Functional restoration refers to a philosophy and approach to medical care that is unique and is based on a biopsychosocial model of medical diagnosis and care that focuses on not just the biology (injury/illness and associated pathology), but also on the individual as a whole person including psychological and social aspects.
Functional restoration involves multiple disciplines who work together in a coordinated fashion and is focused on maximizing function, returning to pre-injury productivity (with sufficient functional capacity to avoid recurrent injuries), while preventing needless disability, unnecessary medical and surgical care and healthcare related complications.
The biopsychosocial model of pain recognizes that pain is ultimately a sum of the individual’s biology, psychological history and state, belief system about pain, along with interactions with the environment (workplace, home, disability system, and health care providers). All of these factors can strongly influence symptom severity and how quickly the individual can return to function.
Functional restoration can be defined as the process by which an individual acquires the skills, knowledge and behavioral changes necessary to assume or re-assume primary responsibility for his/her physical and emotional well-being. Functional restoration thereby empowers the individual to achieve maximal functional independence and the capacity to regain or maximize activities of daily living, and return to vocational and avocational activities.
Fundamental elements of a functional restoration approach include assessment of the person’s dynamic physical, functional and psychosocial status. This is followed by a treatment plan that includes directed conditioning and exercise, cognitive behavioral therapy, patient and family education and counseling; functional goal setting; ongoing assessment of participation and compliance and progress toward achievement of goals.
Functional restoration treatment team members act as educators, de-emphasizing passive and/or palliative therapies, while emphasizing independent self-management. There should be a shift of health and well-being responsibility from the doctors and therapists to the person.
A functional restoration approach can include the limited/adjunctive use of medications and appropriate interventions for the specific purpose of supporting the individual’s effort to reach and maintain maximum functional improvement; institution of preventive measures, expectation management, education for relapse prevention, proper activity and work pacing, ergonomic accommodation; and when appropriate, transitional return to gainful employment with as little disruption from the work site and coworkers, as possible.
Functional restoration involves objective measures of physical performance guiding exercise progression; while physical and occupational therapists, psychologists, nurses and case managers provide education on pain management, coping skills, return to work issues and fear-avoidance beliefs, using a cognitive behavioral therapeutic (CBT) approach consistent with the biopsychosocial view of chronic pain/disability.
Ultimately, the successful individual with chronic pain takes control of and re-engages in life activities and minimizes interactions with the medical community. The goal is a mitigation of suffering and return to a productive life despite having a chronic/persistent pain problem.