Self management for chronic knee pain: using group physiotherapy to teach exercises and coping strategies

NICE Quality and Productivity Case Studies
Sevenoaks District General Hospital
Publication date:
09 April 2013



Chronic peripheral joint pain (usually labelled osteoarthritis) is a major cause of suffering, physical disability, psychosocial distress, and direct and indirect healthcare and socioeconomic costs. Pain induced limitation of mobility and physical function increases the risk of developing or exacerbating comorbidities such as diabetes and cardiovascular and respiratory conditions. These problems are increasing as more people work longer with chronic ill health. Safe, affordable interventions will be needed to maximize people’s independence and ability to function, and ensure the efficient use of health and social care resources.

NICE guidance recommends that exercise should be a core treatment for people with osteoarthritis (NICE 2008). Unfortunately, many people with joint pain are managed in primary care with long-term analgesia, despite the risks of side effects such as gastrointestinal bleeding and myocardial infarcts.

A rehabilitation programme, ‘Enabling Self-management and Coping for Arthritic pain through Exercise’ (ESCAPE-pain), combines education, self-management and coping advice with an exercise regimen tailored to address each patient’s needs. The programme is delivered to small groups of 6 to 8 patients, as opposed to normal individual physiotherapy. Evaluation in clinical trials demonstrated the programme is safe, produces better clinical outcomes compared with management in primary care (Hurley et al. 2007a) and is as clinically effective and more cost effective than normal individual outpatient physiotherapy (Jessep et al. 2009).

Clinicians at Sevenoaks District General Hospital, Kent were trained to deliver the programme, having observed sessions elsewhere. A senior clinician acted as a champion to implement the programme with buy-in from the manager. The programme comprises 10 sessions, each consisting of physical exercises with themed discussions on topics such as setting goals and controlling pain. Participants are given tailored exercises to do at home, and progress is reviewed in the sessions.