Group Wellness Programs for Chronic Pain and Disease Management.

Group Wellness Programs for Chronic Pain and Disease Management

McManus CA. St Louis, MO 63146, Butterworth-Heineman Inc, 2003, paperback, 240 pp, illus, ISBN: 0-7506-7397-4, $39.95.

The stated purpose of this text is to provide a framework for health care practitioners to design and implement wellness programs for patients with chronic medical problems. The author's intended audience includes physical therapists, occupational therapists, nurses, nutritionists, psychologists, and exercise physiologists who are interested in expanding their practices to include wellness intervention. The book consists of 12 chapters in 4 sections, with references cited at the end of each chapter. Most chapters also include an annotated bibliography containing other recommended resources such as related texts, software programs, and audio cassette programs.

Chapter 1 defines the concept of wellness and presents a context far wellness programs that fits within the current health care model. The author cites several articles published in peer-reviewed medical journals that suggest wellness programs have real benefit for patients with chronic medical conditions. She demonstrates that, although the wellness approach may he considered "alternative," substantial evidence supports its use. Chapter 2 completes the first section by describing the benefits of a group setting for this type of intervention and details the skills that an effective facilitator should have before beginning such a program. The author suggests strategies for selecting group size, applying a teaching style, facilitating group discussions, and dealing with challenging participants.

The second section, containing chapters 3 to 6, outlines suggested wellness program topics, including mindfulness, stress and relaxation, attitudes and beliefs, and nutrition. The author addresses each topic with a combination of descriptive text with multiple literature citations and case examples.

Chapter 3 begins with a simple definition of mindfulness as "present moment awareness" and then effectively demonstrates the effect mindfulness can have on injury prevention, medical treatment, pain management, and overall quality of life. The author provides several group exercises to introduce participants to different applications of mindfulness and presents a compelling summary of the available research investigating mindfulness meditation. She describes the difficulties often encountered by participants and suggests strategies for addressing these difficulties.

The 2 chapters that follow addresses stress and relaxation and describe the effect of individual attitudes and beliefs on health. Chapter 4 effectively describes the stress reaction and then reviews and briefly summarizes the medical literature addressing stress and disease. It includes several relaxation exercises designed for group settings and strategies for addressing the difficulties participants often encounter with these exercises. The subsequent chapter introduces the concepts of catastrophic thinking, locus of control, and cognitive restructuring in a manner that should help program facilitators present these concepts to a group, along with suggestions for modifying maladaptive thought patterns and attitudes.

Chapter 6 introduces basic nutritional concepts, generally defines and describes the role of various nutrients, and gives an overviews of weight-control strategies. Although not intended to instruct the reader in nutritional intervention, the information in this chapter is adequate for lecture planning in the context of designing wellness programs.

The third section of the book, consisting of chapters 7 to 9, deals with the role of fitness and exercise in wellness programs. Chapter 7 begins with a brief, but well-referenced literature review outlining the effects of exercise in relation to various disease processes. The chapter then briefly describes principles of exercise program design and suggests some strategies for introducing exercise in a group setting. The author appropriately avoids making specific exercise program recommendations, recognizing that those need to be tailored to meet the needs of each particular group. The remainder of the section introduces the concept of mindful movement and discusses various strategies for adherence to exercise programs. The author appropriately recommends that program designers consult a physical therapist or exercise physiologist for developing this component of a wellness program.

The final section of the book effectively ties the preceding material together and serves to assist the reader with the details of program development. Chapter 10 is a detailed outline of a sample 8-week wellness program, including objectives and plans for each class and a series of effective handouts for class participants. The author and publisher grant permission in the text for these handouts to be copied and distributed. Chapter 11 discusses assessment instruments commonly used in the medical literature and recommends that program designers include an assessment instrument to assess the effectiveness of their program and to provide a basis to plan program improvements. The final chapter discusses the administration of a wellness program; it also covers marketing and budgeting briefly, but in sufficient detail to allow the reader to address these issues during program design.

In summary, the author has constructed a readable, effective, and well-documented resource for clinicians interested in designing wellness programs. I recommend this text to any clinician interested in expanding his or her practice to include this type of intervention.

Todd A Forman, PT

Holliston, Mass

Mr Forman is a member of the multidisciplinary team of clinicians who make up Integrative Therapeutics in Natick, Mass. He specializes in manual therapy and outpatient orthopedic rehabilitation.