Community-based care for people with chronic knee and hip pain: Preliminary clinical outcomes and healthcare utilisation for ESCAPE-pain.

Abstract

Joint pain impairs physical and psychosocial wellbeing, quality of life (QoL) and has a significant socioeconomic impact. Enabling Self-management and Coping with Arthritic Pain using Exercise, ESCAPE-pain, is a rehabilitation programme that mitigates the wide impacts of joint pain. Financial, logistical and workforce constraints in health systems severely limit access to the programme. Delivering the programme by trained exercise professionals in community venues could increase access and reduce costs. Four hundred eighty-two exercise professionals were trained to deliver ESCAPE-pain at community sites to people >55years with chronic knee or hip pain. Pain, physical function, QoL, self-reported activity, mental wellbeing and healthcare utilisation (consultations, investigations, treatments, medication) were measured before, immediately after and 6months after the programme. One thousand four hundred ninety-two people (mean age 70years) were recruited. ESCAPE-pain improved pain, function, QoL, mental wellbeing and objective physical function (p<0.0001). Before the programme, only 24% of participants were classified as 'fairly active/active' (doing ≥30min activity/week); after the programme, 78% were classified as 'fairly active/active'; 6months later, 69% were still 'fairly active/active'. Participants used less healthcare after ESCAPE-pain, resulting in savings of £326.16/participant. Older people with chronic joint pain were willing to attend ESCAPE-pain when delivered by exercise professionals in community centres, and it was found to be as effective as when delivered by physiotherapists in hospitals. Delivering ESCAPE-pain in the community could facilitate access to effective care and on-going support to sustain the benefits of healthcare programmes, producing a more efficient use of health and community resources.