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what is the Progressive Goal Attainment programme(PGAP)?

PGAP is a 10 week active rehabilitation programme supported by a cognitive behavioural approach.  It is aimed at improving the functioning of patients in the acute stages of injury in an effort to prevent the development of chronic pain and disability.  The 10 week one-to-one programme focuses on graded exercise and activity sceduling, instruction in a range of pacing techniques, cognitive therapy to help identify negative thinking patterns and the development of effective challenges and exercising to improve physical function.

This evidence-based programme aims to increase quality of life and facilitate return to work. The PDP is specifically designed to target yellow flags or known modifiable risk factors for disability. 

The treatment is delivered by psychologists through weekly one-to-one sessions over 10 weeks.  Patients receive an instructional DVD and a therapy workbook.  Patients are assessed pre and post intervention.  The participants will be reassessed to examine outcomes after 12 months.

The programme is designed to compliment existing clinical services and to help rehabilitation following injury.

Pgap Programme components (Sullivan, 2003).

(i) Maintaining an activity log.

Since one of the goals of PGAP is to maximize activity involvement, the patient is asked to maintain an activity log throughout the course of treatment.

(ii) Activity scheduling.

Working with the psychologist, the patient develops an activity schedule that is designed to keep him or her as active as possible during the recovery period.  These may include household activities, running errands, and social and recreational activities.  The patient’s spouse is invited to participate in activity planning so that he or she is aware of the program that is being developed for the patient.

(iii) Walking programme.

A main component of the PGAP is the development of a walking programme.  The walking programme starts with one 15-minute walk each day.  As PGAP moves forward, the psychologist works with the patient to steadily increase the distance walked each day. 

(iv) Increasing activity involvement.

Through the course of the treatment programme, the psychologist assists the patient in identifying ways to increase activity involvement.  The patient is taught principles of graded activity participation to maintain momentum of recovery while minimizing the risk of pain flare-ups.  It is through graded activity participation that the patient is first introduced to psychological strategies that can assist in overcoming the challenges of pain and pain-related disability.

(v) Overcoming psychological obstacles to activity involvement.

In the second phase of the program, the patient develops skills to overcome fears of re-injury and learns to monitor and modify self-defeating thinking that may accompany pain.  The European Guidelines for the management of back pain recommend the implementation of graded exercise, supported by a cognitive-behavioural approach (van Tulder et al, 2004). The patient is taught methods of approaching physical activity in a way that minimizes worries and concerns about potential re-injury using cognitive behavioural strategies.   Furthermore, the patient learns to become more aware of the impact of negative or pessimistic thinking on emotional well-being and activity level.  Finally, the patient learns communication skills and problem-solving strategies that will assist him or her in meeting the challenges brought on by the injury. 

For peer-reviewed articles on the effectiveness of PGAP (formerly known as the Pain Disability Prevention Programme) please see below:

Psychologically Based Rehabilitation: The Pain Disability Prevention Programme.

  Secondary prevention of work disability: community based psychosocial intervention.

 
 

 

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