Work Hardening/Pain Management Program
(Item Number: 300095)
Ten Day Intensive Program for Back, Neck, Shoulder
or Complex Joint or Limb Pain.
Program Aim
The program aims to assist patients to develop coping strategies to manage / minimise their pain, as well as improving their general fitness, functional capacity and ability to work.
Indications for Referral
Patients with back or neck pain, shoulder or complex joint or limb pain are managed in this program. The degree of the individual’s symptoms is not necessarily a contraindication for admission.
Patients are accepted into the Program following referral from their Specialist, General Practitioner, or Case Manager.
The patients should be fully investigated and diagnosed prior to admission.
Potential Participants (Patients with back and neck pain)
Patients with back and neck pain who:
- have specific conditions such as discogenic pain, spondylolithesis and musculoligamentous conditions and may be pre and post-spinal surgery
- have been off work or symptomatic for longer than six to eight weeks
- are distressed by their pain or anxious regarding their ability to return to work
- have had recurrent episodes of back pain
- have pain not adequately controlled through medication
- have significant psychosocial problems
Patients with shoulder pain/complex joint/limb pain who:
- have not responded to conservative treatment (i.e physiotherapy, rest, injections)
- have residual pain and restriction of movement several months post surgery
- have identified psychosocial problems and/or are highly anxious about work.
Contraindications for Referral
Malignant tumours, infection, cardiac problems, unstable fractures, acute psychiatric conditions, and those strongly focussed on litigation.
Focus of Program
The emphasis is on education, self-responsibility and self-management to:
- facilitate an early and sustained return to full-time work or other activities
- develop an understanding of their medical condition
- improve general fitness and functional capacity
- develop coping strategies to manage stress and pain
- improve quality of life
- prevent development of chronic pain.
Program Content
The structured ten day program utilises an interdisciplinary approach which includes:
Pre-Program screening
- Assessment and Review
- Physiotherapy
- Occupational Therapy
- Psychology
- General Health Education
- Health Monitoring
- Work Site Assessment and Follow-up (as required)
- Follow-up at three and six months post-discharge
Pre-Program Screening
Once referred, patients undergo a pre-admission assessment. This can be carried out in our Brisbane office or by telephone.
Patients who are referred who have complex psychosocial issues or language difficulties may require a more comprehensive pre-program suitability screening.
Assessment and Review
Team members are responsible for assessing, monitoring and reporting on the patients’ progress according to their field of expertise.
Team members conduct individual assessments on admission and discharge, including functional capacity evaluation, physical assessment and comprehensive psychological testing.
A weekly medical review is conducted with team members and patients, to discuss progress and any change in management, if indicated.
Rehabilitation Case Managers and Workplace Rehabilitation Co-ordinators are welcome to attend the weekly review if they have a patient undergoing the program.
A Progress Report is forwarded to WorkCover/relevant insurer on completion of Week One of the program.
Physiotherapy
There is no passive (hands on) treatment.
Education about diagnosis and likely prognosis is based on information received from the individual's referring Medical Practitioner.
The exercise program consists of walking circuit, floor exercises, gym sessions, cycling, and hydrotherapy.
Other areas covered include the use of correct posture and body mechanics and pacing of activities. Patients are educated regarding alternatives for pain relief that are non-invasive, non-addictive, free or inexpensive and without side effects.
Patients with shoulder or other complex joint or limb pain are reviewed by a specialist physiotherapist during the program. Specific exercises and stretching program will be recommended as indicated with the emphasis being on self-management.
Occupational Therapy
Assessment
Assessment of functional capacity is carried out on admission and discharge.
Various standardised assessments may be utilised depending on the individual patient's condition.
Oswestry Low Back Pain Disability Questionnaire is given on admission and discharge and the resultant scores show how the individual perceives their level of disability.
This questionnaire measures an individual’s self-rated ability.
Education
Posture - in work / home environment
Activities of daily living (work simplification techniques)
Basic ergonomic principles
Correct manual handling techniques
Therapy
Manual handling practice
Reinforcement of correct techniques
Formulation of Suitable Duties Program, if indicated.
Psychology
Assessment
Patients are assessed individually by clinical interview and results from several psychological tests.
Treatment
Patients are treated using a cognitive-behavioural approach, mainly in group sessions, although individual counselling is provided as required. Family members / partners are also invited to attend specific group sessions.
The following topics are covered during group sessions:
Education about pain
Instruction in relaxation and distraction techniques
Goal setting
Problem solving
Management of anxiety, anger and depression
Exercise Physiology
The treatment is exercise based. Whilst patients are working in a group, their program is tailored to their individual needs/injury type and the physical requirements of their job and leisure activities.
The exercise sessions consist of various walking circuits, floor exercises, fit ball exercises, gym sessions, cardiovascular sessions and hydrotherapy. Patients are provided with information in how to utilise correct posture and technique at all times to minimise pain and discomfort whilst still exercising.
Patients are then guided as to how to design their own exercise program to encourage continued exercise post-program, with the emphasis being on self management. Local gym and pool membership can be organised (via their insurance provider) after the program as required.
General Health Education
Healthy lifestyle education is provided in the form of lectures and video presentations.
Topics include:
Substance abuse / pain medication
Insomnia
Healthy diet / nutrition advice
Our Registered Nurse will monitor the patients’ general health throughout the course of the program and will advise patients, in consultation with the treating doctor, on how to reduce their pain medication intake (as required).
Work Site Assessment and Follow-up
Gregory Terrace Rehabilitation aims to achieve a successful and sustained return to work outcome wherever possible.
Services offered (as required) include:
Job analysis
Identification of suitable modified/alternative duties
Formulation of Suitable Duties Program
Suitable Duties Program monitoring.
Half-day review by rehabilitation therapists is available for patients with identified problems after discharge
Follow-up at three and six months post-discharge
All patients who attend Gregory Terrace Rehabilitation are followed up after discharge. Questionnaires are sent out at three and six months post-discharge and this information is used to evaluate program outcomes.
Admission Process
To ensure prompt admission, please telephone ,fax ,email (as below) or complete the attached referral form.
Gregory Terrace Rehabilitation
PH: 07 3831 5538
FAX: 07 3831 5527
Email: info@gregorytcerehab.com.au
Please provide a written referral and any relevant medical reports should accompany the referral.
Discharge Process
All patients are referred back to their treating medical practitioners on completion of the program.
A Discharge Report, with outcomes and recommendations for future management, is forwarded to the Referrer, Treating Specialist, General Practitioner and Insurer.
Back/Neck Education
This is a one day program for well-motivated patients who require guidance in relation to the management of their back pain, but do not necessarily require ongoing management.
The patient attends for one day and has individual sessions with an Occupational Therapist , Physiotherapist and an Exercise Physiologist.
A clear diagnosis is explained and likely prognosis is given, as provided by the individual's treating doctor.
Education in relation to utilising correct manual handling techniques and posture is provided. Work simplification techniques are discussed in relation to work and activities of daily living.
The patient would take part in exercise sessions including gym, hydrotherapy, walking and stretching and strengthening exercises.
An ongoing exercise program that is convenient, affordable and enjoyable would then be designed for the individual. Patients are encouraged to maintain contact with Gregory Terrace Rehabilitation and discuss any problems that may arise.
Follow-Up
Follow-up and upgrading of exercise program can be conducted, if required.
Referral Process
Treating Doctor, Rehabilitation Case Manager or Workplace Rehabilitation Co-ordinator to contact Gregory Terrace Rehabilitation by telephone to arrange an appointment.
Patient must have had a consultation with his/her doctor prior to attending Gregory Terrace Rehabilitation for treatment. Patient to present at GTR with written referral and any relevant medical information, including diagnosis, if this has not already been forwarded by the referrer.
Physical Conditioning Program
(Item NO: 300186 and 300187)
This mobile service is conducted by an Exercise Physiologist. It includes an initial consultation involving assessment and set-up of a physical conditioning program for an individual patient. Local gym, pool or other exercise facilities would be utilised in the program.
Subsequent consultations are then carried out in one-on -one sessions to supervise. Review and/or upgrade the exercise program is carried out at regular intervals.
