Enabling Self-management and Coping
with Arthritic Pain using Exercise


ESCAPE-pain stands for Enabling Self-management and Coping with Arthritic Pain using Exercise.

ESCAPE-pain is an evidence-based, cost effective, group rehabilitation programme for people with chronic joint pain, that integrates educational self-management and coping strategies with an exercise regimen individualised for each participant. The programme was developed by Professor Mike Hurley and was originally devised for people with knee osteoarthritis.


ESCAPE-pain offers two programmes:

  • ESCAPE-pain for knees and hips: designed to benefit people with chronic knee or hip pain, otherwise known as osteoarthritis.
  • ESCAPE-pain for backs: designed to benefit people with chronic low back pain.


ESCAPE-pain for backs

ESCAPE-pain for backs implements the NICE clinical guidelines for the management of low back pain [NG59]. The programme was piloted in 2019 to assess whether the model and principles behind the original ESCAPE-pain programme, for knees and hips, are effective in the self-management of non-specific low back pain. The evaluation of the 2019 pilot showed that ESCAPE-pain for backs delivers effective care, managed in line with NICE guidelines, that significantly improves participant outcomes.


ESCAPE-pain for knees and hips

ESCAPE-pain for knees and hips implements the NICE clinical guidelines for the management of osteoarthritis [CG177]. Rigorous evaluation and independent review shows that the ESCAPE-pain programme for knees and hip is:

  • safe and produces better clinical outcomes [Hurley et al 2007a, Hurley et al 2012]
    • reduces pain;
    • improves physical function, general well-being and quality of life;
    • reduces depression.
  • has lower healthcare utilisation and cost savings
    • compared with usual outpatient physiotherapy;
    • lower overall healthcare costs through reduced use of A&E services, medical consultations, referrals, investigations (i.e. X-rays and MRI scans);
    • reduced use of analgesia and gastro-protective agents, side effects of medication.
  • is more cost-effective than usual care [Hurley et al 2007b, Hurley et al 2009]
  • may help delay or avoid surgery
  • promotes physical activity, reducing the risk of acquiring or exacerbating comorbidities such as diabetes and cardiovascular conditions
  • patients describe how first-hand, positive experience of the programme [Hurley et al 2010]
    • alters beliefs about the importance of exercise in managing their knee pain;
    • allays fears that exercise might exacerbate joint pain and damage;
    • helps them appreciate the benefits of exercise;
    • become more confident in their ability to use exercise as a self-management strategy;
    • are less reliant on other people.
  • clinicians adopt it as the intervention of choice for chronic joint pain [Hurley et al 2009]


Research papers


Clinical Outcomes (Hurley et al 2007a)


Long Term Outcomes (Hurley et al 2012)




Patients Perspectives (Hurley et al 2010)



Economic Evaluation (Hurley et al 2007b)



Exercise - Psychological Benefits (Hurley et al 2002)


Hip Feasbility Trial (Hurley et al 2011)


Long Term Benefits (Jessep et al 2009)



Page last reviewed: 11 February 2022. Page last updated: 11 February 2022. Next review date: April 2022