Millions of people suffer from persistent pain due to injury or illness. Whether addressed in relation to personal, societal or health care costs, persistent pain remains one of the most expensive health problems internationally. Although many people with pain conditions will show complete or partial recovery, many will become permanently disabled. PGAP is a treatment Program for minimising Pain-Related Disability
Activity as the Key to Rehabilitation Success
Pain contributes to activity avoidance. For individuals with persistent pain, activity avoidance can lead to deconditioning, lower tolerance for physical activity, increased disability and ultimately, reduced quality of life. Recent research has supported the view that return to activity is critical to the success of rehabilitation for individuals with persistent pain conditions.
Unfortunately, simple recommendations to increase activity involvement have not been effective in reducing the degree of disability associated with pain. It has become clear that increasing activity involves a complex interplay among many factors including the individual’s physical symptoms, lifestyle, environment, perceptions and beliefs, and his or her confidence in the ability to overcome these difficulties. Indeed, psychosocial factors are currently considered to be the most significant determinants of disability associated with pain.
The Progressive Goal Attainment Program (PGAP) is the first disability prevention program specifically designed to target psychosocial risk factors for pain and disability.
PGAP is a 10-week activity mobilization 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 persistent pain conditions. PGAP is suitable for clients who are suffering from a persistent pain condition, and for whom pain symptoms and psychosocial factors are significant barriers to rehabilitation progress.
PGAP has produced positive results for individuals suffering from chronic musculoskeletal conditions, whiplash, fibromyalgia, osteoarthritis and rheumatoid arthritis.
Intervention within the Community
In order to increase the accessibility of the Progressive Goal Attainment Program, the intervention was developed as part of a broad community-based approach to disability management. This program was developed in Canada and has been brought to New Zealand by ACC.
AIM currently has five practitioners trained in the delivery of PGAP who are available to assist clients.
Measure of Impact of PGAP
A recent study compared individuals who participated in PGAP + Physiotherapy (N = 70) to individuals who participated only in Physiotherapy (N = 60). All individuals had sustained soft tissue injuries to the neck, shoulders or back subsequent to a motor vehicle accident. On average participants in the trial were 6 months post-injury at the time of referral. Participation in the PGAP + Physiotherapy treatment condition was associated with a higher probability of returning to work (75%) than participation in Physiotherapy alone (50%), p < .001.
Differences between treatment conditions were most pronounced for the subgroup of individuals who obtained the highest scores on measures of psychosocial risk factors. The findings suggest that PGAP can be an effective means of improving function and facilitating return to work in individuals at risk for prolonged pain-related disability
