Out-Patient

Comprehensive Outpatient Program

DESCRIPTION

Provides an individualized, intensive and extensive, aggressive physical, behavioral and avocational/vocational rehabilitation.
Designed for persons with acute or chronic intractable pain whose level of function, productivity and life style is moderately to severely impaired.
Designed for persons who can be managed in an outpatient setting.
Designed for patients who are either being transferred to the outpatient setting from the inpatient comprehensive program to complete the more aggressive second half of their program or enter directly into the comprehensive outpatient program if the evaluation findings conclude that he/she is an appropriate candidate and meet the criteria for this program.
The treatment plan is individualized for each patient but will consist of a combination of the following therapy programs:
Physical therapy, occupational therapy, vocational/avocational rehabilitation and behavioral counseling, biofeedback, relaxation, muscle reeducation, ergonomic interventions and job simulation, work fitness, movement therapy, hydrotherapy, educational lectures, cognitive and family, individual and group counseling, daily medical visits (PM&R), nurse case management and counseling and regularly scheduled multidisciplinary patient progress conferences. A home maintenance program will be provided. Home or job site visits will be made if necessary, during the treatment program.
Patients may enter this program directly or be transferred from the Outpatient Rehabilitation Services or may be transferred from the comprehensive inpatient program, if hospitalization is no longer needed.

GOALS / OBJECTIVES

To physically recondition and restore the patient to the optimal level of function to include full range of motion, acceptable strength requirements, decreased pain level and functional tolerances.
To physically condition patients to achieve optimal level of function with minimal to no pain, minimal to no limitations and minimal to no disability on discharge from the program.
To physically condition and restore patients who do not require inpatient care during rehabilitation.
To reduce or eliminate the use of addictive pain medications and educate the patient to use alternative methods to alleviate pain.
To assure that the patient is able to self administer any medication needed to maintain health.
To educate patients in self care to utilize alternative methods such as exercise and specific modalities to manage occasional pain episodes.
To educate the patient to maintain his/her optimal weight to avoid "flare-up" or exacerbation of pain due to excessive loading of the spine, hips, knees, ...etc.
To reduce or eliminate through physical restoration the need for assistive devices such as braces, corsets, canes, crutches walkers, wheelchairs, stimulators, etc. which serve to perpetuate deconditioning and are counter productive in the alleviation of pain.
To achieve realignment of the spine, hips and shoulders to reduce or eliminate poor posture and maladaptive gait which contributes to intractable pain and perpetuates the pain cycle.
To provide stress management, relaxation, psychological support and family counseling so that patient may be able to maintain optimal levels of function after return to his/her own environment.
To effect positive behavioral change so that patient be in control of his/her situation to avoid pain producing activities and initiate self care.
To educate the patient to substitute inappropriate behavior and responses with appropriate behavior to reduce pain producing stress.
To teach the patient to understand self and be totally responsible for actions and rehabilitation.
To enable the patient to perceive self as a well person.
To educate the patient to develop constructive coping strategies to reduce stress.
To master and implement relaxation techniques and understand the relationship between muscle tension, anxiety and pain in order to reduce stress and prevent reinjury.
To alleviate and teach control of anxiety, depression, fear, anger and interpersonal problems so the individual may function in an emotionally healthy manner thereby maintaining the physical and mental gains made.
To dispel disability oriented attitudes in the patient and his family and to educate the patient's family to support wellness behavior and a positive attitude.
To enable the patient to relate to his family and others appropriately.
To educate the patient's family concerning the patient's problem, abilities and their role in his/her rehabilitative process so that they may offer positive reinforcement.
To foster open communication within the family structure.
To teach the patient to maintain rehabilitation gains and prevent reinjury without reliance on health care professionals, medication and assistive devices.
To function at a high level and enjoy optimal wellness through training and awareness to instinctively use good body mechanics, pacing, energy saving techniques, as well as exercise and modalities.
To enable the patient to participate in leisure activities, including active sports in a safe and planned manner so that the patient may prevent injury or reinjury and enjoy a complete well rounded, and satisfying life style.
To restore and enable the patient to return to gainful employment with minimal to no limitations or modification in the workplace (heavy labor not precluded).
To restore the patient physically, psychologically and vocationally to enable him/her to return to full time employment (any type - heavy labor not precluded) with confidence and with the ability to do the job in a safe manner to prevent reinjury.
To teach patient to overcome obstacles which may interfere with return to home, employment and community.
To educate the patient to recognize and avoid situations that would contribute to a recurrence of the chronic pain cycle through knowledge of ergonomics and how to make simply adjustments to the home and workplace setting.

ADMISSION CRITERIA

(Admission to the comprehensive outpatient program is determined prior to and following the multidisciplinary evaluation based on any or all of the following criteria)

Physician, self referral, others.
Completion of multidisciplinary comprehensive evaluation.
The previous methods of treatment have not been successful in alleviating intractable, recurring or debilitating pain.
Diagnosis which can be managed successfully.
The patient's rehabilitation potential is compatible with the program design and the evaluation findings.
The patient is able to learn self-care techniques.
The patient can be managed medically and behaviorally in an outpatient setting.
The patient is willing to participate in an intensive full day of therapy and activities.
Acute or chronic pain which mildly or moderately interferes with functional capacity and a productive lifestyle.
Mild to moderate depression which can be treated in an outpatient setting.
Not susceptible to falling.
History of surgeries for pain related problems.
Able to self-medicate.
Able to commute.
No active suicide ideation or behavioral problems that cannot be managed in an outpatient setting.
Willing to follow prescribed treatment plans.
Willing to follow unit and Center policies.
Willing to participate in an intensive comprehensive full day of treatment and activities.
Ability to learn techniques and concepts of self-care.
Medical clearance prior to admission or during the first hospital week.
Admitting diagnosis with rehabilitation potential for successful outcome in 2-5 weeks.
Cancer patients with intractable pain in remission from active disease who are able to be managed in an outpatient setting but have good potential for rehabilitation and pain management.

DISCHARGE CRITERIA

(Patients are discharged from the comprehensive outpatient program based on any or all of the following criteria)

Successfully rehabilitated and the Home Program established.
Achieved optimal function without pain.
Able to self medicate.
No longer requires comprehensive full time rehabilitation.
Non-compliant, uncooperative, with no improvement after discussion with the Medical Director, RCPC physician, and/or psychologist.
Violation of Center policies and procedures.
Behavioral crisis requiring specialized management.
Associated or complex medical problems which interfere with patient's ability to fully participate in the rehabilitation program.
Inability to follow instructions or follow a schedule.
Inability to fully participate in the comprehensive intensive comprehensive treatment program.
Inability to learn techniques and concepts necessary for self care.
Requires nursing care for associated medical problems.
Medical emergency requiring transfer to acute medical unit or inpatient pain unit.
Cancer patients whose disease becomes active and requires medical management for that problem or prevents full program participation.
Dependent and requires more than minimal assistance with ADLs.
Presents with acute medical problems which cannot be managed in an outpatient setting.
Unable to ambulate safely without assistance.
Any problems requiring inpatient care.
Bowel or bladder problems which cannot be managed on an outpatient basis.
Behavior which is disruptive to therapeutic environment.
Unable to make expected progress in the program.
Unwilling to participate in the intensive program or any planned activity.
Repeated tardiness or absence.

SERVICES

Overall supervision by Medical Director.
24 hour supervision by Doctor of Physical Medicine (Physiatrist).
On call supervision by Team Psychiatrist.
Daily medical visits by Medical Director and RCPC physicians.
Rehabilitation Team daily rounds.
Physical Therapy.
Occupational Therapy.
Movement Therapy.
Muscle Re-education.
Motor Dysfunction Evaluation / Treatment.
Vocational Counseling - Rehabilitation, Placement.
Job Analysis, Job Simulation, and Work Fitness.
Primary Counselor (Doctoral level Psychologists) - 24 hour availability.
Individual Counseling.
Group Counseling.
Family - Individual and Group Counseling.
Stress Management.
Biofeedback and Relaxation Techniques.
Coping Strategies.
Educational Lectures (all disciplines).
Functional Capacity Assessment, tolerance building, work tolerances (Ergonomics).
Rehabilitation Engineering / Ergonomics.
Ergonomic Job Analysis.
Functional Electric Stimulation.
Nursing Interventions - including detoxification monitoring and 24 hour observation.
Case Management.
Weight Control.
Detoxification.
Crisis Intervention.
Multidisciplinary Patient Progress Conferences.
Multidisciplinary Medical Director rounds.
Multidisciplinary Report.
Transfer or Discharge Planning and Coordination.
Patient Relations Services.
Home program.

TYPES OF CONDITIONS TREATED

1. Musculo-skeletal diseases

Myofascial pain syndrome (fibrositis, fibromyalgia)
Cumulative or repetitive trauma (Carpal Tunnel Syndrome)
Cervical pain (strain, whiplash)
Temporomandibular joint disease (TMJ)
Back pain (sprain, strain)
Herniated disc and radiculopathy
Degenerative disease of the spine (stenosis, osteoarthritis, acquired spondylolisthesis, degenerative arthritis - other)
Post-surgical rehabilitation
Geriatric rehabilitation
Chronic fatigue syndrome
Osteoporosis
Atrophy - disuse, non-use
Maladaptive gait
Knee, shoulder, elbow pain and limited range of motion
Sports injuries
Peripheral nerve injuries
Head pain
Other neuromuscular problems
Regional complex pain disorders or reflex sympathetic dystrophy (RSD)

2. Other Conditions

Problems not controlled with traditional medical approaches, in which pain has become chronic and Intractable or interferes with function or quality of life.

Headache
Abdominal
Pelvic
Cancer
Neurological

3. Psychiatric Sequelae Related to Pain

Anxiety
Depression
Drug dependence due to pain (detoxification)
Alcohol abuse
Personality disorder
Suicidal ideation related to pain

STRUCTURE

Comprehensive Outpatient Program with full-day of scheduled treatment and/or activities.
Estimated Length of Program: 4 weeks on the average depending on need or progress. Length of program varies depends upon medical, behavioral, and financial determinations.

ADDITIONAL SERVICES

Free parking.
Discount on meals in cafeteria (patients with name badge).
Preferred rate to RCPC patients in deluxe hotel (if required).