The Royal Mail decided to introduce a biopsychosocial Functional Restoration Programme (FRP) at Royal Mail. This was to help employees with chronic long-term and recurrent musculoskeletal conditions to return to work and normal function. This was a voluntary programme which received full trade union support. Research has suggested that FRPs are the most effective route to a cure for chronic MSDs. The trial ran for 24 months at the Mount Pleasant Sorting Office. 

The biopsychosocial FRP is an intensive programme of involving cognitive –behavioural approach, aerobic capacity, muscle strength and endurance, coordination and work conditioning.

The table below gives the results

About half of those who left did so because of failure to comply with all the requirements of the programme. 

Clients came from 3 groups	Assessed	Started treatment	Did not complete programme	Returned to work, full duties	Success rate	Returned to restricted work
Off work	45	39	10	26	67%	3
Working Restricted duties	92	85	15	63	73%	7
At work but with recurrent absences	75	62	10	52		0
Total	212	186	35	141		10

The financial benefits of the programme to the employer were substantial. Before the programme, the estimated cost to the Royal Mail of the absence and restricted duties of clients in the study group was £1,384,501. Since the programme, this has fallen to  £127,738. On the premise that absence and restricted duties would have continued at similar rates without the rehabilitation programme the saving is in excess of £1m a year. Taking the current annual cost of the programme this provided a return of approximately £5 for every £1 invested. The programme was run by an external provider.

Well-being benefits, from feedback by individuals (141) who completed the programme, are summarised below.

They show personal benefits and the improvement in quality of lives.

Off work for 8 months with a disc prolapse – now back at work and playing football

PATIENT: A 37-year old father of two

JOB: a staff resources manager, which mainly involves office based work. He was unable to tolerate sitting for longer than 15 minutes and had been off work for 8-months at the time of the assessment

PREVIOUS INTERVENTIONS: 18 Sessions of physiotherapy, 2 consultants appointments, 2 epidurals, MRI Scan

PROBLEM: Constant back and thigh pain and unable to sit or function normally despite numerous interventions. He was unable to play with his two young boys and spent most of his day lying down. At the time of the assessment he was very frustrated as he appeared to be getting worse despite following his consultant’s and therapist’s advice. An MRI scan showed a disc prolapse at L1/L2 with degenerative changes at various levels. He was contemplating surgery.

ATTENDANCE: He attended for 12-weeks of biopsychosocial functional restoration at RehabWorks.

OUTCOME: Returned to work on a graduated return to work plan after 8-weeks with reduced levels of pain and perceived disability and managed full duties after 12-weeks. He now manages to sit for a 60 minute play with his children and reports no problem with the job demands. A three-month follow-up showed that despite having episodes of pain he remains at work and has started playing football again.

Off work for 14 months – now back working full time

PATIENT: a 20-year old delivery post person

JOB: Medium-heavy job requiring him to carry a mail bag weighing up to 18kg for long distances. He is also required to push and pull heavy trolleys occasionally. He was off work for 14-months at the time of his initial assessment.

PROBLEM: He had a two-year history of lower back pain that started when he injured his back doing deliveries at work.  He had attended physiotherapy twice a week for 10-months which included exercise and swimming. This helped, but not enough to return to work. As result he was referred for an MRI scan which showed a disc bulge and some wear and tear changes. The consultant advised him to avoid any heavy activities indefinitely. He was very frustrated as he has played football or gone fishing since his back problem started and had sold his motorbike, as he was told this may cause further harm to his back.

ATTENDANCE: Following the half-day initial assessment he attended for 10 day release sessions at the biopsychosocial functional restoration programme.

OUTCOME: He returned to work on a graduated programme 4-weeks into his programme. On completion (6-weeks later) he was back on full duties with minor aches and pains that he could self-manage. Three months following discharge, a re-assessment showed he had maintained his functional improvements and remained on full duties. He was attending a Gym and playing football and fishing. He reported feeling the best he had ever done.

Three years of neck and shoulder pain, now back full-time

PATIENT: a 48-year-old lady

JOB: She worked as a delivery person, which involved carrying heavy bags.  Her neck and shoulder pain became so severe that she was unable to work and had had 14-months off work in the past 2-years.  At the time of the assessment she could only manage light duties only. 

PROBLEM: She reported a three-year history of severe neck and shoulder pain, which gradually got worse. She was referred for physiotherapy and received 24 sessions, which provided her with temporary relief only.  A consultant requested an MR scan which showed three disc bulges. She was advised to learn to live with it and avoid physical activity. She was then referred to a Neurosurgeon, which said he would advise surgery if she is getting worse.  She reported that she had stopped swimming and was unable to drive or do housework, which is starting to affect her marriage. She was very demotivated and felt her only option was ill-health retirement

ATTENDANCE: Following the initial assessment she attended 16 sessions at the biopsychosocial functional restoration programme over a 10 week period.

OUTCOME: Over the course of rehabilitation her functional deficits and perceived pain and disability reduced significantly.  Following a work-place assessment she returned to full duties using a trolley to transport the mailbag. She is now able to drive again and perform all her household chores without aggravating her pain. A standard three-month follow-up assessment showed she remained on full duties and was coping well.  She could do household chores despite some discomfort. 

Off work for 4 months following a slip

PATIENT: a 58-year-old gentleman

JOB: His job involved mainline packet and flat sorting. This required him to lift 11kg bags frequently and push heavy trolleys. His hobbies included DIY and carpentry.   

PROBLEM: He was involved in an accident a work when he slipped and fell. He injured his left shoulder, wrist and lower back. He was off work for 4-months and returned to work on restrictions doing a sitting job only. He had had physiotherapy, osteopathy and been to a chiropractor without any improvement.

 ATTENDANCE: The patient attended 8 sessions of biopsychosocial functional restoration following his initial assessment.

OUTCOME: He improved significantly and managed to return to full duties with decreased pain and improved function within the first 6-weeks. He attended for a three-month follow-up and said he felt strong and fit and had had no problems in the last here months lifting bags or pushing trolleys.

Off work for 11 months after a chair broke

PATIENT: A 61-year old male

JOB:   He worked as a security guard at the main gate. The job involved sitting for most of his shift but he had the opportunity to stand up and move around.

PROBLEM: He was involved in an accident at work when his chair broke and he fell backwards. He immediately experienced back and right leg pain and was off work for 11-months. During his time off work he had two consultant appointments, and an MRI scan, which showed degenerative changes. He had had 7-months of physiotherapy including 10 back classes. He reported that his pain had not changed and he felt very depressed as he was unable to support or carry his terminally ill wife.  He was also under financial strain. He was very angry as he had only 4 years left until he retired but now felt he would  not enjoyed because of the chronic pain. He was unable to walk more than 10 minutes to catch a bus or train.

ATTENDANCE: The patient attended 10 sessions of biopsychosocial functional restoration.

OUTCOME: His mobility and strength increased significantly with decreased pain and disability. He started to increase his walking distance and also managed to sit for extended periods. This enabled him to return to his full duties.  At three months he was well and felt happy that he could now support his wife and work his full hours.

Couldn’t lift a shopping bag – now helping others in lifting techniques

PATIENT: A 49-year old lady

JOB: The requirements are frequent lifting, pushing and bending which requires her to work up to a medium physical demand level. 

PROBLEM: The lady reported a two-year history of back pain, which started after she completed a long shift. The pain got progressively worse and she could hardly get out of bed the next day. She went to see her GP who told her to rest and take painkillers. She did not get better and was referred for 12 sessions of physiotherapy.  This gave her temporary relief only. At her initial assessment she had been off work for 6-months and felt she required a consultant appointment and surgery as she had not improved since her back pain started. She had no confidence in her back or her ability to do any manual handling tasks. She said she lived alone and found it difficult to carry shopping bags or push a trolley around the supermarket.

ATTENDANCE: The patient attended for 8 day release sessions.

OUTCOME: She improved significantly and felt she no longer required further investigations or surgery. Her strength and mobility improved and she regained her confidence in doing manual handling. She returned back to work after 4-weeks.  She asked to do her full duties after 6-weeks which she found light because of her increased mobility, strength and improved work techniques. She was on full duties at the 1-month follow-up and reported she was now showing her colleagues how to perform good lifting and handling techniques at work.    

After a nine year history of back pain – he can now see an active future

PATIENT: A 40-year old LGV driver

JOB:  His job involved driving LGV’s across London and coupling and uncoupling boxes from the cab, which required a one-arm lift of up to 60kg. The job is described as having heavy physical demands.  

PROBLEM: He had a 9 year history of low back pain. His most recent episode started 8 months before whilst pulling a trolley at work.. He had severe back pain and was unable to move. He had 13 sessions of physiotherapy but with only marginal improvements. He was referred to a consultant and an MRI scan showed a prolapsed disc. However, surgery was not indicated.  He was disappointed with his past treatment, as he was unable to play in the park with his children. He was also concerned about his financial situation as he was receiving reduced pay and could not see himself returning to work in the near future. 

ATTENDANCE: Following the initial assessment the patient attended 10 sessions of biopsychosocial functional restoration.

OUTCOME: His function started improving with increased strength and following a vehicle and workplace assessment he began a graduated return to work programme. His pain reduced and his confidence improved in lifting and playing with his children. After 10 weeks he was on full duties and playing with his children in the park.  He reported he was 200% better both physically and psychologically as he can see an active future for himself and his family.

Unable to self-manage back pain any longer – now fit and well

PATIENT: A 53-year Van Delivery Post person.

JOB:  His job involved delivering mail to various companies driving a van and collecting trolleys weighing up to 256 kg.  He had to push these up a ramp and frequently had to lift from floor to knuckle height.  The job is described as having heavy physical demands.  

PROBLEM: He had a 4-year history of recurrent episodes of back pain, which normally resolved themselves within 2 to 4 weeks. The most recent episode was 4 months before, when he lifted a car battery at home. He was able to return to work but was in severe pain at the end of his shift.  Physiotherapy was not beneficial and he relied on painkillers to stay at work. At his initial assessment he said he did not feel able to continue at work.  He thought he would need time off.  He had been on a consultant’s waiting list for three months. He enjoyed gardening and socialising but now could not do these things.

ATTENDANCE: Following the initial assessment the patient attended 8 sessions of biopsychosocial functional restoration.

OUTCOME: He responded quickly to reactivation. Following advice and participating in the programme he experienced less pain at the end of his shift and by the end of the programme reported feeling fit and healthy. Objective measures showed an increase in his physical and perceived capabilities and as result he cancelled his consultant’s appointment. He was now confident he could self manage any future recurrences. At his three-month re-assessment he had had one day with increased pain but managed this with exercise.

Chronic back pain with no clear cause – now back at work

PATIENT: A 48-year old Transport  Manager

JOB:  His job was of a sedentary demand level and was office based. He was, however, required to stand in and do overtime which included driving HGV’s.

PROBLEM: He had a first incidence of back pain 4-months before which started without any specific incident. He attempted to stay at work but when the pain started to radiate down his left leg he had to take time off. He consulted his GP and was prescribed painkillers.  He paid privately to see two osteopaths and a physiotherapist. He had about 18 sessions in total and reported no difference in his pain or ability to function. He was not sure what to do or where to go next. 

ATTENDANCE: Following the initial assessment the patient attended 6 sessions of biopsychosocial functional restoration.

OUTCOME: All objective measures improved quickly and he was able to self-manage his condition. He started swimming regularly and lost 10lbs in weight, which was one of his objectives. At the three month assessment he remained at work and had lost a further stone.  There were no symptoms and he felt the fittest he had been in years.

Told not to walk – now he can go on a pilgrimage

PATIENT: A 30-year old delivery post person

JOB:  His job involved carrying mail pouches weighing up to 18kg covering at least 5 miles per day. The job is described as having a heavy physical demand.

PROBLEM: His problems started 4-months before, after carrying pouches up stairs. The pain radiated into his buttock and both thighs. He saw his GP and was referred for physiotherapy. He was told that his pelvis was not moving as it should and would take months to recover. As sitting aggravated his pain, he was told not drive and not to walk if he experienced pain in his back. He found this very frustrating, as his wife couldn't drive and they needed to go shopping, as they lived some distance away from a supermarket. He was also very depressed as he had flights booked for a pilgrimage to Mecca but he now felt he had to cancel this.

ATTENDANCE: Following the initial assessment the patient attended 10 sessions of biopsychosocial functional restoration.

OUTCOME: His sitting ability increased and he able to drive to the shops after the first week. He was encouraged to increase his walking distance and speed and he managed to walk 2-miles after 4-weeks. This coincided with a return to work and he managed to increase his walking distance until he was back on full duties after 8-weeks. At his three-month follow-up, he had managed to complete his pilgrimage and remained on full duties and was able to do full walks without aggravating his pain.