ORI Wattbike challenge

Members of BU’s Orthopaedic Research Institute (ORI) have devised a cycling and education programme that can help reduce pain and the need for hip replacements for patients with hip osteoarthritis.

In an ageing society, the ability to live well and independently for longer is becoming of greater concern. Around a third of people aged over 45 years in the UK (8.75 million) have sought treatment for osteoarthritis. As the population ages, the likelihood of joints wearing out and the need for treatments or replacements increases – over 17 million people are expected to be living with osteoarthritis by 2030.

ORI is addressing this need by carrying out research to improve orthopaedic practices and patient care. One notable success has been CHAIN – Cycling against Hip Pain – a programme developed with local partners that used cycling and educational interventions as a way of treating patients with hip osteoarthritis.

The programme – which involved 119 patients and initially ran from October 2013 to April 2015 – has now received a £150,000 commission from Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust to run CHAIN for 500 patients locally.

In addition, Associate Professor Tom Wainwright of the project team has been awarded a £350,000 Research for Patient Benefit (RfPB) grant from the National Institute for Health Research, to compare an eight-week cycling exercise and educational programme (an extended version of CHAIN) to standard physio treatment. This will compare participants’ ability to complete activities of daily living, pain levels, quality of life, and psychosocial wellbeing, along with cost-effectiveness.

Cycling Against Hip Pain – a patient story

Where it all started

The aim of the CHAIN programme was to reduce pain and encourage mobility through a six-week programme of education and static cycling sessions, which would equip participants with the confidence to self-manage their condition. Professor Rob Middleton and Associate Professor Tom Wainwright, head and deputy head of ORI respectively, conceived the programme as a way of implementing NICE guidelines (education and advice, exercise and weight loss where appropriate, prior to consideration of hip surgery) for patients with hip osteoarthritis. To take the idea from concept to implementation, Professor Middleton and Associate Professor Wainwright worked with the local commissioners, Active Dorset, local hospitals and councils.

The 2013–2015 programme consisted of a different 30-minute education session each week, and a specially designed 30-minute graduated indoor stationary cycling exercise class. A home exercise programme including stretches and land-based exercise was developed with each participant who was also given an exercise diary to complete outside of the programme to monitor their home exercise activity. This acted as an additional motivational tool to encourage continued commitment.

The people who have sought treatment for osteoarthritis
The number of people who are expected to be living with osteoarthritis by 2030
CHAIN Participants who would recommend the CHAIN programme
The percentage of CHAIN participants who reported improvements in walking

Making a difference

Participants were assessed for function, pain and quality of life before and after the programme. The results have been excellent, with 86% of patients reporting improvements in walking and completing daily activities and 100% saying they would recommend the programme. Participants reported reduced pain, better sleep patterns, being able to walk further, and a reduction in painkiller usage, all of which has led to a more active lifestyle.

One participant commented: “The programme made me realise that exercise was the best way to improve my pain and the use of my leg.  It has made such a difference to me. I can now turn over in bed at night without having pain.  I am determined to keep up with the exercise.”

Another stated: “I had been experiencing hip pain for four years and been advised I was looking at a total hip replacement…. I have been very impressed and delighted with the results so far; most days experiencing significantly reduced hip pain.

Alongside positive participant feedback, the CHAIN programme has received national recognition. A case study on one participant was published in BMJ Case Reports 2015, and CHAIN was a finalist in the UK Active and Matrix Flame Awards 2014, in the Health Partnership of the Year category. The awards – highly coveted in the health and fitness sector – recognise suppliers, operators, educational institutes, health practitioners and corporate organisations who have demonstrated exceptional standards across their area of work.

Associate Professor Tom Wainwright explains how participants can get involved with the CHAIN project

Research areas

Between them, Professor Middleton, a consultant orthopaedic surgeon and Associate Professor Wainwright, a physiotherapist, have a wealth of clinical and research expertise, and are both nationally and internationally recognised for their work. “We take a very interdisciplinary approach to our research,” says Associate Professor Wainwright.

“Establishing ourselves within BU is a real advantage for us, as we can draw on the expertise of colleagues in other areas of research, including other health professionals, psychologists, technologists and engineers. Ultimately our driving force is that we want to ensure that everyone gets the best possible treatment for their condition – it’s just the right thing to do,” he explains.

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