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Functional Restoration Programme

The Birmingham Functional Restoration Programme (FRP) aims to train patients with persistent pain to become experts at managing their pain and improving their function and quality of life.

Many of these types of programmes are now running around the country and experts agree that they can be very effective at improving function, quality of life and learning strategies to manage flare-ups in pain more effectively. The programmes use both physical and psychological principles, to help improve confidence in function, address any fears regarding movement and provide a structured plan of recovery. There is a strong emphasis in helping to understand the biology of persistent pain, and what you can do yourself to reduce its impact on your life

Functional restoration can be either group based or done on a 1:1 basis. Groups are run over a period of several weeks and involve classroom based sessions, exercise and relaxation sessions, provided by a team of clinicians including a doctor, physiotherapist and pain counsellor. On a 1:1 basis, treatment is provided individually by either a physiotherapist or pain counsellor using the same principles of functional restoration. We will arrange an initial assessment for you and will then discuss whether group based or individual treatment would be most suitable.

Patients who have attended previous programmes report less back pain disability, improvements in their confidence to move and function more freely, better management of ‘bad days’ or bad flare-ups in their pain, reduced use of pain medication and a better understanding of the biology of pain. Patients have often been able to return to hobbies, work and social activities which had previously been difficult.

Meet the team

Meet the Team here

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Information for patients

What is a functional restoration programme?

This is an education and exercised based rehabilitation programme to help you to improve your function and manage your back pain more effectively. Many of these types of programmes are now running around the country and are seen to be the best way to manage persistent back pain. The programmes are run over a period of several weeks and involve you both talking through your back pain and using graded exercise to improve your function.

What does a programme look like?

The programmes are done in small groups, as it is recognised that this often results in better outcomes. There will be exercise sessions, where you can try out activities you may be concerned about and also sit down sessions where you can learn information and new techniques to help manage your back problem.

How often do I need to attend?

The programme runs twice weekly, on a Wednesday from 2.00-4.00pm and on a Friday afternoon from 1pm-2pm and continues over a period of four weeks.

Will it hurt?

The aim of the programme is to help you improve your function. To begin with you may feel more uncomfortable, especially after the first couple of sessions, but this normally improves as you continue.

How to access FRP

If your GP or clinician thinks you are suitable to take part in the Functional Restoration Programme they can refer you to us. We will then send you an appointment. At your first appointment you will see a member of the FRP team who will talk with you and discuss whether FRP is the optimal recovery programme for you. If your GP or clinician is unaware of FRP, please direct them to our website, or share our phone number: 0121 685 4000.

Patient Stories and Videos

You can view some patient stories and videos here.

Information for GPs

What is a functional restoration programme?

An interdisciplinary education and exercise-based rehabilitation programme designed to help patients with back pain to restore function and quality of life. This bio-psychosocial intervention is recommended in NICE Guidance (2009) to be the best way to manage persistent back pain. The intervention aim is to train patients to become experts at understanding their persistent low back pain, to manage flare-ups in pain effectively, to set goals to improve function, to reduce reliance on analgesic medication and to engage in healthy behaviours.

Who is it for?

The programme is for patients with persistent low back pain who are struggling to function and manage their pain effectively. This could include patients who have become fearful of moving, have unhelpful beliefs about the nature of their pain or are struggling to stay at work due to their pain. A screening tool, the Startback Questionnaire, can help to identify patients who are most likely to benefit from this intervention.

What does a programme look like?

The programmes are led by a doctor, a physiotherapist and a pain counsellor. Participation is usually in small groups and includes physical exercise sessions, education regarding the biology of pain, management of flare-ups, graded activity and goal setting. Patients are taught relaxation skills and introduced to the concepts of visualisation and Mindfulness to help with rehabilitation. On a case-by-case basis, patients are helped to reduce their reliance and use of analgesic medication.

How often do patients need to attend?

The programme runs twice weekly, on a Wednesday from 2-4pm and on a Friday afternoon from 1pm-2pm and continues over a period of four weeks. Patients then attend a follow-up session four weeks later on a Wednesday afternoon. Patients can be seen on a one-to-one basis if they are unable to commit to a group programme.

How do I refer?

It is recommended that GPs make a direct referral to the Functional Restoration Service by letter. The letter should include a short synopsis of the patients back pain history and any recent investigations or treatments are detailed.

Benefits to patients

Through careful evidence-based assessment screening and treatment, the Birmingham Functional Restoration service can train patients with persistent back pain to become experts at managing their persistent pain and improving their function and quality of life. The NICE guidance states that a “key focus is helping people with persistent non-specific low back pain to self-manage their condition”.

Read a paper evaulating the success of the programme here

Rogers D, Nightingale P, Gardner A.
A 12h combined physical and psychological treatment
programme for patientswith persistent back pain. Musculoskeletal
Care. 2018;1–4. https://doi.org/10.1002/msc.1235

Referral Criteria

Inclusion Criteria

  1. Adults with persistent regional pain of greater than 12 weeks duration
  2. At work, either paid or voluntary but struggling to maintain responsibilities
    b. Off work, but job remains open
    c. Not employed but actively seeking to improve function and quality of life
  3. Not responded to routine primary care management such as GP advice, medication, exercises
  4. Patient appearing motivated to help themselves to get better
  5. Modifiable psychosocial factors impacting on their ability to recover
  6. May have moderate or high-risk StartBack Score

Exclusion criteria

  1. Serious spinal pathology such as tumours, infection, cauda equina signs
  2. Significant motor radiculopathy and signs of nerve root compromise requiring surgery
  3. Widespread multi-joint pain
  4. No other open episodes of care for the same condition
  5. Rheumatological conditions
  6. Communication barriers which would prevent ability to follow cognitive component of program
  7. Other medical problems which would prevent involvement in physical exercise program such as unstable cardiac conditions, significant respiratory problems, poorly managed diabetes
Other medical problems which would prevent

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