Purpose: The prevalence of pain in older adults receiving home health care is high, yet safety concerns for analgesic therapy point to a need for nonpharmacologic approaches to pain management in this population. The purpose of this study was to determine the feasibility and acceptability to physical therapists (PTs) and patients of a cognitive-behavioral pain self-management (CBPSM) program.
Methods: Thirty-one PTs volunteered to participate, completed two 4-hour training sessions, and recruited 21 patients with activity-limited pain who consented to participate in the study. Physical therapists completed pre- and posttest assessments of CBPSM knowledge at the first training session, provided structured survey feedback after the second training session, and responded to a phone survey 3 months after training. Patients provided feedback during weekly phone interviews, while receiving the CBPSM program. Treatment sessions were audiotaped during delivery of the self-management pain protocol. Audiotapes were evaluated by independent raters for program fidelity.
Results: Participating PTs were experienced in physical therapy (average 16.5 years) and in home health care (average 11.0 years). Analysis of pre- and posttest data showed that PTs' CBPSM knowledge increased from a pretest mean of 60.9% to a posttest mean of 85.9%. Audiotape analysis indicated 77.7% therapist adherence to the protocol. At 3-month follow-up, 24.0% of therapists continued to use the entire protocol with their patients presenting with activity-limiting pain. Patient data show high rates of patient recall of being taught protocol components, trying components at least once (ranging from 84.4% to 100.0%) and daily use of protocol components (ranging from 47.3% to 68.4%). The percentage of patients finding a technique helpful for pain management ranged from 71.4% to 81.2%.
Conclusion: This study offers preliminary data on the use of nonpharmacologic pain self-management strategies by PTs in home health setting. Positive feedback from PTs and patients suggests that the translated protocol is both feasible and acceptable.
1Visiting Nurse Service of New York (VNSNY) Home Care, New York.
2Department of Physical Therapy, Ithaca College, Ithaca, New York.
3VNSNY Center for Home Care Policy and Research, New York.
4Division of Geriatrics, Weill Cornell Medical College, New York.
Address correspondence to: Eileen Bach, PT, DPT, Visiting Nurse Service of New York Home Care, 1250 Broadway, 3rd floor, Rehabilitation Services, New York, NY 10001 (firstname.lastname@example.org).
This research project was supported by a grant from the National Institute on Aging: An Edward R. Roybal Center grant (P30AG022845).
The authors declare no conflict of interest.
A portion of this work was reported in a Late-Breaker poster titled “Translating Cognitive-Behavioral Pain Self Management Training Into Home Care Physical Therapy” at the Gerontological Society of America 2010 Annual Conference.