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ESCAPE-pain for backs: The importance of rehabilitation programmes for people suffering from chronic low back pain

Introduction: Low back pain (LBP) is a condition that affects approximately one-third of adults in the UK annually and is a leading cause of disability worldwide. LBP is the second most common reason for work absences and reason why middle-aged people visit their GP, resulting in significant healthcare costs and productivity loss. Back Care Awareness Week is observed between 3 and 7 October 2023. This year, we want to emphasise the importance of innovative self-management programmes like ESCAPE-pain (Enabling Self-management and Coping with Arthritic Pain using Exercise) for backs which help in managing LBP.

The National Institute for Health and Care Excellence (NICE) guidelines recommend educating individuals about their condition, increasing physical activity, and maintaining a healthy weight to alleviate pain and its impact; ESCAPE-pain found this advice rarely reached patients and wanted to raise awareness of LBP.

How ESCAPE-pain for backs works: The ESCAPE-pain for Backs programme involves a combination of tailored exercises, education, and self-management strategies. Participants are guided by trained healthcare professionals through a series of movements designed to strengthen muscles, improve flexibility, and promote better posture. The aim is to help people understand their condition and realise that exercise is a safe and effective self-management strategy. Additionally, participants receive valuable insights into pain management techniques and lifestyle adjustments that contribute to long-term well-being.

Pilot evaluation: The ESCAPE-pain for backs programme was evaluated, with an aim of understanding the impact and effectiveness of self-management of non-specific LBP. Initially, the programme was piloted in six outpatient physiotherapy departments in London, composing a report evaluating the effectiveness and feasibility of the ESCAPE-pain for backs programme.

ESCAPE-pain wanted to determine if there were improvements in clinical outcomes such as pain, function, physical activity levels and mental well-being for people suffering with non-specific LBP after attending the programme. We wanted to establish clinicians’ and physiotherapists’ acceptability of implementing ESCAPE-pain for backs and understand the factors influencing adoption of the ESCAPE-pain for backs programme.

The results were highly encouraging with positive improvements observed in the 286 participants’ physical and mental well-being, as well as their overall musculoskeletal health:

  1. Pain reduction: Participants reported a reduction in pain and better management of pain flare ups, acknowledging the programme’s content, format, and delivery for their improvements.
  2. Improved functionality and enhanced quality of life: ESCAPE-pain for Backs helped participants enhance their physical functionality, allowing them to perform daily tasks with greater ease and comfort. Feedback from participants indicated increased understanding of their condition, improved physical abilities, and a return to previously avoided activities due to fear of pain.
  3. Feasibility and acceptability: Clinical leads and physiotherapists involved in delivering the programme reported an increase in their knowledge base and confidence in facilitating group discussions and addressing complex topics with participants.

Summary of Pilot: The evaluation found that ESCAPE-pain for backs delivers effective care aligned with NICE guidelines and significantly improves participant outcomes. All six sites implementing the programme observed improvements in participant clinical measures and integrated the programme into regular practice.

Benefits of ESCAPE-pain for Backs

  1. Evidence-based approach.
  2. Empowers participants to gain knowledge and tools to actively manage their back pain.
  3. Connects individuals with a supportive community.
  4. Easy to set up and deliver in a variety of locations. 

Conclusion: With a focus on back pain prevention, Back Care Awareness Week is a crucial reminder we need to prioritise back health and explore solutions that might transform lives for the better, one participant explained; “ESCAPE-pain for backs has helped me not to be worried about exercising and causing an injury or making things worse. Also, it’s been good for my mental health to be more active. I’m more confident to add more exercise in my lifestyle now.”

By funding community interventions, such as ESCAPE-pain, more people will have access to local group-based classes teaching self-management techniques and educating about conditions.

ESCAPE-pain want to spread awareness of the ESCAPE-pain for backs classes, get more facilitators trained and expand access to programmes like ESCAPE-pain for the millions of people that are suffering from LBP.