Transformation Directorate

Virtual management of an education and exercise programme for chronic joint pain

The ESCAPE-pain programme is an evidence-based group intervention for people with chronic joint pain developed by Professor Mike Hurley.

For the past eight years, ESCAPE-pain was hosted by the Health Innovation Network. Orthopaedic Research UK (under licence from Guy’s and St Thomas’ NHS Foundation Trust) now deliver the programme. The programme integrates educational self-management and coping strategies with an exercise regimen individualised for each participant.


ESCAPE-pain was designed to be delivered as a face-to-face group intervention (twice weekly for five/six weeks). The programme teaches people how to self-manage their condition and control their symptoms, but the COVID-19 crisis forced all venues to suspend delivery. The challenge faced by ESCAPE-pain sites was how to support people with knee/hip/back pain who were confined to their homes. As it was unknown how long the restrictions would be in place, these people were at risk of deteriorating while waiting for face-to-face classes to resume. This encouraged sites to find new ways of supporting their patients.


Sites were eager to try meet the needs of their local population and growing waiting lists by piloting ‘virtual’ ESCAPE-pain classes. This meant delivering the facilitated education discussion and exercise session virtually, allowing people to access the programme and continue to receive the necessary support with their condition.


People on existing waiting lists and new referrals who meet the eligibility criteria are offered the option of attending a virtual ESCAPE-pain programme. The process requires participants to be reassessed to identify any deterioration since their last assessment, and to garner their interest in participating in a virtual programme. Participants are provided with a technical induction to the chosen platform, which varies between providers.

The education component is conducted in real-time as a facilitated discussion, using videos or presentations to reinforce key messages. Crucially, the exercise component is also delivered in real-time with a demonstration of the exercise by the facilitator, followed by the class completing the exercise together, observed by the facilitator for technique and safety.

Exercises are adapted so that they can be easily replicated in a home environment with no reliance on exercise equipment, and modified to make use of everyday home objects like chairs, tins, towels and so on.


Clinical outcomes for example knee osteoarthritis (OA) outcome score and hip OA outcome scores were collected for the virtual delivery model. Although the initial sample size was small (47 data sets across the country), participants reported improvements across all outcome measures: reduced pain, improved physical function and better quality of life. The magnitude of these changes are very similar to those found in the “real-world” data collected from over 10,000 ESCAPE-pain participants who undertook the face-to-face programme at sites across the UK and in the clinical trial (Hurley et al., 2007).

Between the start of the pandemic to July 2020, the programme was delivered to over 500 participants.


A virtual group-based education and exercise rehabilitation programme delivered across digital platforms.


  • Virtual group-based education and exercise rehabilitation programme which replicates the evidence-based face-to-face intervention.
  • By participating in the facilitated education discussion which covers different education topics per session, participants learn about their condition and ways in which they can help themselves.
  • By being in a group setting, participants give and receive peer support – this helps to build self-awareness, acceptance, hope and improves people’s abilities to cope with their condition.
  • By participating in the exercise sessions participants learn how to exercise safely and that exercise can improve their condition.
  • Over the course of the programme participants can change their health beliefs and behaviours.


The virtual programme is intended to be accessed by participants at home.

Key figures/quotes

Knee OA outcome score

  • Sample size – 33 participants
  • Pain – 84.8%
  • Function – 75.8%
  • Quality of life – 81.8%

Hip OA outcome score

  • Sample size – 14 participants
  • Pain – 78.6%
  • Function – 78.6%
  • Quality of life – 92.9%

Find out more

Learn more on the ESCAPE-pain website

Download further information about the NHS Innovation Accelerator (PDF, 284 KB)

Read more about the HSJ-awarded programme

Download further information on the Clinical Effectiveness of a Rehabilitation Program Integrating Exercise, Self-Management, and Active Coping Strategies for Chronic Knee Pain: A Cluster Randomized Trial (PDF, 117 KB)

Read more on the research papers

Key contact

Central ESCAPE-pain team