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Dartmouth Medical School Dartmouth-Hitchcock Medical Center

Vital Signs

Program puts back problems on the front burner

By Alicia I. Kim

Hazard, left, observes an FRP patient.

As many as 50 million Americans suffer from chronic back pain, and only a small percentage of them can benefit from surgery. For the rest, the options for relief may be limited to standard physical therapy, painkillers, avoiding activities that aggravate their pain, or even changing jobs.

Specialized: But since 2003, Dr. Rowland Hazard and his colleagues at DHMC's Spine Center have been taking a different approach to back pain with the Functional Restoration Program (FRP). The 14-day program helps patients recover mobility, flexibility, strength, and endurance—despite their pain—with specialized physical training and education.

Rather than focusing just on pain relief, the FRP starts with understanding each patient's individual goals—such as returning to work, resuming a hobby, or simply doing household chores. The program includes dynamic workout sessions, as well as training in how to isolate and exercise key muscles whose function is essential for patients to meet their goals. There are also relaxation sessions to complement the physical activity. In addition, physicians teach patients pain-management strategies to help them maintain their newfound functionality.

Model: Patients in the FRP learn "what they can and can't do and what works for them, which is quite different from a top-down, authoritative model," explains Hazard. "Within that model of learning . . . people learn to trust themselves, and that's really a key to getting better. [Patients] leave here with a regimen . . . that they then continue on their own."

After completing the program, patients come back to the Spine Center one month and three months later for a follow-up assessment of their strength, flexibility, and endurance and of their pain, goals, and overall mood. Based on results from 300 recent graduates, the FRP works well; pain and depression scores go down and flexibility and strength scores go up. The program bases success on participants' satisfaction with their progress, rather than on a pathology-focused model based on meeting broad norms.

Idea: "It's very exciting," says Hazard, "to see people getting better with an approach that is not made up of pills and shots and surgeries." Hazard, who helped create the FRP, was inspired by a similar program at the University of Texas, where he did a fellowship in orthopaedics. He brought the concept to the Spine Center seven years ago and has been refining it ever since.

It's "exciting to see people getting better [without] pills and shots."

About 80 people participate in the FRP each year, coming from all over, primarily New England and New York State. They range from a soldier injured in Iraq to a teenager with inexplicable back pain. A great FRP candidate, says Hazard, is someone who can't work, have fun, or perform daily activities, even after trying medication, physical therapy, or surgery.

Patients bring varying attitudes and expectations, Hazard emphasizes. He and his colleagues recently assessed the effectiveness of using goal achievement to measure the success of the program. Their findings, based on one-year follow-up surveys and published in the journal Spine, showed that goal achievement was a better predictor of patients' satisfaction with the program than traditional measures, such as improvements in pain, flexibility, and endurance.

Disseminate: Hazard and his team are also working to disseminate what they have learned to other providers, nationally and locally. In the meantime, he looks forward to the arrival of each new crop of FRP patients, who arrive at the Spine Center with high hopes. "The program itself is 14 days," Hazard says, "but it's just the beginning."


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