ESCAPE-into the community--a community-based rehabilitation programme for elderly people with chronic joint pain.

Abstract

The impact of osteoarthritisThe Global Burden of Disease study identified musculoskeletal (MSK) disorders as the largest cause of years lived with disability and the third largest cause of disability-adjusted life years.1 A major contributor to MSK disorders is chronic knee and hip pain, usually labelled osteoarthritis (OA). OA affects eight and a half million people in the United Kingdom, of whom six million are in constant pain.2 It impairs their physical, mental and emotional wellbeing, independence, family and social lives and quality of life. Four in five people with OA have difficulties with daily activities such as walking, rising from a chair, stairs, gardening, housework and so on, often forcing them to give up or reduce activity.2 Reduced mobility and activity attributable to joint pain increases the risk of developing comorbidity such as diabetes, cardiac and respiratory disorders, depression, obesity and mortality - more people with pain die than those in the pain-free population.3The personal and societal consequences of OA are equally dismaying. People with OA retire prematurely by eight years on average and 45% give up work, change their type of work or reduce their hours. In addition to loss of earnings, OA increases personal costs by £480 per person per year. The annual direct, indirect and hidden healthcare costs of OA are substantial, a result of 150,000 knee and hip replacements were two million general practitioner (GP) visits and 36 million lost working days.4All these problems are increasing as sedentary lifestyles, obesity and the number of people living longer increases. The number of people in pain is predicted to double by 2030,2 producing greater demands of health and social care.Joints are comprised of bone, cartilage, ligaments and muscles. Although most research and clinical attention has focused on arthritic changes in bone and cartilage, muscle sensorimotor dysfunction (weakness, fatigability, proprioceptive deficits) is involved in the pathogenesis of OA.5 This is fortunate because of all the tissues comprising synovial joints, muscle is the tissue we can most easily manipulate. Exercise programmes can improve muscle function and pain.6 Therefore, muscle function is a modifiable risk factor for OA; maintaining well-conditioned muscles might prevent primary or secondary joint damage.Management of OAEvidence-based management guidelines for OA endorse giving people information about their condition, simple advice about how to self-manage it and exercise to reduce pain and disability.4 Unfortunately, the general attitude towards OA is one of defeated resignation. Healthcare professionals and the lay population regard OA as an inevitable consequence of living, which is not only incurable but untreatable and involves slow, relentless deterioration. Few people are referred for exercise - most are maintained on analgesia which is often ineffective, unpopular, expensive, with harmful side effects7 and little, if any, ongoing support, until the pain becomes so disabling they are referred for surgery, if they are not too old and have no contraindications. Consequently, many people endure years of unnecessary pain and disability.People consider exercise harmful as they associate activity with the onset of pain. They infer that the pain is a signal that they are harming their joints and refrain from activity in order to preserve the joint, called fear-avoidance behaviour. Our joints are there to enable us to move; if we don't move our bones, cartilage and muscles atrophy and become weaker and stiff, exacerbating pain and disability. Mismanagement, erroneous health beliefs and confusion about the safety and benefits of exercise lead to people being frozen in inactivity.Effecting Behavioural ChangePatient education and self-management programmes should convey simple, clear and consistent information about a health problem, the need to change an unhealthy behaviour and stress the importance of activity. …