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Joint Pain Advisor service: One Month On

In November 2016, Greenwich Public Health team were successfully awarded an Innovation and Diffusion award (now named South London Small Grants) to pilot their innovative approach to managing joint health in the community. At the beginning of March 2017, the team launched the Joint Pain Advisor service – a holistic approach to helping people self-manage their chronic joint pain.

The Joint Pain Advisor service takes the form of up to four face-to-face consultations between an ‘Advisor’ and clients with osteoarthritis of the hip and/or knee. Patients discuss their lifestyle, challenges and personal goals. They jointly develop a personalised care plan which includes tailored advice and support based on NICE guidelines for the management of osteoarthritis.

Six weeks on we spoke to Stephanie, a Joint Pain Advisor, to find out how the service has been received.

Q. What has been the response from people?

A. [They have been] Intrigued mainly, for most I have found that they do not feel supported by their GP – some saying they have had a diagnosis while sitting opposite each other and then there was no follow up on what they can do to manage the pain, just prescription of strong painkillers in some cases.

Q. Do clients know what to expect when they come in?

A. Clients have some expectation of what will happen in the session regarding setting goals and lifestyle changes, but many have taken an open-minded approach to receive any support that is on offer. I had one older lady thinking she was going to receive a massage – a friend was joking with her and she took it literally!

Some have also expected more of an exercise prescription attitude and have been pleasantly surprised by the discussion approach to their activity levels.

Q. Are clients keen or resistant to the Joint Pain Advisor approach?

A. I find many clients are keen to receive support of any kind and quite open, I have only had 1 or 2 clients that are resistant and this does make the session a lot more difficult, but they have come around in the end and have set goals.

Q. Do you have any anecdotes to share with us?

A. I had one client who, when I first mentioned the sit to stand exercise said ‘No I cannot do that, definitely not, it will hurt too much’. Eventually, after chatting some more about the pain and what helps it, he agreed to give it a go for 10 seconds but then continued for the full 30 and left feeling very pleased with himself. As he works from home, he is using this to break up periods of sedentary behaviour and help him stay alert in the afternoon.

The client described some other symptoms and I also advised him to visit the GP. He was then diagnosed with type 2 Diabetes and put on medication which has helped with the joint pain and general tiredness he was feeling.

When he came for his assessment, a fair amount of the session was around him telling me about what he has previously done that worked and how as a child he spent over a year in braces unable to walk. Doctors had even told him as 12-year old that he would never be able to walk again. He had overcome this but over the years had put on weight and become a full-time carer for his wife. All his choices are based on the need to care for her and whether he will fall and injure himself as a result of the physical activity.

In the first session, he performed four sit to stand exercises but has since started doing 15 both morning and evening. He credits this activity and regularity of it to the slight reduction in pain he has experienced.

The client is now going on to look at [local physical activity] sessions and is attempting to inspire his wife so they can go on a weight loss journey together.

Q. Do you think clients like it and find it useful?

A. I think most people have found it very useful, if not for anything else but to voice their concerns and frustrations about the treatment they have received from the GP in the past. Talking it through allows them to move on from it. A lot of clients have enjoyed the sit-to-stand, they can get others involved and ‘compete’ with themselves.

Q. What is the biggest learning you have had from running the Joint Pain Advisor sessions?

A. No appointment is the same, sometimes you have to take a completely different approach and each person needs something different. It has been very interesting looking at different people’s approaches and attitudes to pain. Some acknowledge that other things such as bereavements have contributed to how they experience the pain.

HIN will shortly be posting applications packs for 2017’s South London Small Grants. 10-15 grants are available of up to £10,000 each. For more information on the grants, follow our Twitter and read this news announcement.

For more information about the Joint Pain Advisor service, watch our short video.