195
Welcome and introduction
Tara Donnelly Managing Director, Health Innovation Network
The Health Innovation Network is the
Academic Health Science Network (AHSN)
for South London, one of 15 AHSNs across
England.
We connect academics, NHS
commissioners and providers, local
authorities, patients and patient groups,
and industry in order to accelerate the
spread and adoption of innovations and
best practice, using evidence-based
research across large populations.
Working as catalysts of change across
health and social care economies,
we enable health improvements and
economic growth.
Population
3 Million
Healthcare
Workforce of
60,000+
55 Member
Organisations
12 South London
Boroughs
The AHSN Licence from NHS England sets out four broad objectives
Focus on the needs of patients and local populations
Build a culture of partnership and collaboration
Speed up adoption of innovation into practice to improve clinical
outcomes and patient experience
Create wealth through co-development, testing, evaluation and
early adoption and spread of new products and services
1
2
3
4
What it is, why it is what it is, what it does, where it’s going
Mike Hurley Health Innovation Network South London
St George's University of London and Kingston University
Chronic joint pain (OA) costly - suffering, management
Numerically overwhelming (and increasingly rapidly)
Medically underwhelming
– affects co-morbidity common in elderly
Enormous direct and indirect health and social care costs
Core NICE recommendations:
Information, advice
– self-management
exercise/physical activity
weight control
Joint damage - cartilage, bone, ligaments
Decreased activity
Muscle weakness
Consequences of muscle dysfunction:
De-conditioned muscles - weak, easily fatigued, poorly controlled - compromise neuromuscular protective mechanisms
that attenuate harmful impulsive heel strike transients, resulting in;
excessive, rapid joint loading and jarring,
abnormal movement, laxity/instability, gait alterations,
stress innervated tissues causing pain,
increase risk of joint damage
Joint damage
Decreased activity
Muscle weakness - ageing process, disuse, injury
Muscle dysfunction may be a cause rather than consequence of joint damage
This is very good news!!
Muscle is an extremely plastic tissue – exercise can increase strength, endurance and motor control, even in the very elderly
If joint damage is due to muscle dysfunction, maintaining well-conditioned muscles may;
– delay the onset of joint damage
– ameliorate its effects
– retard progression
The “biopsychosocial model” - illness complex interaction of physiological, psychological and socioeconomic.
Recognises influence of social and psychological functioning - health beliefs, experiences, emotions, relationships, social networks and external environment on reaction to illness and subsequent behaviour
Addresses unhelpful health beliefs and behaviours - fear-avoidance, catastrophising
Emphasises information and advice, promotes self-management emphasises coping skills
Social
Loss of independence
Social isolation
Strained relationships
Biological
Joint instability
Muscle weakness
Fatigue
Psychological
Decreased control
Reduced self-efficacy
Helplessness
Passive coping strategies
Depression
Anxiety
Catastrophising
Fear-avoidance behaviour
Loss of confidence
Management
Compliance with and effectiveness of treatment
Erroneous Health Beliefs
Inevitable consequence of ageing
Poor prognosis
- relentless physical deterioration
- relentless increase in pain
- relentless increase in disability
Movement = pain = harm
Incurable
Untreatable
Cognitive behavioural restructuring
(address inappropriate health beliefs,
catastrophising, maladaptive coping)
improves physical function,
self-confidence,
self–esteem,
social interaction
Patient education programmes
dispel fallacies
encourage self-management
improve adherence
Experientia docet - experience teaches
Self-efficacy a person’s confidence in their ability to perform a specific health behaviour (exercise) that will improve their health
To promote regular exercise and physical activity patients must believe in the benefits, safety and their ability to be physically active
Self-efficacy can be enhanced and beliefs altered by people experiencing the benefits of a simple, practicable exercise regimen which needs minimal resources - people, equipment, facilities
Active participation on exercise
regimen helps people appreciate
that exercise;
- improves mood, reduces stress
- produces tangible physical
improvements in strength, mobility
and independence
- participation does not increase pain
- controls physical symptoms – pain,
disability, disease activity
- is an active coping strategy enabling
them take control and self-manage
condition
- achieves practical physical goals
- improvement in mobility,
confidence and independence
facilitates social interaction
- demonstration to other people
trying to help themselves
encourages support
- improve feeling of self-worth and
esteem
Education, information, advice to
address health beliefs and
improve understanding about;
- condition
- good prognosis
- treatment options
- emphasise positive outcome
likely
- address specific anxieties and
fears
- movement associated pain does
not signal harm but prolonged
rest = weakness, joint
instability, pain, damage
- rest-activity cycling
- enhance coping/ control/ self-
efficacy - goal-setting, increased,
persistence, compliance,
maintain control
- encourage social interaction
Better adaptation to
condition
Fear-avoidance
Passive coping
Self-efficacy
Catastrophising
Erroneous health beliefs
Depression
Anxiety
Helplessness
social isolation
Increased dependency
Feelings of being burden
Quality of relationship
Benefits of cognitive
behavioural restructuring
Benefits of exercise
Psychosocial
consequences of OA
integrated rehabilitation programme of -
patient information, advice - their “pathology”, self-management, pain coping strategies, weight control
exercise regimen
- individualised, progressive, challenging
shows people what they can do
change health beliefs
change behaviour - adopt physical activity
control symptoms and course of the condition
Psycho-educational Component (15-20 mins)
– to improve understanding of condition
– cognitive restructuring
– practical advice - simple pain control
– reassure what they should (not) be doing
– specific goals / Action Plans – what, where, when, how
– participant learn they can self-manage
Stress physical activity = “informal” exercise = good =/= pain, damage
1 AIMS & OBJECTIVES OF PROGRAMME
ACTIVITY LEVELS & VIEWS ON EXERCISE
2 PERSONAL OBJECTIVES
GOAL SETTING
3 ACTION PLANS
EARLY HOME EXERCISES
4 PACING AND
ACTIVITY-REST CYCLES
5 DRUG MANAGEMENT
REVIEW ACTION PLANS
6 DIET AND
HEALTHY EATING
7 INTERMEDIATE HOME EXERCISES
PROGRAMME REVIEW
8 PAIN GATE
REVIEW ACTION PLANS
9 MANAGING
FLARE-UPS
10 ADVANCED EXERCISES FOR HOME
PROGRAMME
REVIEW ACTION PLANS
11 MINI-RELAXATION
DEEP BREATHING TECHNIQUES
12 INFORMATION ON ACTIVITIES IN THE
COMMUNITY
PURSUING EXERCISE & ACTIVITY
Individualised
– - strength
– - balance
– - co-ordination
– - functional activities
Challenging - work hard
Exercise component
(30-45 mins) EXS 1 2 3 4 5 6 7 8 9 10 1
1 12 TIME/R
EPS
EXERCIS
E
BIKE
5 MINS
QUADS
BENCH 24 REPS
WOBBLE
BOARD 2 MINS
STANDIN
G
ONE LEG
1 MIN
THERA-
BAND 2 MINS
SIT TO
STAND 2 MINS
STEP
UPS 1 MIN
WALL
SQUATS 1 MIN
STEP
DOWNS 1 MIN
KNEE
WEDGE 1 MIN
FOOT
ALPHAB
ET
1 MIN
Usual primary care vs ESCAPE-pain
418 people
Assessed at baseline, 0, 6, 18 and 30 months
after completing ESCAPE-pain
0
-5.49 -4.44
-3.1 -2.78
-8
-6
-4
-2
0
2
Baseline 0 6 18 30Assessment time point / months post intervention
WO
MA
C-f
un
ctio
n
sco
re
27
25.5 25.5 25.5 25.5
27
20 21
22.25 22.35
Baseline 0-months 6-months 18-months 30-months
Usual Care ESCAPEW
OM
AC
-fu
nc
tio
n
• no change in function
for participants
remaining on usual
care,
• ESCAPE produced large
improvements in
physical function
• these improvements in
function lost over time
and became more
similar to usual care
• remained lower than
baseline value at each
assessment time-point
Programme cost = £125/person
Reduction in healthcare utilisation • Physiotherapy
ESCAPE-pain is £66 cheaper than usual physiotherapy
Savings/1000 participants = £66,000
• Medication
£16/person/annum reduction in medication costs
Savings/1000 participants = £16,000 per annum
• Community based care (GP, district nurse, social care contacts)
£48/person/annum reduction
Savings/1000 participants = £48,000 per annum
• Total health and social care utilisation
£1,118/person/annum
Savings/1000 participants = £1,118,000 per annum
Impact on population spending
Annual savings if ESCAPE-pain is delivered to:
Population in England with knee OA 5% 10% 20% 100%
Medication savings £3.29m £6.58m £13.15m £65.75m
Community contact savings
(GPs, district nursing, social care) £9.86m £19.73m £39.46m £197.3m
Total Health and Social Care
savings
(medication, consultations,
investigations, surgery, social care)
£230m £459m £919m £4595m
People in England with OA knee = 4.11m
OA hip = 2.46m
Impact on surgery Combined exercise and education programmes such as ESCAPE
significantly reduce the probability of undergoing hip replacement surgery
Cost of hip replacement = £6,000
Cost of knee replacement = £4,000
If ESCAPE-pain is delivered to 10% of people with hip and knee OA, of
whom 10% decide to delay/avoid surgery, potential savings are:
Hip = 2,460,000 x 0.1 x 0.1 x 6000 = £148m
Knee = 4,110,000 x 0.1 x 0.1 x 4000 = £164.4m
For every 1000 ESCAPE-pain participants, if 10% avoid/delay surgery
hip pain - 1000 x 0.1 x 6000 = £600,000
knee pain - 1000 x 0.1 x 4000 = £400,000
"Duirt me leat
go raibh me
breoite"
"I told you I
was ill"
A couple didn’t benefit - “useless”, “waste of time”
Majority enjoyed the programme, enthusiastic
“…beneficial…” “…informative…”, “…interesting…”
Improvements in pain and functioning described “…slight…” “…great…” “…life-changing…”
Improved understanding of the condition
“…I understand the knee pain more…”
Concerns about detrimental effects of exercise
allayed after experiences of the programme
“…I didn’t do no exercise, I didn’t know I should
do, I was frightened…but since I knew of the
exercise, I have been doing it…”
Exercise - important factor in managing their
symptoms, slow deterioration, an alternative
to drugs
“…This [exercise] is much better because like I
said I found is helpful, because I don’t take
any medicine…I am not a tablet person…”
Mastery of exercises led to sense of achievement
Increased confidence, reduced anxiety and
decreased fear of daily activities
General sense of well being
More hopeful and optimistic
Felt better able to cope, able to use strategies to
delay/avoid surgery
The supervisor is considered vital - instilling confidence, with a caring attitude
People attributed much of their improvement not only to the content of the programme but also to the professional skills, advice and support
“…I think it’s really a lot, in fact an enormous amount, to do with the facilitator, she’s both kind of encouraging and yielding and nurturing and understanding, but also was able to use a bit of
steel and get us off our bums…”
Missed motivating structure of the sessions
Wanted on-going support to motivate them
“…it would be nice to know if you were being naughty
with your exercises you could ring them up and they just sort of say, right, get in here…”
“…I think if there could be ongoing support in a group I’d feel positive...”
-relatively simple, brief,
safe, effective, doable, affordable, deliverable
-active SM and coping strategies
-more popular alternative to drugs
Sevenoaks Study
Increase practicability, sustain benefits
Usual Physio vs ESCAPE-knee pain
- 64 Participants
– 10 sessions in Local Adult Education Centre
– review session 4 month after completion to reinforce key messages and review exercises
– 12-month follow-up
WOMAC-function
Usual physio
ESCAPE-pain
Baseline
Usual Physio ESCAPE
Mean 12-month
Usual Physio ESCAPE
Group diff
at 12-months)
WOMAC-func
15.9 (10.4)
16.1 (11.8)
12.2 (13.7)
11.5 (12.1)
0.06
WOMAC-pain 5.7 (3.2) 5.6 (3.4) 4.2 (4.0) 3.2 (3.3) 0.27
AFPT 43.5 (12.8) 41.8 (11.9) 43.8 (17.5) 41.4
(13.0)
0.15
HADS-anx 3.6 (2.4) 4.2 (2.9) 4.5 (2.9) 4.9 (3.9) -0.17
HADS-dep 2.7 (1.7) 2.7 (1.7) 3.2 (2.4) 2.7 (1.9) 0.23
Ex Beliefs &
Self-Efficacy
66.2 (6.7)
66.2 (12.7)
66.2 (6.9)
70.8 (8.2)
-0.61#
Clinical outcomes
Costs of interventions and healthcare utilisation
Resource
Out-Patient
Physiotherapy costs /£
ESCAPE-knee pain
/£
Intervention costs 130.37 (77.38) 63.67
Out-patient visits 78.58 (125) 57.88 (87)
A & E 3.55 (20) ---
Other secondary care 308.00 (1106) 126.08 (407)
GP home visit 33.23 (41) 34.85 (37)
Nurse home visit 6.77 (14) 2.77 (6)
Other primary care --- 2.25 (8.17)
Medication 22.07 (35) 32.21 (64)
Total Costs 582.57 (1157) 319.71 (469)
Adopted as clinical service for chronic knee pain
– Sevenoaks Hospital
– spread to local hospitals
– now being implemented (faithfully) across Kent
NICE QIPP case study
“ESCAPE-hip pain”
Facilitating Activity and Self-management in
Arthritis – knees and/or hips and/or back
Partnership of health and social care providers, HEIs, Public Health, CCGs, consumers, the public and third sector
ESCAPE-pain sites
December 2015
Over 1200 people
have now
completed
ESCAPE-pain
Knee OA Outcome Scores
43.18 41.25
45.16
27.13 27.71
49.05 49.36
54.59
35.85 34.81
0.00
10.00
20.00
30.00
40.00
50.00
60.00
Symptoms Pain ADLS Sport QoL
Mean Pre-
Mean Post -
Hospital Anxiety and Depression Scale
n = 508
Patient feedback
“This has been a fabulous
programme and I am so
grateful to everyone. I am
much more mobile… The
exercises were new to me
and have given me the
confidence to continue with
them for the rest of my life…
A big thank you!”
“Very friendly
and professional
staff,
compliments and
thanks a lot for
your help.
Excellent job!”
“I have benefitted
100% from the class.
My right knee is much
improved and I have
a training programme
to help me with the
rest of my life.”
“Thanks for the
programme; it
was a good start
for me to
transform my
health and
weight.”
“I learnt how to
manage pain
with exercise
and the pain is
much less now.”
www.ESCAPE-pain.org
Describes programme
content and format
Free registration allows
download of all resources
needed to run the
programme
Since end of November 2015
have had over
22,000 page views
10,000 visits
600 registrants
We have a problem…
…we need to improve access
ESCAPE
at
Lewisham Hospital
Referral to ESCAPE
• Knee triage slots
• Referrals from: on average 60% from orthopaedic consultants
• Initial assessment
• Referral Criteria
– Over 50 years
– Clinical Diagnosis OA knee
– Commitment to attending program
• ‘Opt in’ service
• Staffing- Band 5, Band 6 and assistant to help with admin
Layout of program
ESCAPE • 5 week program
• 10 sessions
• We book in 15-17 patients for each program
• Outcomes – KOOS, HADS, Self-efficacy for exercise
• Education/discussion 20 mins
• Exercise 45-60 mins – Circuit-based (not timed)
– Patient-led
• Patient specific goals set
• 3 month booster session
Attendance/Retention rates
ATTENDANCE Number of patients
100% attendance
More than 70% attendance
Group 1 10 20% 90%
Group 2 12 50% 92%
Group 3 11 63% 73%
Group 4 12 58% 83%
Group 5 13 23% 85%
Group 6 11 36% 91%
Group 7 12 8% 67%
Group 8 13 38% 85%
Group 9 12 33% 75%
Group 10 11 36% 100%
Group 11 14 21% 71%
Group 12 10 40% 100%
Group 13 13 38% 85%
Group 14 14 43% 93%
Group 15 16 31% 81%
184 patients have been through the ESCAPE program On average, 85% of patients attended more than 70% (on average 7 sessions) of their sessions
Benefits of
ESCAPE
Group environment
10 sessions : reinforces the
message
Combination: Advice,
education and exercise
Support over a sustained
period
Improved pathway of
care
Our experience
‘knowing that exercise would not unduly hurt my knees was of great boom to my confidence’
‘ my outlook is more positive’
‘It’s helped me to manage my knee pain better’
‘I found this course very insightful and hope it continues’
‘I find that I have improved in my work load’
Patient comments…
‘Greatly helped me and I hope it will continue to help others’
‘I can now walk to the shops without having to use the bus’
‘lovely group and I will miss coming here ’
ESCAPE – The Sequel
Practicalities
Sally Jessep
Senior Clinical Lead Physiotherapist
MSK Integrated Physiotherapy
Services KCHNHSFT
Background and Development
• Visit to Dulwich Hospital to observe Nicky Walsh running a new innovative
exercise and education class that was being compared to usual GP practice
as part of a research project 2003.
• Set up pilot project funded by Chartered Society of Physiotherapy Novice
researcher award at Sevenoaks Hospital, Kent to compare the ESCAPE
programme with usual individual Physiotherapy management 2004.
• Hosted evaluation of ESCAPE-Hip pain programme at Sevenoaks run by
Nicky Walsh 2005
• Adoption of ESCAPE knee programme as part of the Sevenoaks MSK
Physiotherapy service 2005.
• Commenced roll out of ESCAPE knee programme to other Trust sites such
as Gravesend, Aylesford, Sittingbourne and Deal. Soon to be Herne Bay
2006 to present.
QIPP Quality, Innovation, Productivity and Prevention Evidence Collection.
Submission to QIPP case study collection published on the NICE Evidence
website 13/04/13 at: www.evidence.nhs.uk/gipp
Search reference: 12/0011.
Published as an example of good practice for potential roll out across the NHS.
What convinced managers to allow the
development of the programme?
ESCAPE Knee Criteria
• Over 50 years old and suffering from chronic knee pain for at least 6 months
• Medically fit to exercise.
Exclusions
• Those with unstable medical conditions that are unable to exercise
• Communication problems preventing them participating in a group setting
• Psychiatric problems (with the exception of mild depression)
• Severe joint pain and those with mobility limited to less than 50 metres.
The Challenges
Recruitment
• Despite agreeing broad criteria for inclusion, not every over 50 patient with
OA knee/chronic knee pain will be suitable for the programme.
• Patient may not be able to make the class due to other commitments – twice
a week for 5 weeks is too much for some!
• They may suffer from co-morbidities meaning that they can’t exercise or are
severely limited in what they can do.
• They may have advanced joint degeneration and poor pain control making
this intervention inappropriate.
• There may be communication or understanding issues making it difficult to
participate in a group intervention.
What have we done to address the
recruitment issues?
Promotion at the Kent County
Show – July 2015
Updating information for referrers and
including the website information
A new patient information leaflet
An opt in leaflet for use at triage and
encouraging triagers to identify suitable patients
Exercise facilitation
Retention and follow-up
Once patients commence the programme they attend most of the sessions.
ATTENDANCE TABLE-Sevenoaks 2015
Attendance at the three month follow-up session is approx. 50%.
Course Number of
Patients
Less than
6
6 7 8 9 10 Follow-up
April 7 2 1 4 5
June 6 1 2 3 3
September 8 2 1 1 1 1 2 -
November 8 2 6 -
Collecting data and data entry
Our sites have run 8 sessions and a 3 month follow-up session up until
mid-2015 and collected data from;
• WOMAC
• Modified Self-efficacy scale
• Patient experience questionnaire.
Since mid-2015 we have moved to 10 sessions and will commence using the
following outcome measures in January 2016;
• KOOS
• HAD
• Patient experience questionnaire.
Data entry is carried out either by the Physiotherapist or a Physio Assistant or
Administrator depending on staffing.
References
Hurley M V, Walsh N E, Mitchell H L, Pimm T J, Patel A, Williamson E. Clinical
effectiveness of a rehabilitation programme integrating exercise, self-
management and active coping strategies for chronic knee pain: a cluster
randomised trial. Arthritis Rheum 2007;57:1211-9.
Hurley M V, Walsh N E, Mitchell H L, Pimm T J, Williamson E. Economic
evaluation of a rehabilitation programme integrating exercise, self-
management and active coping strategies for chronic knee pain. Arthritis
Rheum 2007;57:1220-9.
Jessep S A, Walsh N E, Ratcliffe J, Hurley M V. Long-term clinical benefits and
costs of an integrated rehabilitation programme compared to outpatient
physiotherapy for chronic knee pain. Physiotherapy, 2009; 95, 94-102.
Bearne L M, Walsh N E, Jessep S A, Hurley M V. Feasibility of an Exercise-
based rehabilitation programme for chronic hip pain. Musculoskeletal Care
2011.
The future
• Further roll out of the programme to other sites in Kent.
• Collaborative working with other agencies ie…Arthritis charities to facilitate
setting up the programme elsewhere.
• Collaborative working with HIN to evaluate the delivery of the programme
further.
• Review the recent Generic Study to assess value of broadening the type of
participants.
• Investigate further collaborative research opportunities.
Facilitating Activity and
Self-Management in Arthritis (FASA):
ESCAPE for multiple-joint OA
Nicola Walsh
Associate Professor in Musculoskeletal Rehabilitation
Impact of OA
• 8.75m people in UK have
Osteoarthritis (OA)
• >1.75m experience
multiple joint symptoms
(ARUK 2013; Arthritis Care 2012; Nelson et al, 2011)
FASA
• Based on ESCAPE-knee
• Generic programme for
hip, knee and/or lumbar
spine OA
(Walsh et al, Physiotherapy, 2012)
Cluster Randomised Trial
• RCT
• Intervention v GP Mx
• Age 50+
• Clinical OA/CJP
• Primary care
• N=349 (45 Practices)
• 7.5/12 follow-up
• SMFA = 1°outcome
• Cost analysis
• Qualitative studies
Patients receiving intervention have significantly better self-reported
function at PEP compared with GP management (p=0.025)
BUT full analysis, including all secondary measures and costs
not available late January 2016
Qualitative data - Professionals
• N=20 (PTs, GPs and Rheumatologist)
• Positive perceptions
– Reducing time pressures and re-attendance
– More realistic patient approach
• Negative perceptions
– LBP may require more specific approach
– Intensive programme
(Patel, Gooberman-Hill & Walsh, Musculoskeletal Care 2014)
Qualitative data – Patients (n=45)
Positive
• Learn for the future
• Shared pain experience
• Group camaraderie
• Habit forming
Negative
• LSP patients (minority)
• Specificity needed
Mean Age 68 years
Gender (M:F) 17:28
Yrs since diagnosis (mean) 8 years
1 site affected 20
2 sites affected 12
3+ sites affected 13
Knee OA frequency 39
LSP OA frequency 27
Hip OA frequency 19
Realities & Reflections
Positives
• Realistic management
• Patient enjoyment and
confidence
• Increased patient
knowledge
• Fully manualised
Challenges
• Monitoring required
• Good exercise knowledge
• Engaging LBP patients
FASA Team
• Edith Anderson
• Dr Fiona Cramp
• Dr Rachael Gooberman-
Hill
• Prof Colin Green
• Dr Annie Hawton
• Prof Mike Hurley
• Louise Jones
• Dr Lang’o Odondi
• Prof Shea Palmer
• Dr Geeta Patel
• Sonia Phillips
• Dr Jon Pollock
• Dr Tori Salmon
• Rachel Thomas
• Dr Nicola Walsh
My Experience of Implementing and Delivering ESCAPE
Keerthana Rubaseyone MSK Physiotherapist
Bexley MSK Services, Oxleas NHS Trust
Various Sites
• Sevenoaks Hospital
• Queen Mary’s, Sidcup
• Erith & District Hospital
What’s Needed for Successful Implementation?
• Referrer education
• Support from current providers
• Managerial support
Issues around the Delivery of Classes
• Patient expectations
• Attendance rate
• Settling in time
• Unexpected physio leave, physio annual leave
• Admin + Outcome Measures
Other Issues
• Waiting times
• Support after ESCAPE?
Widening access, moving forward
Structured
interventions e.g.
ESCAPE
Simple,
accessible,
tailored advice
Well-informed
community workforce
Improving support for people with osteoarthritis
Web/app
interventions
93 |Background
Physiotherapy
+ E-Learning
94 |Vision
To develop a world leading exercise software to improve health outcomes and physical function by
amplifying the reach of physiotherapy and empowering patients in self-management
95
Increase in percentage of UK population over 75 from 2012 to 2032.
70%
Of over 65s have a long term condition.
60%
|Ageing Population – The Primary Driver
96
Directed Self-Management
The untapped resource the UK Healthcare System needs
97
|Case Study – Lanarkshire NHS Community Rehabilitation Team
Previously: • 3 physiotherapy face to face visits after discharge • Travel time also restricting physio caseload
Now: • 1 face to face physio assessment prior to discharge • Exercise templates and protocols set-up on Salaso • Patient engages at home with exercises • Patient logs compliance and outcomes • Support Worker delivers further sessions online Physiotherapy capacity x 300%
Re-engineered Processes using Salaso
"Adoption of this type of technology is vital for our services in order to plan for the future needs of an ageing population and the anticipated greater demands on our physiotherapy team and resources. We are seeing significant cost savings and increased efficiencies through the use of Salaso’s technology in our care pathways.”
Janie Thomson, Head of Physiotherapy
Service and Professional Lead,
Lanarkshire NHS Health Board,
Scotland
|Case Study – Lanarkshire NHS
99 | Salaso & Escape-pain
• Partnership approach to providing innovative mobile-based programmes to deliver rehabilitation to a wider audience.
• Combination of patient education and dedicated exercises to drive patient engagement and adherence to exercise programmes.
• Inclusion of clinically validated questionnaires to benchmark patients.
• Introduction of social engagement and behavioural change techniques.
100 | Video Montage
https://marvelapp.com/42489fg
101 | Why it works
• High Quality • Scalable solution for physiotherapy • Increases Capacity • Saves Money • Evidence Based • Clinically Sound • Delivers Quality Patient Outcomes
Using Technology to Develop New Models of Care
for
Physiotherapy and other AHP Services
Aoife Ní Mhuirí MCSP, CEO and Founder
104 Today’s Presentation
• Background
• Vision
• Case Study – NHS Lanarkshire
• Our Partnership with ESCAPE-pain
• Questions
105 Background
E-Learning
Physiotherapy
+
106
“If the benefits of exercise could be
packaged into a pill, it would be the
single most widely prescribed and
beneficial medicine….” (Dr. Robert N. Butler MD)
107 Demand on Services
108
Increase in percentage of UK population over 75 from 2012 to 2032.
70%
Of over 65s have a long term condition.
60%
Ageing Population – The Primary Driver
109 Traditional Physiotherapy Model
Labour intensive
Costly
Non Scalable
Will Not Meet Demand
110
Physiotherapy Directed Self-Management
The untapped resource the Healthcare
System needs
111 Salaso Vision
Develop world leading exercise software
solutions that improve health outcomes
and physical function by amplifying the
reach of physiotherapy and empowering
patients in self-management
Case Study – Lanarkshire NHS Community Rehabilitation Team
Previously:
• 3 physiotherapy face to face visits after discharge
• Travel time also restricting physio caseload
Now:
• Physio assessment prior to discharge
• Physio directs exercise protocol set-up on Salaso
• Patient engages at home, logs compliance and outcomes
• Support Worker delivers further sessions online
Physiotherapy capacity x 300%
Re-engineered Processes using Salaso
"Adoption of this type of technology is vital
for our services in order to plan for the
future needs of an ageing population and
the anticipated greater demands on our
physiotherapy team and resources.
We are seeing significant cost savings and
increased efficiencies through the use of
Salaso’s technology in our care pathways.”
Janie Thomson, Head of Service and Professional Lead,
Lanarkshire NHS Health Board, Scotland
114 Salaso & ESCAPE-pain
• Partnership approach to providing innovative mobile-
based programmes to deliver ESCAPE-pain
New Patient Facing Resources
• Online – bringing programme to a wider audience
• Patient Education – exercise videos
• Inclusion of clinically validated questionnaires to
benchmark progress
• Introduction of social engagement and behavioural
change techniques
115 Video Montage
Preview of new ESCAPE-pain patient education exercise videos
117 Why it works
• High Quality
• Scalable
• Increases Capacity
• Saves Money
• Evidence Based
• Clinically Sound
• Delivers Quality Patient Outcomes
OUR VISION
“Everyone has the opportunity
to optimise their health and
wellbeing”
About RSPH
• The RSPH is an independent, multi-disciplinary charity dedicated to the improvement of the public’s health and wellbeing.
• We are the world’s longest-established public health organisation
• Formed in October 2008 with the merger of the Royal Society of Health and the Royal Institute of Public Health, we help inform policy and practice, working to educate, empower and support communities and individuals to live healthily.
Strategic objectives
• Enable communities to make the most of their health and wellbeing
• Develop and support networks of individuals and organisations concerned with improving and protecting the public’s health
• Be the trusted, independent voice for the public’s health and wellbeing
We do this through …
• Membership: Open to anyone working in the area of public health. We
have over 200 physiotherapists as members! • Qualifications for professionals working in all areas of public health.
Each year over 70,000 people achieve RSPH qualifications in subjects as diverse as food hygiene, health and safety, behaviour change and health improvement.
• Conferences and training: We offer a wide range of conferences, seminars, events and training in water hygiene, infection control, mental wellbeing and occupational medicine and more
• Accreditation: We provide an accreditation service for public health training programmes and campaigns
• Projects, policy work, reports and campaigns: We work closely with our members, the public health workforce and wider community to develop and implement a wide range of policy and projects to educate and empower individuals, effect change and celebrate excellence.
Policy
Improve and Protect • Improve and Protect is an in-depth programme exploring
some of the nation’s major public health challenges and initiatives with the aim of heightening awareness among policy makers, politicians and the wider public.
• Introduced by Natasha Kaplinsky, the news-style piece combines key figures and reports with editorial profiles of some of the leading organisations aiming to improve the public’s health.
Wider Workforce
Any individual who is not a specialist or
practitioner in PH but has the opportunity
or ability to positively impact health and
wellbeing through their paid or unpaid
work. (CFWI and RSPH)
e.g. Fire Service, Social Housing, Welfare,
Physiotherapists, Teachers, Local Communities.
Wider Workforce
In England the estimated headcount for wider workforce is:
• 15 million people in England in paid employment in
occupations that have the opportunity or ability to impact health and wellbeing though their work.
• 500,000 early adopters - wider workforce professions delivering “on the ground” effective community assets based interventions and working across vulnerable populations in addressing public health issues.
Why engage the Wider Workforce?
• Create a culture of public health as ‘everybody’s
business’
• All-system approach: ‘Making Every Contact
Count’
• Ensure that more people get the support and
advice they need
• Reduce the burden on the overstretched NHS
West Midlands Fire Service
Physical activity in Public Health
• Physical activity is a priority • More than 4 in 10 adults do not do enough physical activity to
achieve good health. It has negative impacts on the life of the individual and their communities. These can be: – health costs: for example, physical activity helps prevent and
manage over 20 health conditions and inadequate physical activity contributes to 1 in 10 early deaths (equal to smoking)
– social costs: for example, communities with higher levels of physical activity have greater community cohesion and inclusion, but the number of walked trips (including journeys to school) are on the decline
– economic costs: for example, a physically active individual on average earns £6,500 more each year
Reference: Public Health England 2014
Physical activity and mental health
• Physical activity has a huge potential to enhance
wellbeing in our population. It is known that even
a short burst of 10 minutes brisk walking
increases mental alertness, energy and positive
mood states.
Reference: Mental Health Foundation 2013
RSPH contributed to the development of the ukactive
Blueprint for an active Britain - the first ever joined-up
strategy for tackling the UK’s physical inactivity
pandemic.
The national cost of physical
inactivity now stands at
£20 billion per year.
Ukactive
Health & Wellbeing Awards
Public Health is everybody’s business
• RSPH believes that, although the responsibility
for improving the health of the local population
and commissioning of public health services
now sits with local authorities (in England), a
broad range of organisations and professionals
from all sectors have a role to play. The RSPH
Health & Wellbeing Awards showcase these
roles and their contributions.
The aim
• Is to recognise achievements in the promotion of health and wellbeing through activities, policies and strategies which empower communities and individuals, improve the population’s health and address the wider social determinants of health.
The criteria
• Health improvement and community wellbeing principles (The Ottawa Charter)-
– Building on national public health policy
– Creating supportive environments - in settings where people live, work, learn and play
– Strengthening and promoting community action
– Implementing population/targeted community engagement strategies
– Developing a broad understanding of health improvement
The process
• Submission of an application form and a folder of supporting evidence
• Following an initial appraisal of the submitted documentation by a peer assessor, organisations are invited to attend a peer challenge session which incorporates a panel review process. This focuses on key elements in the application as a basis for discussion. This is also an opportunity for RSPH to explore any issues in your submission that need clarification.
• It takes 6 months to go through the whole process!
Organisational development
• The RSPH Awards, are not a competitive scheme
• It provides organisations with the opportunity to reflect on their work against a set criteria and to achieve an award on their own merit.
• The winners, who receive the highest level of the Health & Wellbeing Award, are recommended for the Public Health’s Minister Award.
ESCAPE-into the community
The award for the Health Innovation Network is due to its contribution to public health through their ESCAPE – pain self-management programme.
• The programme’s model and strategy has demonstrated to be effective at improving physical and mental wellbeing of people suffering with osteoarthritis.
• The robust evidence based and external evaluation of the programme demonstrates readiness for extending in further settings such as workplaces and in the community.
Strategic partnership
ESCAPE into the community: feasibility of delivering a community-
based exercise programme for chronic knee and hip pain
South London Membership Council Innovation Grant
Award Winner 2014
ESCAPE into the community
• Why ESCAPE into the community?
The population is increasing…
1 in 4 will be > 65 years of age by 2040…
Facing the effects of obesity and reduced physical activity…
Demand for healthcare is increasing…
NHS expenditure per capita is 3 times higher for people 65 years and older than for those aged between 5 & 64 years of age…
Office for National Statistics 2011; The Nuffield Trust; Seshamani & Gray, 2002
Our award enabled us to…. Develop Literature
Hire Venues
Hire Staff
[email protected] Direct line & voice mail
Choice of venue & group
Camberwell: Tuesday 10:00 – 11:30 & Friday 15:00 – 16:30
Peckham: Tuesday & Thursday 15:-00 – 16:30
Brixton: Monday & Thursday 08:30 – 10:00
Electronic referral form
Building
self-efficacy
Group educational session
Group exercise programme
Our participants • 13 cohorts of people participated between January
and August 2015
• 169 people registered on the programme (23 people cancelled or did not attend)
Total N 146
Age in years, M (SD) 63 (12.5)
Age (%) 45-54 years 55-64 years 65 and > years
22.6% 26.7% 50.7%
Female Gender N(%) 116 (79.5%)
Sessions attended (out of 12)
9 or > sessions 6 or > sessions < 6 sessions
9 (mean)
63.7% 83.6% 16.4%
Knee Osteoarthritis Outcome Scores (KOOS)
Increased values = improvement
N = 136 *
* 1 participant did not complete pre or post outcome measures
Hip Osteoarthritis Outcome Scores (HOOS)
0
10
20
30
40
50
60
70
Symptoms Pain ADLS QOL
49
57 57
39
59 62 61
48
Mean pre-programme value
Mean post-programme value
Increased values = improvement
N = 9
Hospital Anxiety and Depression Scale (HADS)
Decreased values = improvement
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
Anxiety Depression
8.3
7.5 7.0
6.2
Pre-programme value
Post-programme value
Planning to continue?
No plans to continue
Plan to continue
Helping with symptoms
My hip feels a lot better. I can now put my socks on [Camberwell Participant]
I now have more movement and less pain
[Brixton Participant]
Increasing knowledge & skills
It has helped me to realise that exercising will strengthen the joints
[Brixton Participant]
It has helped me get back into regular exercise
[Peckham participant]
Increasing self-efficacy
I have gained more confidence and knowledge about my
arthritis [Camberwell Participant]
Patient perceptions of the programme (satisfaction questionnaire n=50)
Patient perceptions of the programme (interviews)
No adverse incidents affecting the safety of patients attending the programme
I am a born again person with regard to exercise because I had all sorts of unnecessary attitudes to physical exercise…..I had stopped doing things.
Actually doing it [the class] together is much more effective than saying I will do it on my own at home [and] even though from time to time I think
I’ve got to sit down because it’s getting painful, it doesn’t stop me any more.
I am very happy with what I’ve got, with what I’ve achieved and with what I am continuing to do.
[Brixton participant]
Sustainability
+
Camberwell leisure centre Peckham Pulse Healthy Living Centre
Diverting activity away from the hospital
Releasing capacity within physiotherapy services Increasing access to ESCAPE pain
Some wider benefits
* Opportunity to the Trust is the income related to the released capacity created by the fact that appointments for NP and FU are not necessary anymore, i.e. creates capacity for other patients (reduce waiting list + increased income)
Any Questions
Thank you
CITY OF LONDON PROGRAMME
Oxford City Council
Fusion Lifestyle
ABOUT FUSION Registered Charity
• a bona fide registered charity and company limited by guarantee.
• created to promote healthy lifestyles and encourage participation in sport and physical activity.
• social enterprise combining the social agenda with the best commercial practice.
• voluntary board consisting of professional people committed to community services.
• all incoming resources put to developing, extending and improving our services.
Oxford City Council
Fusion Lifestyle
• core to our charitable objectives and reflected throughout our management approach.
• embedded in facility programming, pricing, marketing, sports development and outreach work.
• committed to developing locally empowered partnerships.
• committed to delivering impact on services and communities.
• work in close collaboration with a range of key local partners.
-local authorities, public health organisations, schools/academies, charities. sports clubs, NGBs and
community organisations.
AN ACTIVE ROLE IN THE COMMUNITY Intrinsic to our Approach
Oxford City Council
Fusion Lifestyle
• dedicated Head of Sport and Community Development.
• 30 Sport & Community Development officers.
• removed from day-to-day operational responsibilities.
• developing partnerships in local communities across 20+ boroughs and 90+ leisure centres across the UK.
• delivering proactive sport and community development programmes.
• securing external grant funding. • c.£600,000 in 2014
• driving up target group participation.
AN ACTIVE ROLE IN THE COMMUNITY SPORTS & COMMUNITY DEVELOPMENT FUNCTION
Oxford City Council
Fusion Lifestyle
ESCAPE PAIN IN THE CITY – THE NEED?
• PHAST analysis of the health of the working age population found that the most common cause of work related illness are musculoskeletal disorders.
• Means an estimated 180,000 could and would be able to access our programme for their disorders.
• No other program in the City of London.
• Information and individual feedback from a qualified physiotherapist, but without the need to wait for appointments or referrals through the NHS.
Oxford City Council
Fusion Lifestyle
OVERVIEW OF THE PROGRAMME:
• Delivered locally in a community setting to both residents and workers in the City of London.
• The programme is delivered to small groups of people in 12 classes, twice a week, for 6 weeks.
• There are two components to the programme;
1. Educational component
2. An exercise regime
Oxford City Council
Fusion Lifestyle
OVERVIEW CONTINUED:
• The project will initially seeks to have over 50's.
• Osteoarthritis being more prevalent in older adults.
• Age is the strongest predictor of the development and progression, but obesity is also a well known risk factor as well.
• We have also targeted manual labourers as well as low paid workers.
Oxford City Council
Fusion Lifestyle
FUNDING:
• Big Lottery Fund - £10,000
• The programme is delivered to small groups of people in 12 classes, twice a week, for 6 weeks. 6 times annually.
• 2X Physios
VENUES: • Golden Lane Sport & Fitness 50%
• Artizan Street Library 25%
• St Boltophs Church 25%
Oxford City Council
Fusion Lifestyle
MARKETING:
The programme has been promoted in a number of ways:
• Contacts in all the HR departments for companies based in the City of London.
• Publicised through our current partners.
• Promo work at events we attend in our partnership with the City of London.
Oxford City Council
Fusion Lifestyle
PARTICIPANTS:
• Block 1 – Golden Lane (8 participants)
• Block 2 – Artizan Street (20% capacity)
We believe that the decrease in participants was due to the venue and time of the session according to feedback.
• Block 3 – Golden Lane (11 participants)
Oxford City Council
Fusion Lifestyle
TESTIMONIALS:
• “ESCAPE pain has given me the confidence to exercise and partake in more vigorous activities compared to what I am use to, due to my osteoarthritis.“
• “I love the fact that the programme can be targeted at all levels meaning it is very socially inclusive”
Oxford City Council
Fusion Lifestyle
WHAT NEXT?
• Sustainability and Exit Routes:
• - Young at Heart: discounted membership.
• - Exercise and Referral: continued 1to1 support.
• - Fusion Membership: £15 a month
• We are currently in the process of collating the statistical data to show how effective routes have been.
Oxford City Council
Fusion Lifestyle
THANKYOU!
Piloting ESCAPE Principles in COMMUNITY
Nimalini Ajith
[email protected] Joint and Bone Health Physiotherapist
Kingston Public Health 13/01/16
Why it started
• Audits and consultation with GPs established the need for a preventative/ early intervention OA service in Kingston
• best fit within the Better Bones Service of the Public Health Team.
What we decided
• NICE Osteoarthritis guidelines (2014) – Self management – education and exercises
• Group programme – cost effective and group interaction
• Similar to our Osteoporosis programme
• Escape – well researched and adapted at various areas
What we did
• Pilot 2 classes – twice weekly, once weekly
• Class of 8, Physio led
• Early morning and afternoon classes
• Tel screening and GP consent
• Outcome measures- WOMAC and PA form (local)
• 15 mins information followed by 45 mins exercises
Experiences so far
• Early morning classes: hard to recruit 6/8 • Afternoon 8/8 (new client added as one
participant declined after first class)
• Waiting list
• Class Frequency:
No. Of people answered: 9
• Twice a week: 5
• Once a week: 5
• Note: one person ticked both
Experiences so far
• Age: mean 64.4 (47-73)
• Gender: 13 F and 2 M (1 M discontinued)
• OA Knees: One -1, Both -14
• Comorbidities: OA other joints, BP, Chronic Back Pain, Osteoporosis, Depression, Cervical radiculopathy, Heart conditions, Sight problems, Spina Bifida, Gout, Vertigo, Hypotension, Hypothyroid, Diabetus etc.
Experiences so far
• No. Of sessions: average 7.7 (excluding 1M, unable to attend 1 session per week, holiday, work commitments, hosp app, surgery. Overdid the previous day etc)
• Reasons for discontinuing: other commitments (2), family situation (1), doesn’t think exercise will help (1).
Experiences so far
0
10
20
30
40
50
60
70
80
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
WO
MA
C s
core
s
participants
WOMAC SCORES
WOMAC initial
WOMAC final
Experiences so far
0
1
2
3
4
5
6
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
no
.of
day
s/w
ee
k
participants
Physical Activity (initial)
days of mod activityn/week
sports and active recreation/week
cycling/walking n/week
domesticn/week
physical paid work n/week
Experiences so far
0
1
2
3
4
5
6
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
no
of
day
s/w
ee
k
participants
Physical Activity (Final)
days of mod activity
sports and active recreation/week
cycling/walking/week
domestic/week
physical paid work/week
Participant feedback
• 6 completed forms
• Overall positive feedbacks except one participant who didn’t like the wobble board.
• Longer/ continuing classes, other joints, prepared to pay and advertise more.
• all were able to list three things to take away
To Conclude
• Classes well received
• Outcomes – physical activity
• Exercise instructors to lead
• Weekly or twice weekly classes
• Comments/ feedback welcome
• In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate?
• • This may include sport, exercise, and brisk walking or cycling for recreation or to get to
and from places, but should not include housework or physical activity that is part of your job.
• • 0 1 2
3 4 5 6 7
• • What is your weekly activity
routine?..........................................................................................................................
• Health Screening YES NO • • In the past month, have you had chest pain when you were not doing physical
activity? • • Do you feel pain in your chest when you do physical activity? • • Has your doctor ever said that you have a heart condition and that you should only do
physical activity recommended by a doctor? • • Do you lose your balance because of dizziness or do you ever lose consciousness? • • Do you have any bone or joint pain? • • Do you have a bone or joint problem that could be made worse by a change in your
physical activity? • • Is your doctor currently prescribing drugs (for example, water pills) for your blood
pressure or heart condition? • • Do you know of any other reason why you should not do physical activity? • • FOR OFFICE USE ONLY • Appropriate: Not Appropriate: • NOTES • • •
KNEE OSTEOARTHRITIS SCREENING FORM
DATE....................................................................... How did you find out about the Knee Class................................................................
Patient Details
Title: Mr/Mrs/Miss/Ms Date of Birth: Over 45 years of age: Y/N
Name: Height: Weight:
Address:
GP Details (name and surgery):
Post code: Is the person registered as disabled? (yes or no)
Tel no: Gender:
Email: Ethnicity:
OSTEOARTHRITIS SCREENING Yes No
Diagnosed with Osteoarthritis of the knee (not rheumatoid or other arthritis)
Have joint pain during or after an activity
Joint related stiffness in the morning
Morning stiffness lasts less than 30 mins
Recent procedures of the Knee in the last 6 months Injections or surgeries to the joint
Recent knee problems unrelated to Osteoarthritis History of trauma, prolonged morning joint –related stiffness, rapid worsening of symptoms or the presence of a hot swollen joint.
Other Medical Conditions:
Medication:
Current Levels of Physical Activity
Public Health Department
2nd Floor Guildhall 1
Kingston upon Thames
KT1 1EU
Tel: 0300 123 8086
Email: [email protected]
Dear Dr. Date: 21/8/2015
RE: DOB Add:
The above patient wishes to commence an exercise and information programme for osteoarthritis of the knee. I am
seeking medical approval before continuing the patient onto the programme.
The exercise programme is planned by Band 6 Physiotherapist and instructed by Band 3/4 qualified exercise
instructors. The programme includes a warm up, exercise circuits at a designated rate of perceived exertion,
including strengthening, flexibility, balance and cardiovascular based activity, a cool down and stretches. In order
for staff to plan a safe and effective exercise programme for your patient please confirm the suitability to this
exercise program.
Please tick as appropriate:
The patient has osteoarthritis of the Left /Right/ Both knees
The patient may exercise without any restrictions
The patient may NOT exercise at this time
The patient may exercise with the following restrictions:
Signed..............................................................Printed............................................................ Date.............................
Please return this form to the Better Bones programme by Safehaven Fax No: 0208 547 6849
Kind Regards,
Nimalini Ajith
Joint and Bone Health Physiotherapist
Restrictions
GENERAL PARTICIPATION SURVEY (INITIAL)
Name:_______________________________________________ Date:___________________________ 1. How many days a WEEK do you take part in at least 30 minutes of moderate intensity
physical activity? 0 / week 1 / week 2 / week 3 / week 4 / week 5 +/week
Moderate intensity physical exercise includes all types of physical activity that makes your breathing and heartbeat faster and you feel warmer than normal such as sport, recreation, active travel (walking and cycling) and domestic activities (housework and gardening).
2. Of these, please indicate the type and frequency of activity that you take part in each WEEK:
Sport and active recreation: never 1/week 2 3 4 +5
Cycling and walking: never 1/week 2 3 4 +5
Domestic (housework, gardening): never 1/week 2 3 4 +5
Physical paid work (manual): never 1/week 2 3 4 +5
3. Are you satisfied with your current level of physical activity?
YES NO MAYBE
4. Which of the following reasons prevent you from being more physically active?
Cost Lack of time Health Reasons
Transport Family Commitments Not interested
Access to facilities/location Other
If other, please explain ___________________________________________________________
______________________________________________________________________________
5. Are you interested in receiving information on other activities or programmes? YES NO
If YES, please indicate what activities you are interested in and complete the address slip below:
Walk for Health Healthy Eating Weight management
Stop Smoking Healthy Lifestyle Services Fit as a Fiddle 50+
Physical Activity Cycling Other
If Other, please identify ___________________________________________________________
______________________________________________________________________________
• The following questions concern your physical function. By this we mean your ability to move around and look after yourself. For each of the following activities, please indicate the degree of difficulty you have experienced in the past 48 hours because of your knee(s).
• • None Mild Moderate Severe Extreme • A. Going down stairs • • B. Going up stairs • • C.. Standing from sitting •
D. Standing •
E. Bending down to the floor •
F. Walking on a flat surface •
G. Getting in/out of a car • • H. Going shopping •
I. Putting on socks/tights •
J. Rising from bed •
K. Taking off socks/tights •
L. Lying in bed •
M. Getting in/out of the bath •
N. Sitting •
O. Getting on/off the toilet • P. Heavy domestic duties (e.g. • lifting/carrying heavy items) • Q. Light domestic duties (e.g. • tidying a room, dusting) • • Thank you for taking the time to fill in the questionnaire. • • • •
Office use only • WOMAC Osteoarthritis Index Version LK 3.0 © Dr. Nicholas Bellamy • Total score: ……………….x 100 / 96 = ………………………..
WOMAC OSTEOARTHRITIS INDEX
Note: Put an ‘X’ in the box which best represents how much pain you experience with each task stated below. Example: If you put your ‘X’ in the far left hand box, that is: None Mild Moderate Severe Extreme
then you are indicating that you have no pain with that task.
1. The following questions are designed to measure the amount of pain you are currently
experiencing in your knee(s). For each situation, please enter the amount of pain you have experienced in the past 48 hours.
None Mild Moderate Severe Extreme
A. Walking on a flat surface B. Going up or down stairs C. At night while in bed D. Sitting or lying E. Standing upright
2. Please describe the level of pain, if any, you have experienced in the past 48 hours for each
one of your knees. None Mild Moderate Severe Extreme
A. Right knee B. Left knee
3. What level of stiffness do you feel immediately after waking up in the morning? Stiffness is a sensation of restriction in the ease with which the knee moves.
None Mild Moderate Severe Extreme
4. What level of stiffness do you feel after sitting, laying or resting later in the day? None Mild Moderate Severe Extreme
Please turnover to continue with the questionnaire…
NAME: DATE:
• Please reflect on the Better Bones Service and respond to the following: • • What part of the service was the most useful for you and your daily life? • • • • What part of the service was the least useful for you and your daily life? • • • • • • • Please list three things that you learned during this service that you will take away with
you to improve your bone health. •
a. • • • b. • • • c. • • • What information/topics would you like to see added to this service? • • • • • • • The technical level of the material covered in the service was: (circle one) • • Too basic Just right Too difficult/too technical • • • How could the service be improved? • • • • • Thank you for completing this form!
Osteoarthritis Knee Group Exercise Evaluation
Date of course: Venue: Instructor: Instructions to Participant: Thank you for participating in Better Bones Osteoarthritis programme. In this feedback form, there are no WRONG or RIGHT answers. You do not need to put your name on this form – your responses are anonymous. Please respond to ALL the questions below to help us to improve the curriculum, program materials, and the conduct of the program. For each item below, please circle only ONE response.
RESPONSE NOT AT
ALL SOME-WHAT
VERY MUCH
1. The Osteoarthritis Service was well organized. 0 1 2
2. The exercise sessions were relevant to my needs. 0 1 2
3. The instructor was well prepared. 0 1 2
4. The instructor was receptive to participant comments and questions.
0 1 2
5. The exercises helped me to learn the educational material. 0 1 2
6. There was enough time to cover all materials, and answer my questions.
0 1 2
7. The service enhanced my skills and knowledge about bone health.
0 1 2
8. I expect to use the skills and knowledge gained from the Bone Health Service in the future.
0 1 2
9. The exercise facilities were adequate. 0 1 2
10. I would recommend the Bone Health Service to a friend. 0 1 2
How did you travel to these exercise classes? (circle one) Bus Train Walk Car Other (Please specify)
Making ESCAPE work in the workplace
Context
Osteoarthritis - leading cause of absence from work
• 36 million lost working days
• 45% OA patients give up, change type of work or reduce
hours
• retire prematurely by 8 years on average
Context (continued)
The Five Year Forward View : Workplace health
Planning guidance (16/17 – 20/21)
“NHS England and NHS Employers
will …ensure the NHS supports its
own staff to stay healthy, and serve
as health ambassadors in local
communities.”
“How are NHS and other
employers in your area going to
improve the health of their own
workforce?”
193
ESCAPE in the workplace
• Could be delivered in a range of ways e.g.
• by existing Occupational Health services/personnel
• by directly-employed clinical staff
• by contractual arrangement with existing local ESCAPE services
• Workplace pilots planned early 2016:
• Epsom and St Helier NHS Trust
• London Hospice
• Your organisation?
- we can offer support with set-up, mentoring, data collection
