Medicosnext
Chronic pain in the knee, hip, and back affects many people, which impairs the quality of life itself. Most guidelines to manage the pain emphasize the role of physical activity/exercise and maintaining a healthy body weight. However, people associate physical activity with the onset and increase of pain, assuming that activity may cause joint “wear and tear”, and so they avoid physical activity. But, inactivity can lead to stiffening of joints and decrease muscle strength, with the result that, over time, the affected find they can do less and less.
In response to this vexing problem, a rehabilitation program called ESCAPE-pain (Enabling Self-management and Coping with Arthritic Pain using Exercise) has been developed in the U.K., which combines information and advice with an exercise program, giving patients a deeper understanding of their condition and helping them to experience the benefits of exercise/physical activity in controlling joint pain. Originally developed by Mike Hurley, Professor of Rehabilitation Sciences at St George’s University of London and Kingston University, it was adopted by the Health Innovation Network and is currently operated by Orthopedic Research UK. Professor Hurley was appointed Clinical Director of the ESCAPE-pain program last year.
As per the plan, groups of 8-12 patients over 45 years of age with chronic knee and/or hip pain attend 12 sessions twice weekly for six weeks. Led by a specially trained physiotherapist or exercise instructor (facilitator), each session comprises of:
• A 20-minute education session, where causes of joint pain, prognosis, advice, and self-management strategies ( heat/ice, rest-activity cycling, relaxation, etc.) are discussed and learning is shared.
• A 40-minute exercise session, where patients undergo a personalized, progressive exercise routine to increase strength, endurance, and function.
• In both the above sessions, behavioral change techniques, such as motivational interviewing, goal-setting, action planning, and positive reinforcement, are undertaken to help patients regain better control of their lives.
The goal of the plan is to encourage patients to be more active and lose weight, if necessary. A number of studies have shown that the ESCAPE-pain plan was successful in lessening pain and enhancing physical function, mental, and emotional well-being for up to two-and-a-half years. Besides reduction of pain, marked improvements were noted in functional ability, walking, climbing stairs, sleep quality, and socialization. ESCAPE-pain can also be delivered virtually.
