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 November 2012 and November 2013. Pain related disability was reduced on average by 26% from start to completion of the FRP, and these improvements were maintained at a four week follow up. 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 14% on average and anxiety scores reducing by 11%. Positive outlook scores were improved by 17% on average. On average, functional ability improved by 27% from programme start to programme completion, and improvements of 39% were observed 4 weeks following programme completion, indicating further gains. 80% of patients who completed the FRP rated it as “Excellent” overall and another 20% rated the programme as “Good” overall. No patients rated the programme as “Average” or “Poor”. Most patients verbally reported meaningful positive changes in aspects of their functioning and quality of life Representative sample based on 35 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 shows that for the clients in the Functional Restoration Programme (FRP) there was a significant average reduction of 26% in pain related disability scores between admission and discharge from the programme. Reducing Pain-Related Disability Real Health 2013 The Oswestry Disability Index (ODI) is a self –report measure used to assess the extent that back pain affects a patient’s ability to manage everyday life. Total scores are converted to a percentage with 0% representing the highest level of functioning. Scores under 20% are classified as minimal disability while scores of 20-40% are classified as moderate disability. Our clients showed an average reduction in ODI scores of 25% from the start of the FRP to programme completion, indicating a significant reduction in the impact of pain on everyday life.

3. Real Health 2013 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, marginal clinical improvements were nevertheless achieved: depression and anxiety scores were reduced by 14% and 11% respectively from start to completion of the FRP.

4. Reclaiming lost roles Analyses of our qualitative information based on patients’ feedback indicates 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 2013 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 17% 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 four weeks after programme completion. Walking further Walking distance improved by 24% at the end of the programme with gains being maintained at follow-up, indicating a 21% improvement compared to the start of the programme. Real Health 2013

6. Climbing stairs There was a 18% average improvement in sit-to-stand ability by the end of the programme and further gains were observed at follow-up, indicating 45% improvement compared to the start. Moving better A 38% average improvement was noted at the end of the programme which had risen to 51% average improvement by follow-up, indicating patients were continuing to build on their gains. Real Health 2013

7. Rating of the FRP as a whole At the end of the FRP, patients were asked to rate the programme as a whole. The graph below shows that 80% of our patients rated the programme as excellent and 20% rated it as good. No patients out of a total of thirty-five who completed our FRP over the past twelve months rated the programme as average or poor. Real Health 2013

8. “I have really enjoyed the past two weeks. I have so much to take away with me and I am no longer scared of the future” 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!” “I am now clear on why I need to exercise regularly and the benefits this will bring.” Real Health 2013 “Great team, all singing from the same hymn sheet. Thank you all” “Expectation met above what I was expecting.” “I came with a totally open mind and have come away feeling more positive and confident about my future.” “Beyond expectations.” “I feel the programme has given me a new lease of life.” “Made me think about my lifestyle and has given me the tools to change.” “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.” “Delivery was brilliant. Course content was relevant and empowering.” “Thank you all so much for all of your help! I’m a totally different person compared to when I started. Thanks to all at Real Health.”