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Exploring community physiotherapy groups as a means to improve the lives of those living with chronic hip and knee pain

With funding from NHS England Healthy New Towns programme, Care City delivered an Escape Pain programme in Thames Ward, Barking, between August–October 2018.

Osteoarthritis affects approximately 8 million people in the UK, and is becoming more common as we live longer. ESCAPE-pain is a rehabilitation programme for people with chronic joint pain, that integrates educational self-management and coping strategies with an exercise regimen individualised for each participant. It helps people understand their condition, teaches them simple things they can help themselves with, and takes them through a progressive exercise programme so they learn how to cope with pain better. 

The Escape Pain programme was delivered at the Sue Bramley Children’s Centre, a community centre in the heart of Thames Ward to residents who were either self-referred or referred via the local GP Practice at Thamesview. All participants were screened by a Physiotherapist for suitability for the programme. 

Over the next seven days we will share with you the feedback that we received from the participants of the programme including what has changed for the participant as a result of Escape Pain, what they can do now that they couldn’t do before and what key things they have taken away from the group sessions.

Day 7 – Sustainability

As part of support to participants to sustain behavioural change, Care City worked closely with the local authority to provide up to date information and signposting about the local health and wellbeing offer. Community Solutions presented to the group and explained how they could access gym passes through the Exercise on Prescription pathway. Doing this as a group provided peer support to utilise this resource. While the gym was previously an intimidating location for many of the participants, gaining confidence in exercise through Escape Pain meant many of them now felt confident and prepared to join the gym and attend exercise programmes within the leisure centre. As an additional session a taster yoga session was provided to the participants as an example of another local offer which they could engage with. This was met really well. Transitioning participants into other services and peer led groups is challenging in Thames Ward due to limited resources and opportunities. Care City will continue to work with the local authority and local residents to develop the pathway for graduates of Escape Pain to support sustained behavioural change.

In addition, two exercise practitioners from LBBD will be training in delivery of Escape Pain to increase the offer across Barking and Dagenham.

“We’re definitely going to continue to meet up as a group; we’ve got the whatsapp group. We will carry on helping each other to exercise” 

“I’d never thought to try yoga before; it’s harder than it looks! This has made me confident to try other things too, and it was good to do it with my friends here in the group”

 

Day 6 – Impact 

Participants were particularly enthusiastic about the impact of the programme, both on their physical symptoms, but also their mental health and wellbeing. This was translated into increased confidence in managing their pain, feeling less anxious about their condition and seeing marked improvement in their physical symptoms, such as improved range of movement and reduced pain. This manifested in practical changes such as being able to walk further, take the stairs, taking up an additional exercise and feeling generally more active. Participants actively highlighted where they had seen such improvements in their peers, and the general group progress was another marker of success for them. 

“I can move more than before, I couldn’t believe it. I feel so happy with myself and really proud. I’ve walked from my house – the long way not the short one, for the first time in six months and I felt confident about it” 

“Now I come to Escape Pain, I feel confident to walk without my stick. I didn’t do that before” 

“This group [Escape Pain] has challenged me to think differently about my pain and I’m less scared to exercise. I’m not making it more damaged” 

“Well, thanks to you, I’ve just seen my surgeon and because of all my work here at group [Escape Pain] he’s said that we can hold off surgery on my knee for now. I don’t need it for at least another 6 months when we’ll review again. And even if I do need it eventually, I’m stronger and will be better ready for it and the recovery” 

“Confidence is the big thing. All I done before was walking. I’d walk here and there, but I didn’t do exercise. Coming here [to Escape Pain] has given me confidence to try other exercises and take them from here to a gym or whatever.” 

“I go to yoga now, it’s another way I can carry on the things I’ve learnt here”

 

Day 5 – Peer Support

Peer support was crucial to the success of this programme. Not only did this happen within the group, but participants had begun to support and encourage each other outside of the session. Many of the participants reported feeling lonely and isolated, but were positive about the relationships they built within the group and the value of peer support and mutual understanding.

‘I think the others will agree, we find it hard to talk about our condition and living with pain like we do, can make you invisible. Others don’t see it so they don’t understand. Coming here, I just felt relaxed and knew I was with people like me, who understood about what I’ve been through and could encourage me to feel better’ 

“There’s a shared understanding here. People aren’t bored of me talking about my pain, but they’re supportive” 

“Long-term illness and injury makes you feel so isolated. I’ve really appreciated the common bond I’ve found here at the group” 

“We’ve made new friends and can support each other”

 

Day 4 – Group Structure 

Some participants felt that the age range from 45+ was quite broad and could have both a positive and negative effect on group dynamics. For example, a younger person in a group of much older participants could find this intimidating, and vice versa. They felt that in order to get the tone and content right, it would be helpful to have participants from a similar age band. However, others felt that it could be inspiring for both older and younger participants and that there could be some effective inter-generational support and encouragement.

“I think it would be good to get a better, smaller age range. Because I’m only 45 and turning up to work with a 90 year old, I’m just not there yet.” 

“I think it can be really encouraging for people of a wide age range to support each other and it’s really inspiring to see someone older than you working hard at exercise. I think its inspiring having a broad age range”

 

Day 3 - Content 

The participants were positive about the balance between exercise and education/discussion sessions. Initially the sessions kicked-off with an education component, followed by the exercise circuit. However, on participant suggestion, this was reversed, so that they commenced exercise as soon as they arrived and finished with an education discussion and debrief. This also meant that they stayed longer than the hour to speak to other participants and bond as a group and allowed for participants to have some ‘cool down’ time whilst taking part in the discussion.

“We really learnt so much from Hannah, but also from each other. We could share things that helped us and see how other people were improving. It was amazing to see other people making improvement, from being afraid of exercise to adding dancing into the mix!” 

“Escape Pain really is just a ‘come as you are’ group, doesn’t matter if you don’t have the right clothes or whatever, it’s just a supportive place” 

“My advice for anyone else taking this course is to give it your best, support each other and be ok to laugh about things. That makes a really safe environment to try new things and be able to manage the pain”

 

Day 2 – Timing 

The programme was delivered on Monday mornings (9.30am-10.30am) and Wednesday afternoons (3.30pm-4.30pm). Participants must attend the two sessions delivered each week. Timing was extremely important to the group, and they provided invaluable feedback as to how timings could be improved i.e. they should not clash with school run times when roads are busy.

The intensity of two sessions a week was also debated, some felt this was problematic because if they missed a week (for holiday or sickness) they had then missed two sessions which could be significant. Others felt that the frequency had helped with motivation and encouraged them to continue to be active throughout the week. Some also felt that having two sessions a week close together had enabled the group to bond quickly and created a supportive and motivating environment.

“At first I was worried about the commitment with work and everything, but I’ve actually found it really motivational coming here twice a week, and the two sessions really keeps up the energy” 

“I loved having Monday and Wednesday, even though I find it hard to get out of bed, when I turned up it really kicked off my week. But, I did find the gap between Weds and Monday a bit big, and would have liked another session or to have another day between”

 

Day 1 - Location

We worked closely with local residents to identify the best location for delivery of the ESCAPE-Pain programme. Considerations included, access, location and type of venue which were all found to be of importance to local residents. Finding a venue which was central to Thames Ward, easily accessible and familiar to the local community was crucial to ensuring uptake and engagement with the programme.

In addition, some residents highlighted their discomfort at entering a leisure centre or gym as was intimidating and off-putting and they would have found it difficult to go to a class in that setting, but indicated that they would feel happy using a community hall. As a result, the Sue Bramley Centre, a community centre adjacent to the Doctor’s practice was identified as the most ideal venue. The centre hosts a number of community groups, is easily accessible and is at the heart of the Thames View community. 

“Sports centres can be intimidating. Escape Pain helps break down some of the barriers” 

“For some of us, like we don’t even own a pair of trainers. So going into a gym isn’t going to happen. They can be, like, intimidating, you know? I’m there with my broken bits and not looking fit, you feel like you stand out. Whereas now after coming to this [community centre based Escape Pain] and making friends I feel like I could go with them to the sports centre and make the most of the gym pass. But you need a first step to help break that fear”