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PPP Management How to help PPP patients.

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Old 04-11-2011, 11:29 PM   #1
Diane
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Thumbs up The wonderfulness of PGAP

I'm through the first day of this training workshop in the "progressive goal attainment program", taught to all sorts of different professionals by Michael Sullivan of McGill. (John Ware, you would like this guy - he's Irish, interesting sense of humor and good stories. )

Anyway, I'm sitting in the restaurant waiting for dinner, some yummy mushroom pasta thingy I've ordered, sipping white wine and feeling like a grownup.

I really like the fact that in a room full of people taking the workshop (maybe 60 or 70 people) more than half are PTs, the next largest group are OTs, some nurses, some social workers, a couple kinesiologists, a medical physician, oddly no psychologists, but that's OK because they probably already know all this stuff anyway.

I heard about PGAP ages ago, from other members of PSD, but this is the first time I've ever had a chance to take the training. In the summer, Michael Sullivan was a speaker at Congress, brought in by the ortho division no less. He was pretty good and I knew this was something I should get. So here I am. I think this is way better (more practical, more immediately applicable, way less "biomedical") than the pain management certification program I dropped out of. It's interdisciplinary without being obvious about it. It's practical, doesn't make any promises it can't keep, is an evidence-based set of tools that anyone can use, is certifiable (I'll be "certified" as a PGAP provider from this), helps people overcome unhelpful, disabling beliefs and cognitions, prevents them from getting them in the first place, teaches one how to develop healthy treatment relationships with difficult patients. I love this. It's exactly what our profession needs large doses of.
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Old 05-11-2011, 12:09 AM   #2
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Glad you are enjoying the course Diane!

I have to say in practice, the program has been extremely valuable. It has improved my outcomes drastically in patients with persistent pain that has kept them from work for more than 6 weeks. It is sometimes hard to implement PGAP as the standardized program (due to funding issues getting in the way), but the ideas that underlie the program can and should be used all the time.

Enjoy day 2!
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Old 05-11-2011, 12:20 AM   #3
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Hi Jordan,
Sounds like you have this - when did you take it?
It used to be only for chronic pain. Now it's also streamlined for depression, cancer, and something called "other" conditions (CV, various autoimmune stuff).
Soon there will be a branch for PTSD.
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
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Old 05-11-2011, 12:24 AM   #4
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What a bummer- I just checked the PGAP website and found out that Sullivan is taking a sabbatical next year. The site says they're not sure the course will even be offered in 2012.
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Old 05-11-2011, 12:29 AM   #5
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Well, I'm sure he'll be back after that John. Invite him to teach in New Orleans and offer him a bunch of mardigras beads to wear.
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
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Old 05-11-2011, 12:42 AM   #6
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I took the course sometime in Feb/March (I think). It was a very well attended course in the Toronto area with mainly OTs, Psychologists, a few MDs and PTs. I have used it with several people since then whom I was having challenges with overcoming some psychosocial barriers.

It was already the 3rd generation course (includes disability secondary to depression/CV problems), but I didn't know about the expansion to the PTSD population. Interestingly, I am about to start using the program with a patient who is experiencing chronic pain, but I also screened her for PTSD and she appears to be experiencing PTSD as well. We will see how it goes.

Michael was mentioning his sabbatical back at the beginning of the year and his wife seemed very excited for the break. He has done such an incredible amount of work in the last several years, I guess they have earned it.

I think it would be well worth organizing a course in New Orleans when he is finished his sabbatical!
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Old 05-11-2011, 12:52 AM   #7
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The whole thing makes so much good sense.
Sullivan is very transparent about the whole thing. Like, the whole pain catastrophizing questionnaire came out of a single conversation he had with a colleague.

If there was a "like" button here, I'd "like" your post Jordan. I agree, get him lined up for 2013 John.
I was impressed with a study he did with PGAP-tel, where he trained a bunch of people to work out of Indianapolis, to phone people all over the US, and conduct the program by telephone. It was during the meltdown of '08, so not that many people found work, but at least they were able to show that with PGAP more people at least looked for work than did those without PGAP.
PGAP-tel works better than nothing, but not as well as face to face. It works better than PT by itself, measured against several parameters, although PT by itself works pretty good for return to work, better than I ever suspected. We are CBT-ers and don't even know it.
What I really like is the explictness of it -
a) how to recognize yellow flags (although he doesn't call them that)
b) here's what to say to gain cooperation
c) here's how not to get caught up in a gnarley situation such as taking sides
d) here's what to say in order to create an alliance and support the patient but retain a treatment boundary.
Literally, what to look for and say, and when.
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
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Old 05-11-2011, 03:04 AM   #8
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I've not heard of PGAP before. Thanks for bringing it here Diane. I'll be interested in your thoughts. I discovered he's got skills too. Check out his music.

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Old 05-11-2011, 03:08 AM   #9
Diane
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Quote:
Originally Posted by Jon Newman View Post
I've not heard of PGAP before. Thanks for bringing it here Diane. I'll be interested in your thoughts. I discovered he's got skills too. Check out his music.

Common Ground

Huh! That explains why he likes to play all those music videos at breaks.
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
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Old 05-11-2011, 03:14 AM   #10
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I see he has Tim Wideman on his team, PT and psych, who is a friend of PSD, and of Dave, who recently wrote a paper with David Seminowicz.. I feel pretty cheered up about PT tonight about the direction it's heading in spite of inertia and overt criticism by certain other PT pain researchers.
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
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Old 05-11-2011, 11:37 PM   #11
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Today I learned how:
1. to interact with an angry person (don't start any sentence with "you", remain an ally, remark on how you imagine they must be feeling frustrated, which will signal to them that they have been an effective communicator)
2. to go through 10 weeks of a PGAP program, step by step, with all the rationale for the bits that are included at each step
3. to score the tests/instruments/tools/questionnaires
4. to write a mid-term and termination report to a third-party payer/case manager.

Long day, but I learned more this weekend than I ever learned in PT school about how to handle all sorts of difficult patients, interact with them, let them think everything is their own idea (retain internal locus of control), and "manage" helping them to learn how to "manage" themselves/their own lives, not just treat symptoms.

Sullivan even played us a music video of a song he wrote and performed for his own baby. Not just ones by Bruce Springsteen, or Shania Twain.

There are three huge booklets, each a couple inches thick, to wade through and contemplate. I don't know if I'll become the official local south Sask PGAP provider. I still yearn to be free of insurers like I was before. But at least I know what's involved, what level of responsibility, how to score the questionnaires, how to order booklets, what to say to people, so ostensibly I could do it... I could do it a lot easier if I were a lot younger and more sociable and wanted to be "part of something much bigger than myself". None of that is likely to happen. So I may just stick to being the local person that people go to to get their cranky whatever treated in a nervous system friendly way. However, I am awfully impressed with this as a form of care for PTs in systems who need to manage back-to-work stuff.
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Canadian Physiotherapy Association Pain Science Division Facebook page
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Neuroscience and Pain Science for Manual PTs Facebook page

@dfjpt
SomaSimple on Facebook
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
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Old 08-12-2011, 04:00 AM   #12
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Diane ,

thanks for posting about the pgap.

I especially liked the advice you gave on dealing with an angry person . I have had some frustrated patients , who were annoyed at their progress or something and I would just get defensive. Not a very good approach.

Martin
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