Spring Frequently Asked Questions

  1. What is a functional restoration programme?

    ‘An interdisciplinary programme of activity and education geared towards minimizing disability. Functional restoration emphasizes physical and behavioural improvements over pain eradication and is guided by repeated measurement of function’.
    • Critical components of a functional restoration programme include:
      • Interdisciplinary staff
      • Consultant direction, medication management
      • Robust planning and communication structure to coordinate treatment
      • Consistent client centred interdisciplinary co-operation
      • Staff-client ratio: minimum group size 4; maximum 10
    • Quantification of function
      • Measurement of physical capacities before, throughout and after treatment to guide training and inform resumption of work and other activities
    • Physical training
      • Emphasis on active exercise and development of personal coping strategies
      • Minimal individual therapy modalities
      • Whole body and spinal training for flexibility, strength, and endurance
      • Integrated simulation of work and other functional activities
      • Exercise, self-management and lifestyle education programmes
    • Cognitive Behavioural Therapy
      • Initial psychosocial and socioeconomic evaluation to inform goal setting and training plans
      • CBT; group focus, indentify individual counselling needs if appropriate
      • Case management: work and lifestyle planning with consideration of socioeconomic issues
  2. What support exists for applying Functional Restoration Programmes?

    National Institute of Clinical Excellence (NICE) guidelines for low back pain determine that, if someone has not recovered through out-patient modalities after 2-3 months of traditional physiotherapy etc, they should be included in a group based programme of intensive exercise and psycho-social treatment involving up to 100 hours treatment over maximum 8 weeks. These principles are further underpinned by European Guidelines for the Management of Chronic Non-specific Low Back Pain www.backpaineurope.org
  3. Why is a residential programme desirable?

    Spring’s Active Residential Programmes:
    • Motivate involvement in a supportive group environment greatly reducing the negative impact of isolated effort – a fundamental motivating characteristic of the programme
    • Extend the day’s work in a ‘self-sufficient’ setting, building on the foundations laid to empower individuals to assume control of their future
    • Strongly facilitate progress towards breaking down individual’s unhelpful perceptions of impairment and disability
    • Provide a unique opportunity to engage in a positive process of ‘commitment studies’, including filling in questionnaires, activity diaries and goal setting exercises etc. and social activities, avoiding adverse and unsupportive influences encountered in working environments and regressive over-protective routines at home
    • Enable full focus of un-interrupted attention, both physically and psychologically, on recovery in a productive and supportive team setting extended beyond the working day
  4. Why Spring?
    • Spring Rehabilitation is the only provider of this type of Consultant led programme
    • Care Quality Commission (CQC) Registered
    • Spring programmes deliver evidenced based treatment and clinical management strategies advocated by National guidelines
    • Demonstrated success in over 300 cases
    • Proven experience of the therapy team who have been engaged in delivery of similar programmes within the NHS, Defence Services and Private Sector.
    • Corporate registration with the British Association of Rehabilitation Companies (BARC) and CMSUK.
    • Participating corporate member of PAS 150 Special Interest Group contributing to a National rehabilitation provider accreditation document under the chair of UKRC.
  5. How will a cognitive behavioural approach be applied within Spring Programmes?

    The CBT approach to address pain and psychological management issues on Spring programmes is based on a model which recognises the notion that pain is a complex experience; that it is not only influenced by its underlying pathophysiology, but also by an individual’s cognitions, emotions and behaviour, and situations which form their whole experience. The CBT components on Spring programmes are aimed at:
    • Helping clients to realise that they can manage activities
    • Introducing clients to skills for responding in more adaptive ways that can be maintained after the programme has ended
    • Improving the way an individual manages and copes with pain, rather than just seeking a biological solution to problems
    • Teaching problem solving skills and returning perceived control to the client
  6. What is a successful outcome from the Spring programme?

    Readiness for work, renewed self-reliance, return to productive lifestyle, and client and referrer satisfaction are primary measures of success.
  7. How can a functional restoration programme save on claims costs?

    The largest part of the claim is future loss of earnings. The key focus of the Spring programme is to bring the client through the intensive programme to a point of readiness and fitness for work, thereby reducing the cost of the future loss of earnings.
  8. Who needs functional restoration?

    Most people with acute spinal (and other MSK) disorders recover without intensive treatment. Those who remain disabled and absent from work beyond the first 2-3 months of primary interventions face a longer term prognosis. Persons in this latter category are likely to encounter significant biopsychosocial and economic barriers to recovery. Persons who will benefit from assessment, planning and treatment services include those with:
    • Complex MSK injuries and conditions requiring expert review
    • Unclear medical diagnosis and/or prognosis regarding return to pre-injury function and employment status
    • Pre and post-operative conditions requiring medically supervised functional restoration
    • MSK injuries and conditions that are not appropriate for treatment within the standard continuum of care, including those with protracted recovery or co-morbid medical conditions requiring close clinical supervision
    Below is a summary of basic referral criteria for assessment of persons likely to gain from attending a 3 week residential Functional Restoration Programme.

    The list is not exhaustive nor prescriptive.
    • Age 18 years or over
    • Injury/disability/dysfunctional back pain and/or MSK disorder beyond 2-3 months
    • Continued absence from work
    • No further immediate medical or surgical interventions are planned, and for whom surgical intervention is unlikely
    • Long term reliance on multiple high dose medication for pain management
    • Psychological and cognitive capacities to interact in a group environment
    • Failure to respond positively to previous appropriate medication and/or physiotherapy or other similar modalities
    • No previous history of having already attended a similar Functional Restoration Programme
    • Self report of up to 25% of individual’s daytime activity spent in resting
    • Informed willingness to participate and proper motivation to attend 3 consecutive weeks on a residential programme to challenge pain related limitations of activity
    • Not significantly depressed or distressed to a degree which would result in major disruption/diversion to others attending the course, and to an extent which would prevent the individual’s active participation in the programme
    • Medically and/or neurologically stable
    • Independently mobile and capable of self-care
    • No medical condition which would contraindicate active exercise
    • If a client’s English language comprehension, or other difficulties such as visual or hearing impairments present a barrier to participation, programme admission may be delayed until e.g. translation services and or other appropriate arrangements and/or reasonable adjustments can be put in place
  9. Who might be excluded from attending a functional restoration programme?

    Below is a summary of basic exclusion criteria for persons unlikely to gain from attending a 3 week residential programme.
    The list is not exhaustive nor prescriptive.
    • Under 18 years of age
    • Back pain (or other MSK/ medical conditions) related to upper motor neurone lesions, neoplasms and rheumatoid arthritis
    • Any medical condition which would preclude physical activity
    • Current major (diagnosed) psychiatric illness including, psychosis, severe intractable depression, suicidal ideation, major personality disorder
    • Drug/alcohol dependency; significant continuing substance use/abuse
    • Individuals who have already attended similar programmes, particularly in circumstances where there are documented adverse reasons for withdrawal
    • Lack of ‘medical closure’ relating to earlier medical interventions such that it is not safe to reactivate issues within a residential programme
    • Rigidly held belief that ‘cures’ resulting from medication and/or surgery are the only acceptable solutions for presenting problems
    • Unequivocal expression identifying absence of motivation to: participate in the programme; to address reduction of medication under Consultant guidance; to work towards increasing activity levels; to pursue a self-management approach.
  10. How do you decide who to accept into the programme?

    Selection is achieved as a result of a comprehensive evaluative process utilising:
    • Review of records prior to call forward
    • Psychosocial assessment tools to evaluate motivation and readiness for engagement
    • Objective functional and clinical assessment led by a Rehabilitation Medicine Consultant
    • Frank, open discussion at assessment, and throughout the programme
    • Statement and acceptance of targeted objectives by all stakeholders before commencement

FAQs