Does the ESCAPE-Pain Programme for Patients with Knee Osteoarthritis Work in Malaysia? A Mixed-Methods Study Evaluating Feasibility in the Malaysian Healthcare Context

  • Muhammad Kamil Che Hasan

Student thesis: Phd


Background: In Malaysia, it is estimated that around one in ten older people are diagnosed with osteoarthritis (OA) and the most common form is knee OA. This can lead to functional limitations, impaired activities of daily living and reduced quality of life. A systematic style review of the literature concluded that a programme integrating exercise, education and active coping strategies called Enabling Self-management and Coping with Arthritic Pain using Exercise (ESCAPE-pain) provided the best evidence for implementation in Malaysia. Aims: Evaluating an evidence-based programme in this study used a sequential exploratory mixed-methods research approach. A qualitative study aimed to explore the views and perspectives of healthcare professionals and patients with knee OA in the ESCAPE-pain programme before adapting the programme into the Malaysian context. A quantitative study aimed to investigate the feasibility and acceptability of the adapted ESCAPE-pain programme among patients with knee OA in Malaysia. Methods: The qualitative study was conducted first, using semi-structured interviews with the healthcare professionals and patients with knee OA; it was analysed using framework analysis to inform the adaptation process. The feasibility randomised controlled trial was conducted by recruiting patients from two hospitals. The study compared intervention and control patients with knee OA in terms of retention rate, physical tests, self-report questionnaires and a satisfaction survey. Repeated measures ANOVA was conducted to the data at three points: baseline, six weeks, and after twelve weeks of intervention. Findings and discussion: Findings from the qualitative study of 32 healthcare professionals and patients with knee OA yield positive views, allowing an adaptation of the ESCAPE-pain programme including the resources materials and the implementation, to suit the context. The quantitative study recruited a total of 72 patients. The recruitment rate was 90.5% and the retention rate at 12 weeks was 87.5%. Attendance at the intervention programme (≥10 of 12 sessions) was high (82.4%). Participants in the intervention group reported better outcomes for health beliefs (95%CI: 3.01, 8.96; P=0.004), mental wellbeing (95%CI: 4.36, 0.28; P=0.004), and fear of falling (95%CI: 1.21, 4.67; P=0.042) after 12 weeks compared to the control group. There were no significant changes (p>0.05) between the groups in self-reported symptoms, pain, activity of daily living, recreation or quality of life. The satisfaction survey revealed that the ESCAPE-pain programme is easy to follow, straightforward and tolerable for future implementation. No adverse events were reported. Conclusion: The findings of this study indicate that the ESCAPE-pain programme appears to be acceptable to the healthcare professionals and patients with knee OA. It may be feasible and potentially effective to deliver the adapted programme to support patients with knee OA in maintaining their activities of daily living, including decreasing symptoms and reducing the fear of falling. A further definitive trial is needed to evaluate long-term outcomes in the population and cost-effectiveness before it is integrated within the Malaysian healthcare system.
Date of Award1 Aug 2019
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorChristopher Todd (Supervisor) & Emma Stanmore (Supervisor)

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