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An Evidence-Based Treatment Program for Reducing Disability Associated with Pain, Depression, Cancer and other Chronic Health Conditions.
Each year, hundreds of thousands of people become disabled due to injury or illness. Whether addressed in relation to personal, social or health care costs, chronic disability remains one of the most expensive health problems facing modern society. PGAP™ was designed to prevent or reduce the severity of disability that can arise following injury or illness.
Reducing Psychosocial Barriers to Rehabilitation Progress
The primary goals of PGAP™ are to reduce psychosocial barriers to rehabilitation progress, promote re-integration into life-role activities, increase quality of life, and facilitate return-to-work. These goals are achieved through targeted treatment of psychosocial risk factors, structured activity scheduling, graded-activity involvement, goal-setting, problem-solving, and motivational enhancement.
The Process of Treatment
In the initial weeks of the Program, the focus is on developing a structured activity schedule to assist the client in resuming activities that have been adversely impacted by injury or illness. Activity goals are established in order to promote resumption of family, social and occupational roles. Intervention techniques are invoked to target specific obstacles to rehabilitation progress (e.g. fear of symptom exacerbation, catastrophic thinking, perceived injustice and disability beliefs). In the final stages of the Program, the intervention focuses on activities that will facilitate re-integration into the workplace.
What is Unique about PGAP™
The Progressive Goal Attainment Program (PGAP™) is the first disability prevention program specifically designed to target psychosocial risk factors for disability. Psychosocial factors were chosen as targets of the intervention on the basis of emerging research supporting their relevance to return-to-work outcomes and their amenability to change through intervention. PGAP™ is a life-role re-integration Program that has been tailored to meet the rehabilitation needs of individuals who are struggling to overcome the challenges associated with a wide range of debilitating health and mental health conditions. PGAP™ is a standardized community-based intervention delivered by rehabilitation professionals such as occupational therapists, physical therapists, kinesiologists, nurses, rehabilitation counselors and psychologists. PGAP™ was designed to complement existing clinical services for the treatment of debilitating health and mental health conditions.
By adding a psychosocial risk-factor targeted intervention to existing treatment services, the goal is to establish ‘virtual’ multidisciplinary treatment teams at the level of the community. The website www.PDP-PGAP.com provides contact information for providers who have completed the two-day PGAP™ training workshop. The development of a large network of service providers ensures that clients can be seen in a timely fashion and in a location within or near their community of residence.
Essential Features of PGAP™
An initial screening determines whether a client is a suitable candidate for PGAP™. During the first session of PGAP™, clients are invited to view one of 4 PGAP™ Information Videos. Different videos have been developed to address factors specific to different disabling conditions. The videos feature interviews with medical and rehabilitation experts on the factors that contribute to successful rehabilitation and recovery. The information content addresses the nature of various chronic health and mental health conditions, the importance of activity involvement and return to work, and briefly describes the goals of PGAP™. The videos were conceived as vehicles for providing important medical/rehabilitation/reassurance information that is often difficult to communicate effectively within the time constraints of typical physician visits. Clients are also provided with a copy of the PGAP™ Client Workbook. The Client Workbook serves as the platform for the implementation of many of the intervention components of the Program and also serves to maximize fidelity to treatment protocol. The client and PGAP™ provider meet on a weekly basis, for approximately one hour, for a maximum of 10 weeks.
Treatment costs can be kept at a minimum as a result of the low number of direct clinical contact hours. The Program can be terminated prior to 10 weeks if the client is ready to return to work.
Impact of PGAP™
PGAP™ has produced positive results for individuals suffering from musculoskeletal conditions, depression, cancer and other debilitating health conditions. Recent clinical trials have supported the use of PGAP™ as a cost effective intervention for reducing disability associated with persistent pain. One recent study showed that participation in PGAP™ increased the probability of return to work following whiplash injury by more than 50% (Physical Therapy, 86, Jan 2006). Ongoing clinical trials are assessing the efficacy of PGAP™ for the management of disability associated with depression, cancer survivorship, and other chronic health conditions. Findings to date, suggest that PGAP™ can be a cost-effective means of improving function and facilitating return to work in individuals at risk for prolonged disability. (Journal of Occupational Rehabilitation, 15, No.4, Dec 2005; Journal of Occupational Rehabilitation, 17, 305-315, 2007; Work and Cancer Survivors, Springer, 2009).