CASE STUDY A
Kevin Smith
Fall from a ladder, 2 years off work
Kevin Smith was a painter who injured his ankle and shoulder in 2003 in a work-related accident. Chronic pain and related problems meant that Kevin was off work for 2 years. Before coming to AlphaOne Intensive, Kevin had tried various treatments with limited or no success including regular physiotherapy, gym strengthening, two arthroscopies and acupuncture. He had also attended a hospital-based pain management program but, due to his argumentative and destructive behaviour, he was asked to leave that program. Kevin's insurer indicated that he was difficult to work with and he tended to resist referrals to various rehabilitation programs.
On arrival at AlphaOne in 2006, Kevin was unfit for work. His baseline psychosocial scores indicated that he had high levels of psychological distress and fear avoidance, both factors suggesting a poor prognosis for work return.
Given his history and presentation at the baseline assessment, the AlphaOne Intensive team recommended that Kevin take part in the one-to-one program option, in preference to the group-based option. Initially, Kevin was confrontational and posed various barriers to improvement. However, once he realized that the Personal Achievement Coaching (PAC) and psychology sessions were tailored to his specific needs and that, when applied, he found the strategies helpful, his approach changed.
Kevin learned about and was able to improve his core and lumbo-pelvic stability and lower limb function. These measured improvements in physical capacity probably improved his chronic symptoms. Kevin also reported improvements in managing pain using distraction, relaxation, pacing, stretching and cognitive restructuring. Kevin increased his daily activity by applying pacing techniques and developed new strategies to complete tasks and avoid the boom-bust cycle that had caused him to relapse in the past.
Kevin attributed improvements in his attitude to practicing the skills of replacing Automatic Negative Thoughts (ANTS) with Performance Enhancing Thoughts (PETS) and learning to recognize and restructure his 'hot thoughts' which typically set off his bad moods. In particular, he found the cognitive restructuring techniques most helpful. Kevin stated that by using these techniques he had developed more control over his emotions, particularly his anger and also his pain. He also reported lifestyle improvements in relation to sleep and diet.
Before the end of the program, Kevin achieved an upgrade to 25 hours per week work-readiness and had a plan to attend the Job Placement Program (JPP).