Psychosocial factors play a deeper role in injury rehabilitation than originally suspected, and innovative therapies are seeing surprising success.
Research suggests that pain accounts for only 10 percent of a disability, whereas psychosocial factors can explain as much as 30 percent variance in the magnitude of a disability experience. Historically, treatment for chronic pain-related conditions included opioid prescriptions, multi-disciplinary programs or cognitive-behavioral pain management tactics.
However, it wasn’t until recently that psychosocial intervention began to gain new ground, thanks in large part to the research and methods developed by Dr. Michael Sullivan of the University Centre for Research on Pain and Disability.
Sullivan has spent the last 20 years investigating how to introduce an intervention program targeting psychosocial barriers in the rehabilitation process. The program that emerged was the Progressive Goal Attainment Program, or PGAP™.
Now new studies have illuminated the positive impact PGAP can have on clinical outcomes when combined with physical therapy.
Why has this new intervention model seen more success than previous efforts?
1. Early intervention
Research has shown that the probability of return-to-work outcomes decreases the longer an injured individual is out of commission. Similarly, recently injured individuals have a faster recovery time than those who have a chronic work disability.
In the past, patients with complex psychosocial risk were often identified only after their condition had become chronic and treatment-resistant. At this stage, the multidisciplinary interventions, in combination with repeated treatment failures, tended to produce only modest improvements – if any.
Injured workers who require physical rehabilitation typically visit their physical therapist 1 – 2 times a week for a period of weeks. These professionals are ideally positioned to assist in the early identification of psychosocial risk factors for faster intervention.
2. Integrated treatment
Traditional cognitive behavioral therapy is handled by psychologists or those with a mental health background. This has been limiting in two ways: (1) it has restrained access to psychosocial resources and (2) it has often resulted in a fragmented physiological and psychological treatment program.
PGAP—when used in conjunction with physical therapy—creates a more integrated and more efficient treatment strategy that addresses both the physiological and psychosocial barriers to recovery at the same time.
3. Activity-based therapy
Unlike traditional pain management treatments, PGAP focuses on behavior versus cognition, yielding a much more active treatment process. The first few weeks of the program are intended to establish a strong working relationship with the PGAP consultant through disclosure and validation techniques, but the focus then moves to developing a structured activity schedule. When combined with physical therapy the program focus and activity schedules encourage safe reintroduction into the workforce.
4. A focus on return to work
Unlike other rehabilitation interventions, PGAP’s main objective is not symptom reduction, but reduction of disability. Research shows that symptom reduction is not a precondition for successful return to work. In fact, an overt focus on symptom reduction may reinforce the patient’s belief that symptoms must be eliminated before work activities can resume.
In one study, the addition of PGAP to a functional restoration physical therapy program increased return-to-work rates by more than 50%, and in a sample of 70 individuals with chronic disability caused by cervical sprain injury, 75% of clients were able to resume work following PGAP completion.
MedRisk’s solution for delayed recovery cases incorporates these proven treatment strategies, combining evidence based treatment guidelines, early identification of psychosocial barriers, PGAP and physical therapy to deliver a more direct road to rehabilitation, and an improved quality of life for your workforce.
Bibliography
Sullivan,M. J. L., Adams, H., Rhodenizer, T., & Stanish,W. D. (2006). A psychosocial risk factor-targeted intervention for the prevention of chronic pain and disability following whiplash injury. Physical Therapy, 86(1), 8–18.
Sullivan, M. J. L., & Adams, H. (2010). Psychosocial treatment techniques to augment the impact of physiotherapy interventions for low back pain. Physiotherapy Canada, 62(3), 180–189.
Sullivan, M. J. L., Adams, H., & Ellis, T. (2013). A psychosocial risk-targeted intervention to reduce work disability: Development, evolution, and implementation changes. Psychological Injury and Law, 6, 250–257.
University Centre for Research on Pain and Disability (2013). A Community-Based Intervention for the Prevention of Pain-Related Disability [PowerPoint slides]. Retrieved from http://indep.ca/wp-content/uploads/2013/11/PGAP1.Presentation.pdf.
