The CHAIN programme
The CHAIN (Cycling against Hip Pain) programme is an exercise and education treatment pathway for people with hip osteoarthritis and other forms of hip pain.
It was conceived by Professor Robert Middleton and Professor Thomas Wainwright of the Orthopaedic Research Institute at Bournemouth University, with the aim of promoting the self-management of osteoarthritic symptoms through lifestyle change. The programme is based on the latest National Institute for Health and Care Excellence (NICE) guidelines for the treatment of osteoarthritis, which recommend exercise (local muscle strengthening and aerobic training), education and weight loss where necessary.
The programme was first launched in 2013. Patients presenting with hip osteoarthritis or other forms of hip pain at a primary care service were referred by their GP. Ninety-six participants completed the course, and demonstrated improvements to pain, function and quality of life. In addition, participants reported an increase in knowledge, confidence, and motivation to exercise. The success of the programme and the partnership with BH Live was recognised by UK Active in 2014, when the CHAIN programme was a finalist in the national Healthy Partnership Award. CHAIN was also highlighted by SAGA in a publication looking at the best exercise for arthritis.
Following completion of the initial programme, the local NHS trust (The Royal Bournemouth and Christchurch Hospitals NHS Trust) commissioned the programme to take referrals from secondary care to the CHAIN programme, which ran between February 2018 and September 2019. 167 participants completed the course, and demonstrated improvements similar to the original cohort in terms of pain, function, quality of life and motivation to exercise. A five year follow up of the original programme found that the majority of participants were still using self-management strategies to manage their hip pain, and 57% had not pursued surgical intervention.
In 2019, the CHAIN programme featured in the Made at Uni campaign which aimed to highlight the work Universities are doing to improve everyday life. In addition, it featured as a case study in the FAB NHS campaign, which highlights treatment pathways that have impacted patient experience.
In February 2020, ORI launched the CLEAT trial, a randomised controlled trial to compare the CHAIN programme with usual physiotherapy care in the treatment of hip osteoarthritis. The trial, being delivered in collaboration with University Hospitals Dorset, aims to recruit 256 participants who will be randomised to receive one of two interventions. Participants randomised to receive CHAIN will attend a local leisure centre for one hour a week over eight weeks. In each session, they will receive 30 minutes of education from a physiotherapist on how to manage their arthritis, and a 30 minute cycling session, led by an exercise specialist. Participants randomised to the Physiotherapy group will receive usual care physiotherapy at their local hospital.
The CLEAT trial has now finished, and the study results will soon be published. For more information about the CLEAT trial please visit the study website. A virtual CHAIN course is now available on our ORI Education app – more details can be found here.
A short YouTube video outlining the CHAIN programme –
