A Virtual Pain Management Programme for Osteoarthritis Patients Awaiting Surgery

Mr Balasundaram Ramesh FRCS, Consultant Orthopaedic Surgeon, Clinical Director – Trauma and Orthopaedics
Mr T R Madhusudhan FRCS (Trauma and Orth), Consultant Orthopaedic Surgeon
Mr Deepu Bhasker FRCS (Trauma and Orth), Consultant Orthopaedic Surgeon

Betsi Cadwaladr University Health Board

In partnership with: Aparito


Our Musculoskeletal service is facing unprecedented pressure following the Covid 19 pandemic. There is a huge backlog of cases waiting to be managed. The majority of them being elderly and suffering with severe arthritis. If there are no challenges to capacity and capability, the ideal solution for them is timely surgery. Unfortunately this is not possible due to obvious constraints due to the effects of the pandemic on the available resources.

Therefore it is essential to offer a good quality pain control physiotherapy service coupled with uplifting pain management psychotherapy and healthy lifestyle management programme via a digital platform.

Project Aims

The Health boards are struggling to cope with the challenges due to Covid-19. Arthritic patients who are waiting for their joint replacements are unfortunately expected to wait longer.

This approach helps to address some of their issues like – pain management, mental health issues and general fitness at this difficult time. This will certainly help manage our patients waiting for surgery.

This is proven by many papers in scientific journals that the 5 modalities of pain management such as pain medication, Physiotherapy, Yoga/Taichi, bio feedback and fitness exercise therapy have positive impact in pain and over all mobility. This endeavour helps to manage the patients waiting on this mammoth waiting list.


Although the idea is very relevant to the crisis, it was extremely difficult to get the necessary funding and of course finding the right technology partner. I am grateful to the Bevan commission for linking me with the Life Sciences Hub Wales for further assistance.

Finally our planned care delivery team has kindly agreed to incorporate the plan with their plan for a digital solution to our long Waiters.

Aparito LLP, a reputed industry partner based at Wrexham, is willing to become involved with our vision and have developed a prototype app. We are currently fine-tuning it.

Key Outcomes

Next Steps

We need to fine-tune the trial version with necessary additional interventions including videos and PROMS scoring relevant to this. There is a possibility of linking in with various support groups like Versus Arthritis, Arthritis Action, NRAS etc, to link in with our digital solution.

Our Exemplar Experience

The Bevan Commission and the team are very helpful in stimulating our thought process towards prudent ideas and concepts in bringing efficiency into the system.