The programme

Chronic joint pain, or osteoarthritis, affects one in five of the population over the age of 50 and one in two over 80. This condition causes considerable suffering and distress and is a life-inhibiting disease.

Only a small proportion of cases (about five per cent of the 8 to 10 million sufferers in the UK) result in surgery. Most are managed in the community, usually with painkillers, which are both unpopular with patients and potentially harmful. One in four GP appointments are estimated to be related to joint pain.

ESCAPE-pain is a group rehabilitation programme for people with knee and/or hip osteoarthritis. It provides self-management support in the community.

This video shows the impact it can have:

The robust evidence for ESCAPE-pain shows that people achieve a marked improvement in mobility and pain reduction and are more able to enjoy the activities of everyday life.

There is also a marked impact on mood based on anxiety and depression score improvements.

The ESCAPE-pain programme is less costly than usual care plans and generates savings in both primary and secondary care.


The programme was developed by Professor Mike Hurley, a physiotherapist by background and an NHS Innovation Accelerator Fellow

ESCAPE-pain is now recognised nationally as worthwhile healthcare innovation. It is available in 86 sites across the country, benefiting more than 7,000 people.

More than 300 facilitators have now been trained across the UK.

Osteoarthritis: Facts and figures

  • Over 8.75 million people aged 45 and over have sought treatment for osteoarthritis
  • People with osteoarthritis are at increased risk of developing cardiovascular disease and diabetes
  • One third of people with osteoarthritis retire early, give up work or reduce their working hours
  • 2.46m (10.9%) of adults over 45 in England have osteoarthritis of the hip
  • 4.11m (18.2%) of adults over 45 has osteoarthritis of the knee
  • Around 20% of people with osteoarthritis experience symptoms of anxiety and depression
  • 101,651 hip replacements carried out in 2016 (an increase of 5% since 2015)
  • 108,713 knee replacements carried out in 2016 (an increase of 3.8% since 2015)

ESCAPE-pain was adopted as a case study in NICE’s Quality, Innovation, Productivity and Prevention programme [2013] and delivers the NICE core recommendations of exercise and education for the management of osteoarthritis.

It is proven to be both clinically effective and cost effective by:

  • Reducing pain
  • Improving physical function
  • Improving the psychosocial consequences of pain
  • Reducing healthcare and utilisation costs

The financial return on investment is £5.20 for every £1 spent.

How does the programme work?

ESCAPE-pain was originally delivered by physiotherapists in hospital outpatient departments but it need not by limited to clinical environments.The programme is also being offered in numerous gyms, leisure centres and community halls and can be delivered by both healthcare professionals and fitness instructors.

The programme is delivered to small groups of people twice a week for six weeks (a total of 12 classes). There are two parts to the programme:

  1. An education component where people learn about the problem, what might be causing it, why they experience pain and simple ways to cope and self-manage their problems
  2. An exercise programme tailored to each individual’s needs and abilities

How we are helping?

The AHSN Network has identified ESCAPE-pain as a national programme that all 15 AHSNs will support across the country during 2018-2020.

We are supporting this programme by:

  • Raising awareness of ESCAPE-pain
  • Helping to set up new sites
  • Ensuring adequate support for existing sites
  • Supporting the sustainability of sites both in clinical and non-clinical settings

Our impact to date

In the Yorkshire and Humber region, there are currently 21 sites delivering ESCAPE-pain.

Next steps

We will work with local providers, commissioners, public health organisations, Integrated Care Systems and Sustainability and Transformation Partnerships to make ESCAPE-pain accessible to all.

ESCAPE-pain will continue to be rolled out through clinical departments but also in leisure and community centres.

We will support roll out to additional sites as well as identifying opportunities for innovative delivery.

If you would like to discuss this programme in more detail, please contact Oliver Barnes Programme Lead  or Ruth Pitman Jones Project Manager