1. This Outcome Report is based on data from patients who completed a Functional Restoration Programme (FRP) at the RealHealth Treatment Centre in Coventry between February 2014 and October 2014. Pain related disability was reduced on average by 54% from start to completion of the FRP, and these improvements were maintained at a six week follow up. Patients presented with reasonable levels of self-efficacy (confidence in managing pain) at the start, but further improvements of 33% on average were achieved by the time of discharge. While FRP patients did not present with high levels of emotional distress as expected at the start, further gains were nevertheless achieved - with depression scores reducing by 33% on average and anxiety scores reducing by 27%. Positive outlook scores were improved by 16% on average. On average, functional ability improved by 14% from the start of the programme to the end, and improvements of 24% were observed 6 weeks following programme completion, indicating further gains. Fear of pain relating to movement and activity was reduced by 24% at the end of the programme. These gains were maintained at 4-week follow-up. Most patients verbally reported meaningful positive changes in aspects of their functioning and quality of life Representative sample based on 20 patients

2. The Roland & Morris Disability Questionnaire (RMDQ) is a widely used health status measure for low back pain, providing self-ratings of the level of physical disability experienced by the patient as a consequence of the pain. Scores on the RMDQ range from 0-24, with higher scores indicating a greater level of pain related disability. Our data show that for the clients in the Functional Restoration Programme (FRP) there was a significant average reduction of 54% in pain related disability scores between admission and discharge from the programme. Reducing Pain-Related Disability Real Health 2014 Improving Self-Efficacy The Pain Self-Efficacy Questionnaire (PSEQ) is a 10-item questionnaire developed for people with ongoing pain to assess a patient’s confidence in performing activities while in pain. Higher PSEQ scores indicate stronger self- efficacy beliefs and are associated with return to work and maintenance of functional gains. Scores on the PSEQ were increased by 33% from start to completion of the programme, indicating significant improvements in self- efficacy beliefs. These benefits were maintained at a 6 week follow up, with additional improvement..

3. Real Health 2014 The Depression, Anxiety and Positive Outlook Scale is an 11-item scale specifically designed to assess mood and emotional outlook in chronic pain patients. The scale consists of three subscales: Depression (5 items), anxiety (3 items) and positive outlook (3 items). Reducing emotional problems As would be expected for patients selected for the Functional Restoration Programme, high levels of emotional distress were not present at the start of the FRP. However, clinical improvements were nevertheless achieved: depression and anxiety scores were reduced by 33% and 27% respectively from start to completion of the FRP.

4. Reclaiming lost roles Analyses of our qualitative information based on patients’ feedback indicate meaningful improvements to aspects of life functioning. The highlights from the qualitative data are as follows: Most patients reported some improvement in their general well- being. Generally, patients reported increase in activity levels. Better ability to pace was often reported. Patients reported better interactions with other people. Most patients were able to progress goals relating to hobbies/ leisure. Patients reported being more confident of addressing and resolving work-related issues arising from their pain condition, regarding their work capacity Real Health 2014 Improving positive outlook As would be expected for patients selected for the FRP, their own perception of outlook was reasonably positive at the start of the programme. Nevertheless further marginal gains were achieved through the FRP with positive outlook increasing by 16% on average.

5. Improving functional ability Functional ability measures were taken to assess any improvements in strength, flexibility, co-ordination and self-confidence in activity over the course of the programme. Specific functional ability measures included timed walk, sit to stand, and step ups. These measures were taken at the start of the programme, on completion of the programme, and at a follow up six weeks after programme completion. Walking further Walking distance improved by 8% at the end of the programme with gains being maintained at follow-up, indicating a 15% improvement compared to the start of the programme. Real Health 2014

6. Climbing stairs There was a 15% average improvement in sit-to-stand ability by the end of the programme and further gains were observed at follow-up, indicating 33% improvement compared to the start. Moving better A 19% average improvement was noted at the end of the programme which had risen to 24% average improvement by follow-up, indicating patients were continuing to build on their gains. Real Health 2014

7. The TAMPA Scale for Kinesiophobia (TSK) is an 11 item questionnaire that provides subjective self-report ratings of the extent of fear of movement or activity as a result of chronic pain. Possible scores on The TSK range from 0 -44, with higher scores indicating an increasing fear of movement, injury or re-injury. Scores above 26 are usually of clinical concern. Programme users showed a promising reduction in TSK scores of 24% from programme start to programme completion, with a mean reduction maintained by 6 weeks following programme completion. Reducing fear of movement Reflecting on positive changes Over 90% of patients verbally reported meaningful positive changes in aspects of their functioning and quality of life. Patients were proactively pacing themselves better. Confidence in undertaking exercise improved. There was less avoidance of daily tasks. Programme users had made a real effort to routinely improve posture. Patients were more willing to reduce their pain medication. Analyses of our qualitative information based on patients’ feedback indicate meaningful positive changes through attending the programme. The highlights from the qualitative data are as follows: Real Health 2014

8. “This has been a very helpful and worthwhile course and educated me about coping with the pain” What our patients have said: “Thank you so much for having me on the course. Really feel it has helped a lot in so many different ways!” My confidence has grown a lot, I am no longer scared of exercise or certain movements and I now know the pain is just the nerves working and it’s not a bad thing” Real Health 2014 “The biggest change in the last two weeks has been in my confidence to achieve my goals and deal with my pain. Really given me confidence to go on with my goals” “I am in control of my pain. I feel a different person, empowered, in control again, positive” “I came with a totally open mind and have come away feeling more positive and confident about my future.” “It surpassed my expectations, beyond belief” “I feel the programme has given me a new lease of life.” The non-judgemental approach by the team here is excellent. They have helped me start on the road to recovery which at one stage I did not think possible. This programme has helped change my outlook not only of life, but of myself and my capabilities. Thank you all so much, I cannot thank you enough” “This programme has given me the confidence to take responsibility for managing my pain and general health so a very big thank you to everyone.” “I have learnt that I can take control! A very big thank you from me! You are a great team and I feel that these 2 weeks have set me on a journey and inspired me to set my plan to ensure that I maximise my fitness going forward. This course has been a life changing experience for me. I feel equipped to go back to the big wide world (!) with the tools and confidence to achieve my goals”