Virtual delivery of ESCAPE-pain classes

“Thanks to the HIN’s ESCAPE-pain team for supporting us roll out the programme virtually. It’s meant that as clinicians we’ve been able to continue to support our patients, even when we couldn’t see them face-to-face.”

From ESCAPE-pain provider Sirona care and health

Challenge / Problem Identified

The ESCAPE-pain programme is an intervention for people with chronic joint pain developed by Professor Mike Hurley. The programme is hosted by the Health Innovation Network (HIN) and supported by NHS England.

The programme was designed to be delivered as a face-to-face class for groups of about 10 people in Physiotherapy Outpatient Departments, and leisure and community settings. Over 290 venues across the UK were delivering ESCAPE-pain prior to April 2020. However, COVID-19 forced all venues to suspend face-to-face classes. The challenge faced by ESCAPE-pain sites was how to support people on their waiting lists with knee/hip/back pain who were now confined to their homes. As it was unknown how long the government restrictions would be in place, people on these waiting lists were at risk of deteriorating whilst waiting for face-to-face classes to resume.

This encouraged the HIN’s ESCAPE-pain team to find new ways of supporting ESCAPE-pain sites.

Actions Taken

The HIN’s ESCAPE-pain team received requests from sites who were eager to pilot ESCAPE-pain classes via a digital platform. The team adapted to meet this need and undertook to support sites to trial virtual delivery if they could.

The HIN’s ESCAPE-pain team has offered ongoing support to sites willing to pilot the virtual delivery through:

  • Bespoke support via telephone, video and email
  • Monthly email updates
  • Linking sites up with other providers who had experience of virtual delivery
  • Helping sites with the key considerations for managing their referrals, waiting lists, assessment process and recruitment
  • Supporting sites with how they adapt the programme to suit a digital platform
  • Technical and IG support
  • Supporting sites to collect clinical outcomes via the new outcomes’ website, reducing the administrative burden
  • Organising a webinar to share the early experience of sites with others
  • Collating the webinar learnings into a shared FAQ resource
  • Conducting a service evaluation of virtual delivery to better understand the challenges faced
  • Delivering the ESCAPE-pain facilitator training programme via Zoom to keep up with demand.

The guidance around the virtual model made it clear that this form of delivery was new and would need to be evaluated by the HIN’s ESCAPE-pain team if it were to be considered appropriate for longer term use.

Impacts / Outcomes

Participants of virtual ESCAPE-pain classes have provided positive feedback.

Clinical and leisure/community delivery partners are thinking creatively and making changes to their service delivery thanks to our change management support.

Twenty-three organisations are delivering ESCAPE-pain over thirty-two different sites. In total they have delivered/are delivering fifty-seven programmes.

Several sites have fed back that virtual delivery of ESCAPE-pain has provided an opportunity to explore and inform changes to other services.

Waiting lists for the ESCAPE-pain programme reduced as people have booked onto these classes. However, sign-up has been limited due to people being digitally excluded or digitally illiterate.

Lessons Learned

There is still great demand for the ESCAPE-pain programme

The ESCAPE-pain ‘community’ of sites and facilitators have remained engaged and keen to explore different ways to deliver ESCAPE-pain throughout lockdown as they have concerns about people on their waiting lists not having the opportunity to benefit from this support during COVID-19.

The virtual model can be challenging for both providers and participants

The benefits of virtual delivery need to be considered alongside the challenges encountered by both providers and participants. Those who have made a success of it have done so with great effort and planning.

The ESCAPE-pain sites require more complex support from the HIN’s ESCAPE-pain team

The support required from the sites to trial virtual delivery (and to return to face-to-face delivery) has been more bespoke and resource intensive. The team regularly offers 1:1 support to many of the 290+ ESCAPE-pain sites still active across the country. This often includes technical and IG support, adapting elements of the programme, and signposting to government guidelines.

One size does not fit all

The issues of digital exclusion and digital illiteracy must be considered when thinking how best to reach the group of people who would normally benefit from the face-to-face programme.

Blended approach: virtual and face-to-face classes

There are advantages to the different models of delivery, and a blended approach may be helpful in making the programme more accessible to a wider audience.

Supporting the use of NHS Estate

There are advantages to the different models of delivery, and a blended approach may be helpful in making the programme more accessible to a wider audience.

Supporting the use of NHS Estate

As space in the NHS was under huge pressure due to the need to separate COVID and non-COVID patients, being able to run digital classes meant that physiotherapy departments could continue to care for musculoskeletal patients effectively using an evidence-based programme, even if it was online rather than face to face.

Future Plans / Next Steps

The HIN’s ESCAPE-pain team continue to support ESCAPE-pain sites who are exploring virtual delivery by providing bespoke one-to-one assistance. This support also includes delivering national webinars to help spread the learning from sites who are trialling virtual programmes, across different platforms. These sites share the challenges they have faced, their successes, and the pitfalls, across a range of themes such as:

  • Chosen platform/technology
  • Screening, recruitment and uptake
  • Safety considerations
  • Optimal group size
  • Education and exercise delivery
  • Data collection.