From clinical trial to community centre: getting proven rehabilitation into NHS practice

Rehabilitation programmes for conditions like rheumatoid arthritis, spinal stenosis, and shoulder problems after breast cancer can transform patients' lives – but only if people can access them. Clinical trials consistently demonstrate what works. The problem lies in what happens next. Proven interventions routinely take years to reach routine NHS care, leaving patients waiting for treatments that already exist.

Three programmes illustrate the gap. SARAH – a hand exercise programme for rheumatoid arthritis – was shown to be clinically and cost-effective in a large trial and recommended by NICE. PROSPER helps prevent shoulder problems after breast cancer surgery. BOOST supports people with spinal stenosis. All three had strong evidence behind them. But evidence alone does not change practice. The specialist training needed to deliver these programmes was a bottleneck, and for patients, access still depended on getting to a hospital clinic.

Our approach and partners

ARC OxTV researchers set out to build a pipeline that could move interventions from completed trial to routine NHS care faster. The approach had three strands: train clinicians online, give patients direct access to programmes digitally, and test whether community settings could replace hospital clinics.

Working with the National Rheumatoid Arthritis Society, the British Association of Hand Therapists, the British Society of Rheumatology, and the University of Exeter (PenARC), the team developed free online training courses for each programme. For SARAH, they went further – creating a patient-facing online course co-designed with patients, so people with rheumatoid arthritis could follow the exercise programme at home with minimal therapist support. They also partnered with community organisations – Headington Gurdwara, African Families in the UK, and Active Leeds – to pilot rehabilitation delivery in community settings, specifically targeting underserved populations.

What we found – and why it matters

1. Online training works as well as face-to-face. In the BOOST implementation study involving 105 patients, physiotherapists trained via the online course achieved clinical outcomes equivalent to those trained in person. Across all three programmes, clinicians reported high satisfaction with the training.
2. Patients can follow structured programmes online. Of 65 patients given access to the SARAH patient course, 70% successfully completed the programme. This reduced the number of hand therapy sessions required from six to two – without compromising clinical outcomes.
3. Community-based delivery is feasible and acceptable. Piloting the BOOST programme with exercise instructors rather than hospital physiotherapists produced similar clinical outcomes and high patient satisfaction. A further pilot delivering group rehabilitation for back pain at the Oxford Gurdwara and through a women's group run by African Families in the UK showed this model can reach people who might not attend hospital clinics.
4. Implementation barriers vary by programme. The PROSPER programme faced specific barriers to adoption that the SARAH and BOOST courses did not, highlighting that each intervention needs its own implementation strategy.

The SARAH and BOOST online training courses are freely available through the University of Exeter, and the British Association of Hand Therapists and British Society of Rheumatology are actively promoting SARAH to encourage wider clinical uptake. For iSARAH – the clinician training platform – 99% of trained therapists reported confidence in delivering the programme, and 85% of their patients experienced lasting improvements in hand function.

What this means

These results point toward a more sustainable model for NHS rehabilitation. Online clinician training removes a major bottleneck in getting evidence-based programmes into practice. Patient-facing digital courses can reduce appointment pressure – in SARAH's case, cutting required sessions by two-thirds – freeing capacity in overstretched therapy departments. And shifting delivery into community settings brings rehabilitation closer to where people live, particularly for communities that face barriers to accessing hospital-based care.

Not every patient will choose the digital route. Some prefer face-to-face appointments, and digital exclusion remains a real concern. Effective implementation means offering choices, not replacing one model with another.

What needs to happen next

The team will continue monitoring the real-world impact of the online courses as adoption spreads. For PROSPER, where implementation barriers were most significant, an NIHR Programme Grant Development award (commencing December 2025) is funding the University of Exeter to develop a patient-facing version of the programme – applying the lessons learned from SARAH. The community-based delivery models need to be expanded and formally evaluated, and findings from the current pilots will inform a funding application to take this work forward at scale.