3LY

Places are limited so please register early.

To book your place or receive more information, email: rheumatology.conference@porthosp.nhs.uk or telephone 02392286935

For frequently asked questions about our Flare Rollercoaster workshop, please see our leaflet [PDF].

If you have arthritis or a connective tissue disease, the festive period can be tough. For starters, the months of December and January come at the coldest time of year, which can cause more problems, and although cold weather doesn’t cause arthritis or connective tissue diseases, it may increase joint pain and possible flares.

Colin Beevor, Matron: “Sometimes flare-ups can’t be avoided, no matter how hard you try. If you start to feel increased pain or joint stiffness, take action.”

There are many self-management treatments that can help reduce joint pain:-

  • Hot/warm packs and even warm baths can soothe painful joints and relieve stiffness;
  • Ice packs can relieve pain, reduce inflammation, and cool down joints during flare-ups. Remember: do not apply heat or ice packs directly to the skin or for more than 20 minutes at a time;
  • Topical cream or gel that contains the nonsteroidal anti-inflammatory drug NSAID. Ask your local pharmacist before using a topical treatment that contains NSAIDs particularly if you already take over-the-counter or prescription NSAID tablets.
  • TENS Machines – Transcutaneous electrical nerve stimulation machine administers mild electrical currents through the skin to the nerve fibers which can help to block or suppress pain messages.

 

Keeping Active

Although arthritis and connective tissue diseases and exercise may not seem like a natural match, staying active can definitely help your joint pain.

Getting out in the fresh air has proven benefits to your health, from strengthening your muscles to improving your blood pressure and helping with a good night’s sleep, spending time in the open is good for your health.

Swimming is a form of exercise suitable for all age groups. Even if you are not a strong swimmer or have non-swimmers in your family it is a great way of spending time together and getting fit whilst doing it. Swimming is a great low-impact activity that helps burn calories, strengthen muscle mass, and improve cardiac endurance.  The water allows your body to exercise without impacting too much on the joints; this makes it an ideal exercise for those with stiff joints, sore muscles. If you find going to the swimming pool very cold, a tip is to wrap your towel and clothing in a hot water bottle.

Fourteen patients and their partners and staff from the Department of Rheumatology are about to complete their 6-week ballroom class. Over the weeks they will have taken an additional 12,000 steps and exercised for around extra 5.5 hours.

Claire Jeffries, Rheumatology Specialist, Physiotherapist and Hydrotherapy Manager, points out that there are many health benefits of dancing: “it’s great for people of all ages, shapes and sizes”.

Dancing offers a wide range of physical and mental benefits:

  • improved condition of your heart and lungs
  • increased muscular tone, strength, endurance and motor fitness
  • increased aerobic fitness
  • weight management
  • stronger bones and reduced risk of osteoporosis
  • better coordination, balance, agility and flexibility
  • increased physical confidence
  • improved mental functioning and psychological wellbeing
  • greater self-confidence and self-esteem

The Department of Rheumatology would encourage people living with Arthritis and connective tissue diseases to consider dance as a form of activity. To get started simply choose a style you enjoy, or would like to try, look for dance schools in your local area and join a class.

Colin Beevor, Matron, said: “There are many forms of dance, from ballroom to barn dancing and disco to Morris dancing. Ballroom dancing has been great for our dancing patient group; it’s been such an enjoyable way to be more physically active and help with overall fitness for people living with arthritis. We are so grateful for the support from P. Peskett from the PP Dancing Club; she had made it fun to get more active!”

See a photo of the PortsHosp ballroom dance group.

Remember: you can dance in a group, with a partner, or on your own. There are lots of different places where you can enjoy dancing, for example, at dance schools, social venues, community halls and in your own home. Dancing has become such a popular way to be active and keep fit that most fitness clubs now offer dance classes in their group exercise programs.

Join us for our fundraising tea dance on Saturday 9th December 2017 at St Colman’s Church hall, Cosham from 3:00-5:00pm.
Tickets are available at £5 from margaret.fletcher@porthosp.nhs.uk.

Our next dance class will be Scottish Dancing. Join us for classes starting on Wednesday 14th February 2018 for 6 weeks at the Queen Alexandra Hospital, Cosham. Anyone who has ever been to Scottish country dancing knows just how much fun a Dashing White Sergeant can be. It is likely, too, that anyone who has attempted the Gay Gordons or Strip-the-willow also knows the physical effort needed for a full night of traditional Scottish dancing.