Psychologically based occupational rehabilitation: The pain-disability prevention program

Objectives: To describe the development, implementation, and preliminary outcome of the Pain-Disability Prevention (PDP) Program. The PDP Program is a 10-week cognitive-behavioral intervention program that aims to increase daily involvement in goal-directed activity and minimize psychological barriers to activity involvement after occupational injury. Workers' Compensation Board claimants with soft tissue injuries to the back, who were still off work 6 weeks after injury and showed evidence of at least one "yellow flag," were offered participation in the PDP Program. Design: A single-group, prospective treatment outcome analysis. Participants: Data from the first 104 claimants who participated in the PDP Program are summarized. Results: Participation in the PDP Program was associated with a 60% success rate, where success was defined as return to work (45%) or readiness to return to work (15%). Initial scores on measures of catastrophizing, fear of movement/reinjury, and depression afforded 92% correct classification of treatment outcome. Early treatment changes in catastrophizing and fear of movement/reinjury were also predictive of treatment outcome. Conclusions: The findings suggest that a psychologically based activity mobilization program can be an effective means of yielding reductions in psychological risk factors for occupational disability. Challenges to program implementation, fidelity to protocol, and issues related to cost efficacy are discussed.