Breaking News!

 

RehabOne Medical Group Salinasis proud to announce the opening of our Functional Restoration Programs, in our Salinas office.  Our expanded services will include medically-supervised programs to assist pain patients in achieving optimized function in their lives.  Starting March 1st, we will be accepting new referrals and look forward to working with your patients/clients.  If you would like to make a referral, please fax patient/client demographics and insurance information to (408) 445-0875.

 

Functional Restoration Programs (FRPs), also referred to as chronic pain management programs, chronic pain treatment programs, and comprehensive pain programs, have existed for quite some time. The earliest programs were only available at medical centers and required lengthy hospital admissions.  Changes in medicine over the past several decades have shifted the trend in providing this type of treatment to privately administered outpatient programs. Functional restoration became popular in the 1990s when health care providers and payers, frustrated with costly and ineffective treatment, began seeking alternative approaches to managing chronic pain.

The conceptual framework of functional restoration programs involves an interdisciplinary team approach to delivering care. While there is no consensus about who comprises the team, it generally includes licensed healthcare professionals such as physicians, physician assistants, chiropractors, physical therapists, physical therapy assistants, occupational therapists, nurses, psychologists, marriage family therapists, and/or social workers. Other team members may include ancillary healthcare providers such as kinesiologists, fitness trainers, vocational counselors, acupuncturists, and/or nutritionists, in addition to administrative support personnel.

The fundamental goal of functional restoration is to optimize or (in the most ideal, but unfortunately rare circumstances) completely restore function after an illness or injury that has left someone with residual impairment and limitations. In order to achieve this goal, functional restoration programs rely on a paradigm shift from the biomedical model of care (e.g. to identify the cause of symptoms à treat the cause à cure the symptoms) to a biopsychosocial model, which relies on an integrated, rehabilitative approach to long-term management of an illness or injury.

This biopsychosocial model has been widely used for many decades in the treatment of spinal cord injury, head injury, stroke, multiple sclerosis, polio, and various neuromuscular injuries and disorders. In these instances, cure is not yet possible and the emphasis is on maximizing function. Functional restoration programs rely on the same principles and apply it to chronic pain conditions that have not responded and/or are not likely to respond to standard medical treatment.

A comprehensive evaluation is the initial step. The purpose of the evaluation is to not only obtain baseline functional data, but also to determine factors favoring a good outcome as well as obvious or potential barriers to treatment. The evaluation also introduces the patient and their family to the team. Developing trust and rapport is part of the evaluation process since they too will become an integral part of the team once they are accepted into the program.  A critical part of the evaluation includes identifying functional goals that are important and meaningful to the patient and that can realistically be achieved within specified timeframes. Equally important is identifying patients that are not medically or emotionally stable or ready to participate in this type of treatment.

Functional restoration programs generally involve the patient participating in physical activities directed on improving strength, endurance and cognitive-behavioral therapy to assist them toward acceptance and to help reframe their thoughts and actions to healthier living. Additional treatment may include nutritional guidance, relaxation classes, vocational counseling and return to work planning, yoga and/or tai chi.  The interdisciplinary team typically meets weekly and as needed to review the patient’s progress, barriers to treatment, and strategies to assist them in overcoming those hurdles. Some functional restoration programs have aftercare or transitional programs to help patients maintain gains and/or minimize the risk of relapse after program completion.

At present, there are no universally agreed upon short-term or long-term outcome measures for functional restoration programs. However, there is evidence-based scientific data documenting the benefits and cost-effectiveness of these programs for the treatment of chronic pain. The key to achieving a successful and sustainable outcome relies heavily on empowering the patient to regain control and responsibility over their health and well-being, while at the same time minimizing their reliance on healthcare professionals, which ultimately translates into reduced utilization of healthcare resources.

Contributor:

Michael Post, M.D.

Chief Medical Officer RehabOne Medical Group

Diplomate, American Board of Physical Medicine & Rehabilitation

Subspecialty Board Certification in Pain Medicine

Diplomate, American Board of Pain Medicine

Qualified Medical Evaluator

References:

Gatchel, R.J. & Okifuji. Evidence-based Scientific Data Documenting the Treatment and Cost-Effectiveness of Comprehensive Pain Programs for Chronic Nonmalignant Pain. The Journal of Pain, Volume 7, No 11, 2006: pp 779-793.

Gatchel, R.J. & Mayer, T.G. Evidence-informed management of chronic low back pain with functional restoration. The Spine Journal, Volume 8, 2008: pp 65-69.

California Division of Worker’s Compensation, Medical Treatment Utilization Schedule. Chronic Pain Treatment Guidelines, 2009, pp 30-32, 49.

American College of Occupational and Environmental Medicine, Occupational Medicine Practice Guidelines, Second Edition, 2004. pp 113-114.

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