@HINSouthLondon healthinnovationnetwork.com

Joint Pain Advice

Prof Mike Hurley, Clinical Director for MSK, Health Innovation Network

Ambra Caruso, Senior Project Manager MSK, Health Innovation Network

Sally Irwin, Joint Pain Advice Project Manager, Health Innovation Network

Diana Stovell, Health and Wellbeing Manager, Richmond and Wandsworth Councils

Lucy Brown, Healthy Lifestyle Delivery Advisor, Cornwall Council

Contact details

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If you’re interested in finding out more about Joint Pain

Advice then get in touch

Email: hin.jointpainadvice@nhs.net

Academic Health Science Network (AHSN)

3Saving money

Improving lives

Driving economic growth

Our continuing mission is to find, develop and support healthcare innovation.

The Health Innovation Network (HIN)

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The HIN is the AHSN for South London but leading on MSK nationally

Our MSK work

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Our focus is the self-management of joint pain. We support

the national spread and adoption of two interventions:

• ESCAPE-pain knee/hip or backs

• Joint Pain Advice (JPA)

If you’re interested in finding out more about Joint Pain Advice

then get in touch

Email: hin.jointpainadvice@nhs.net

What is joint pain?

Chronic joint pain:

• Very common

• Often labelled osteoarthritis

• Most common joints affected are knees, hips, hands and back

• Main symptoms - pain and stiffness in affected joint, reduced mobility

• Long term condition that cannot be cured but doesn’t necessarily get worse

Chronic low back pain:

• Very common

• Majority of back pain non-specific/mechanical/general

• In most cases not caused by a serious underlying problem

Chronic or persistent pain:

• Pain lasting longer than 3 months

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The problem

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10 million people in UK live with chronic joint pain / osteoarthritis

• 33% >55 yrs have disabling joint pain, 50% over the age of 80 years

9.11 million (16.9%) people in England have back pain

longevity, inactivity & obesity = prevalence

• 2030: ≈17 million people affected in UK (OA)

Impact on individuals & society

• Pain, mobility, function, physical + mental co-morbidity

• 1/5 1o consultations; >1K arthroplasties; 3rd biggest NHS spend

• Work – 30m days lost, 2nd biggest cause of

absenteeism after coughs and colds

• ~1.5% GDP

(mis)Management

• Mostly drugs

• Erroneous health beliefs and attitudes

(movement = pain = harm) not addressed

Joint and back pain: impact on the workplace

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• changed duties, reduced hours, sick leave and early retirement

• OA 3 million lost working days each year

• Back pain 4 million lost working days

• 1 in 4 who consult their GP about OA leave the workplace prematurely

• Association between chronic pain, depression and stress can lead to

increased absence from work

• Prevalence of joint pain increases with age. As the working age is

extending, the impact of joint pain will increase

• 1 in 5 (20%) are worried they won’t be fit enough to continue working

in the next year

• Impact of Covid-19 on MSK Health

Joint Pain Advice

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A model of care to support people understand and manage their chronic knee and hip pain (often labelled

osteoarthritis) and low back pain

Joint Pain Advice

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Joint Pain (NICE) Advice

≥40 years with knee or hip pain ≥ 3 months

≥18 years with low back pain ≥ 3 months

Increasephysical activity

Weight management

Healthy eating

Education, information

Behavioural change techniques- motivational interviewing- goal setting- action/coping planning

Signposting, social prescribing

Jointly developed, personalised action

plan

Who can deliver and where?

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GP Self AHP Manager OH

At home

Hospital

Community

Pharmacy

Workplace

GP surgery

Physio

Health Trainer

/Champion

Occupational Health

Link worker

Pharmacist

Healthy Lifestyle Advisor

Referrals

Is the Joint Pain Advice service…

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➢ Practicable

➢ Safe, effective, efficient

➢ Acceptable

➢ Able to reduce healthcare and social care/resources

Lewisham* & Greenwich results

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Significant improvements

• function and activities of daily living

• pain and its impact

• mental health and wellbeing

Physical activity increased

by 2 days/week

2kg weight reduction;

BMI

18% pain reduction

* Fewer;GP visits (21%); Imaging; physio

Increase function

Social Return on Investment (SROI) £1 spent = £4 return in value*

Participant satisfaction

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• it worked(!) – less pain, better function

• understood problem and what to do

• more confident about self-management

• longer, better consultations

• tailored advice to personal needs

• easier access to care and information“…I was given

advice and exercises that

have transformed my mobility

and now I feel so mentally positive…”

“…I can get in and out the bath

better…”

“…it’s the ‘I can do this’ feeling…released the

fear and barriers from stopping you doing stuff…”

“…it’s not ‘you need to this do that’ it’s about

encouragementwhich is so

important…”

“I can put my tights on by

myself again!”

“…not using walking stick any longer…”

“…What’s changed? No

painkillers and that’s a big

deal…”

Joint Pain Advice (JPA) in the workplace

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• Funding awarded

• November 2018 to February 2020

• Study to test the feasibility, acceptability and effectiveness of the JPA

model delivered in the workplace to employees

• Offered to employees of 20 organisations across London and Cornwall

Joint Pain Advice in the workplace was funded by the Work and Health Challenge Fund

32%

8%

13%14%

4%

7%

21%

1%

Pain locations

Back Back and Hip Back and Knee

Back, Hip and Knee Hip Hip and Knee

Knee No Pain

Demographics

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481 participants

74%

26%

Female Male

18-242%

25-3410%

35-4416%

45-5439%

55-6430%

65-743%

75+0%Age

75%

25%

Sitting at a desk, computer or machinery, etc

Up and about doing manual tasks and activities

Average age

49 years

Outcomes

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32.6

42.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

Baselinen= 480

6 monthsn= 206

MSK-HQ

5.6

3.5

0.0

1.0

2.0

3.0

4.0

5.0

6.0

Baselinen= 478

6 monthsn= 208

Pain scale

11.5

14.5

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Baselinen= 464

6 monthsn= 200

Sit to stands

2.8

3.5

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Baselinen= 479

6 monthsn= 210

Days physically active

4.7

2.7

0.0

1.0

2.0

3.0

4.0

5.0

Baselinen= 479

6 monthsn= 209

Physical Function

5.5

7.8

0.0

2.0

4.0

6.0

8.0

10.0

Baseline 6 monthsn= 210

Confidence to self-manage

Summary

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For an investment of about £62 per employee using the

JPA service, the savings for the employer and

employees were:

• better physical and mental health and wellbeing

• one less sick day

• one less GP appointment

• less time off work for investigations, interventions

• fewer over-the-counter/prescribed medications with

their possible side-effects

JPA overview video

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Joint Pain Advice – overview video

Watch this video to find out from both JPA Advisors and

participants about its benefits

Case studies

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• 2 models of care tested

• ‘In house’ Advisor – employee(s) of an organisation trained to

deliver JPA within their own workplace

• ‘Peripatetic’ Advisor – trained Advisor (external to organisation)

provides JPA to multiple organisations

• Cornwall Council

• Richmond and Wandsworth Councils

Cornwall Council Healthy Workplace

Lucy Brown

Healthy Lifestyle Delivery Advisor

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Cornwall Council – Healthy Workplace

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Why JPA?

• Included as part of a new role, opportunity to learn additional skills

• Opportunity to expand healthy workplace offer, more support to local workplaces

• Organisations recognised need to support MSK health and saw JPA as benefitting the health and wellbeing of staff

Existing MSK/joint pain offer:

• Not part of existing Healthy Workplace offer

• Services available to staff at organisations varied

Approach

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• 1 member of Council staff trained

• Offered service to multiple workplaces

• JPA offered to workplaces across Cornwall signed up to the Healthy Workplace Programme

• Workplaces expressed interest, JPA service discussed, workplace engaged

• Lead contact/link worker at each workplace identified

• Workplaces responsible for promotion and recruitment

• Resources supplied to workplaces to support them with this

Administration

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• Date and times JPA Advisor would attend the

workplace agreed and suitable room booked

• Minimum of 4 participants per visit agreed

• Workplace screened and booked in participants

• Booking sheets and participant information

shared on the day

• Data collection

What went well?

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• What went well?

• Large number of organisations came forward to take up the offer

• Training and support

• Additional resources

• What helped?

• Promotion from workplaces to participants

• Good communication and organisation of allocated link worker

Challenges

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• Link worker engagement/multiple link workers

• Organising appointments in larger organisations with

multiple sites

• Mobile workforce, shifts/on-call duties

• Trialled telephone appointments at 3 weeks

Benefits - workplaces

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Cornwall Council, Healthy Workplace:

• Another service to offer to local workplaces

• Able to offer to Council employees

• Additional skills and knowledge of Healthy Workplace team members

• Engagement with SMEs who may not have otherwise been able to offer a service such as this to employees

Workplaces/organisations

• Offer of new/additional service to support employees with joint pain

• Supporting healthy workplace/employee health and wellbeing agenda

• Potential reduction in staff sickness and associated costs

Benefits to participants

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• 87% likely or extremely likely to recommend to friends and

family

• Useful information

• Better understanding

• Time to think

• Feel supported

Richmond and Wandsworth Councils

Our experience of the Joint Pain Advice programme

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Health and Wellbeing ManagerDiana Stovell

My team includes Occupational Health trained professionals who as part of their normal work offer guidance around developing and maintaining healthy lifestyles.

This is why Joint Pain Advice fitted in so well with our current practice.

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This Photo by Unknown Author is licensed under CC BY-SA

Approach

• 4 staff members of Occupational Health Department trained

• JPA appointments offered at 2 main council sites

• Promoted on staff intranet as regular news item - majority of staff have access to this

• Great response with over 82 participants during the project

• Now being offered remotely with online support materials

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This Photo by Unknown Author is licensed under CC BY-SA

Administration

• Employees able to self refer using email address provided

• Eligibility criteria then confirmed and appointment booked

• JPA appointments were booked by OH administrator

• Booked using existing booking system on Outlook calendars with allocated time blocked out

• Data collection overseen by administrator

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This Photo by Unknown Author is licensed under CC BY-SA

What went well?

• Professional materials provided by HIN

• Knowledge of signposting and referral options and being able to directly refer to these e.g. weight management support

• Positive response from promotion and engagement of employees attending appointments

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Challenges

• Perhaps being one of the earlier organisations to join the programme so support materials etc. were still being developed

• However this is now all in place to support new organisations

• Capacity and fitting JPA appointments in, around other commitments

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This Photo by Unknown Author is licensed under CC BY-NC-ND

Benefits for Participants

• 96% extremely likely or likely

to recommend JPA to friends

and family

• Time to discuss their joint pain

and management

• Positive encouragement to

make changes

• Helpful/useful

information provideddiscuss their joint pain and management

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This Photo by Unknown Author is licensed under CC BY-NC-ND

Feedback after Programme

eme likely or l

“I have completed the Couch to 5k and now run 5k 3 times a week. It takes me longer and I end up running for around 50 mins but I am happy😊 Thank you so much for getting me there”heir joint pain and

management

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This Photo by Unknown Author is licensed under CC BY-NC

Benefits to OH staff

“One of the most valuable and

inspiring aspects I got from

delivering the Joint Pain Advice

programme was seeing people gain

in confidence and from a point of

not doing any exercise finding the

confidence to start and then

finding it helped their symptoms.’’

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This Photo by Unknown Author is licensed under CC BY-SA

Benefits to the Organisation

• Another offer to support

employees at work

• Improved health of

participants

• Hopefully reduced sickness

absence

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This Photo by Unknown Author is licensed under CC BY-SA-NC

Going Forward

• We plan to continue offering the

JPA pr0gramme to staff as a

positive service now the project

has finished

• We would definitely recommend

other organisations consider

offering staff this great initiative

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This Photo by Unknown Author is licensed under CC BY-SA