London Borough of Sutton: ‘MSK Hubs’ rehabilitation delivered at community leisure centres

The ‘MSK Hubs’ programme is a UK-wide mobilisation of the leisure sector to deliver inclusive, accessible and personalised health services for older adults with musculoskeletal (MSK) conditions.

It aims to improve outcomes for patients, reduce waiting times, and provide a seamless pathway for patients to continue exercising when they complete the programme. At the start of 2023 there were 15 MSK hubs up and running, and this was expected to increase to 100 by the end of the year.

Early in 2022, two leisure centres in the London Borough of Sutton began delivering therapeutic exercise programmes as part of the MSK Hubs programme.  

During the COVID-19 pandemic, the Sutton physiotherapy outpatients’ gym was closed – so group exercise sessions were no longer being delivered. These sessions were an important element of condition management, helping to support patients to transition away from physiotherapist-led services to therapeutic exercise in peer groups.

In order to fill that gap and, post-pandemic, cut waiting times and provide a new option for clinicians to refer patients into, a programme to utilise existing community spaces was developed in collaboration between NHS physiotherapy services in Sutton, Sutton Council, Everyone Active (which operates the leisure centres) and Good Boost. It included the creation of a therapeutic exercise programme delivered in Sutton Council’s leisure centres, utilising the swimming pools and fitness studios.

Social enterprise Good Boost provided the digital therapeutic exercise programme which supports group classes, with artificial intelligence technology providing personalised programmes. This enables mixed-condition and mixed-ability group classes to be delivered by a physiotherapy assistant or a member of the leisure team.

The physiotherapy service created a new referral pathway for patients to access four free sessions of the MSK programme, in the water or on land. New participants register on the Good Boost tablets at the venue. They are guided through their individually tailored exercise programme and to capture key outcome measurement data. Following the free sessions, participants can continue into affordable ‘pay as you go’ sessions or monthly membership.

Since its launch, hundreds of Sutton residents have accessed the MSK Hubs programme, with many progressing to self-funded activities in the leisure centre. Sutton’s physiotherapy outpatient department has reported low re-admission of patients after participation in the programme. During the first nine months of active delivery:

• 156 patients took part in 992 sessions
• participants completed 6.3 sessions on average
• the average age was 59
• the female to male ratio was 80/20
• the proportion of participants from minority ethnic backgrounds was 35.5%.

Analysis of the data revealed that a high proportion of participants were at increased risk of health inequalities, with 34.8% in the lowest two income quintiles. Prior to taking part, two-thirds of the participants had experienced their MSK problem for more than three months. Just over 63% reported an improvement in their symptoms.  

Key benefits of the Sutton programme included:

• non-swimmers gained the confidence to take part in pool classes
• some participants were inspired to take up swimming lessons
• participants were keen to continue with the sessions as part of their own self-management
• people felt more confident to go to leisure centres by themselves
• participants feel better supported for longer, helping with the transition away from physio-led rehab
• the programme brought some people into the leisure centre for the first time.

One participant said: “I find the exercises are easier to achieve in the water than on land, and if I have difficulty with any of the exercises there is always an alternative suggestion. The program is easy to follow and can be done at your own pace.”

Another said: “My pain levels are decreasing and I am increasing mobility and strength. This has made me feel better and my mood has improved.”

The Sutton programme is to be expanded to two further leisure centres, which will increase the number of group classes each week and create a borough-wide service for local residents.

Lessons learned

• Good relationships between the council, NHS and leisure providers, with regular meetings, is essential to the ongoing good practice in delivery.
• Aquatic programmes have been highly valued by participants who find land exercise challenging due to mobility and pain.
• The ‘familiar face’ of physiotherapy staff is an important element, helping to build trust and removing barriers to the first visit

Contact

Andrew Clark, Head of Service – Promoting Independence, London Borough of Sutton: [email protected]