NHS England - Transformation Directorate

Transforming community venues and leisure centres into musculoskeletal (MSK) health and wellbeing hubs

Physiotherapists at King College Hospital (KCH) worked with a local leisure centre in Southwark on a grant-funded pilot project. The project aimed to increase capacity for its MSK outpatient service during the COVID-19 pandemic.

Situation

Because of finite hospital clinic capacity, there was a need to deliver MSK services in the community.

Community services would help people self-manage their bone, joint or muscle conditions.

It was challenging for patients to access MSK services because of the pandemic. There is also a limited number of hydrotherapy services available. A solution was required.

The leisure centre is in the centre of Southwark. It has:

  • good transports links
  • disability access
  • on-site staff

This makes it a suitable venue for supporting self-management for people with MSK conditions.

Aspiration

The team wanted to create a personalised and accessible supported self-management programme. The programme would involve water-based exercises in the community for people with MSK conditions.

The team also aimed to develop a welcoming and supportive community. The community would promote physical and emotional wellbeing while delivering a service which overcomes technology inequality.

Integrating the hospital and the community through a clear pathway and programme helps to:

  • reduce wait times for MSK services
  • increase self-management
  • reduce health burdens without using extra NHS resources

Solution

Southwark’s leisure centre swimming pool is used for community water-based exercise services.

The KCH physiotherapy team runs rehab sessions for patients alongside KCH volunteers and leisure centre staff.

The team uses waterproof tablets and the Good Boost app to deliver individual or group sessions for up to 12 people.

Good Boost creates personalised rehab exercise programmes for people with MSK conditions.

Each patient has a tablet to follow their exercises and give feedback at the end of the session.

1 member of the physiotherapy or leisure team can run multi-condition and multi-ability groups. This approach is efficient and enables lots of patients to access personalised water-based exercise.

The sessions provide a concrete path for patients with MSK conditions to transition from hospital care to an aquatic supported self-management programme in the community.

Impact

The service has delivered over 150 sessions in 4 months to patients, on average, aged 59.

Patient-reported outcome measures showed that:

  • 66.7% of patients reported an improvement to their symptoms
  • 22% of patients saw an improvement in pain between week 0 and week 8
  • 23% of patients said their function improved

The success of the pilot programme means the number of Good Boost sessions will increase from April 2022.

An independent health economic analysis shows that a leisure centre delivering this programme saves the health system over £90,000.

Patients who continue with their exercises and pay for it themselves will generate a projected £11,700 each year for the charity-run leisure centre.

Functionality

The waterproof tablet features an AI-powered app called Good Boost. Good Boost:

  • registers the patient
  • collects information about their condition, symptoms and function
  • prescribes a rehab exercise programme
  • shows animated exercises and instructions
  • gathers feedback and patient-reported outcome measures to adapt the exercises

Capabilities

The solution:

  • enables KCH to support MSK patients waiting for care sooner
  • is suitable for people who find exercise on land difficult
  • bridges the gap between MSK hospital care and community rehabilitation services

The programme gives patients the opportunity to manage their condition alongside other people living with similar MSK conditions. This creates a social support system for people who are isolated and have low confidence as they join a supportive community who are active together in the pool.

Scope

  • The programme is delivered in a community leisure centre in Southwark.
  • Another pilot is delivered in a Sutton leisure centre.

The programme is offered as:

  • an alternative to physiotherapy in some situations while patients wait for care
  • a self-management tool while receiving treatment
  • part of an exit route after discharge

Key learning points

  • Physiotherapy capacity can be released by creating supported self-management services in community leisure centres.
  • Technology facilitates cost-efficient group sessions where just 1 member of staff leads a group of 12.
  • Patients will attend supported self-management sessions in community venues and pay for their attendance.
  • Trained staff can help patients who have low confidence with technology as the device, software and WiFi are provided.
  • Having a physiotherapist at the leisure centre can help MSK patients during their initial sessions build confidence, enabling them to progress to sessions led by leisure staff.

Digital equalities

Waterproof tablets with WiFi are available in the leisure centre, ensuring easy access to the required technology.

The software follows W3C accessibility standards and was designed in collaboration with adults with low confidence when using technology. This ensures the software is easy to use.

Physiotherapy and leisure staff can support patients using the app as necessary.

Key quotes

“Most exercises like squats and lunges are not doable on dry land. The sessions have been really wonderful and the exercises work you out. The exercises matched my needs.

2 weeks in, my back was a lot better, and my walking was a lot better and I can sit for longer in a sitting position, whereas before I had to lay flat.

My mental state has been that I’m having less panic attacks, doing the sessions helped my mental state. I’m more mobile, I’m doing more at home, I’m much stronger, I’m less falling over."

Dawn, Patient attending the community water-based exercise service in Southwark

“I found the sessions absolutely brilliant; I’ve really, really enjoyed them. Exercises that I could actually do, and I’ve found all of them really good."

Flo, Patient attending the community water-based exercise service in Southwark

“It’s been very helpful, I’ve had a stroke, and it’s given me the confidence to build up my walking outdoors. It’s nice to come together as a group, it’s nice to come together at the end of a session and socialise.”

Angela, Patient attending the water-based exercise service in Southwark

“Having ‘Good Boost’ in place at The Castle offers so many opportunities for people with bone, joint and muscle conditions living in Southwark.

For individuals, the programme is a tangible link from hospital-based care to long-term self-management, as it helps people to develop skills and confidence to exercise and the support networks with others to sustain regular physical activity habits.

It is a great example of hospital and community sector integration.

The programme is proving to be very popular! Patients gain confidence and ability very quickly through Good Boost, and it is great fun, which I think contributes to people wanting to keep coming. It is a fantastic resource, which I hope we will be able to expand in the future.”

Dr Nicky Wilson, Consultant Physiotherapist, King’s College Hospital NHS Foundation Trust

“I’ve been referring patients post hip and knee replacement to Good Boost at The Castle since the programme started in October 2021.

At the moment there is quite a delay in accessing rehabilitation for some of these patients so it’s fantastic to have Good Boost available as an option.

Many of the patients I see live in Southwark, so The Castle leisure centre is easily accessible to them.

Patients seem very keen to try water-based exercise, especially those who are a bit isolated, struggling with land-based exercise and who don't feel confident to go to a gym or a swimming pool independently.

The programme provides a bridge between hospital-based treatment and swimming or aqua aerobics in a more public setting and having that sort of stepping stone in place has been really positive.

Feedback about the programme has been great. Patients seem to really enjoy the social setting and atmosphere and they don’t seem fazed by using the technology to create their exercise programme, which I was surprised about.

They feel supported and the programme gives them confidence and competence. They realise ‘I've done this. I could continue doing this.”

Nicky Underdown, Clinical Specialist Physiotherapist, Department of Orthopaedics, King's College Hospital NHS Foundation Trust

Key contacts

Ben Wilkins, CEO, Good Boost

ben.wilkins@goodboost.org

Nicky Wilson, Consultant Physiotherapist, Kings College Hospital NHS Foundation Trust

nicky.wilson1@nhs.net