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Pain and Function in Home Care: A Need for Treatment Tailoring to Reduce Disparities?

Murtaugh, Christopher M. PhD; Beissner, Katherine L. PT, PhD; Barrón, Yolanda MS; Trachtenberg, Melissa A. BA; Bach, Eileen DPT; Henderson, Charles R. Jr MA; Sridharan, Sridevi MS; Reid, Manny C. MD

doi: 10.1097/AJP.0000000000000410
Original Articles

Objectives: To describe racial/ethnic group differences in pain presentation and the prevalence of psychosocial factors among patients admitted to home health care, and to determine the extent of racial/ethnic group differences in the association of psychosocial factors with pain intensity and pain-related disability.

Methods: We analyzed cross-sectional data on 588 patients with activity-limiting pain admitted to home care for physical therapy. Three psychosocial factors were assessed: depressive symptoms, pain self-efficacy, and health literacy. Statistical methods included estimation of general linear models of pain intensity and pain-related disability.

Results: Hispanics and non-Hispanic blacks report a greater number of pain sites, worse pain intensity, and higher levels of pain-related disability than non-Hispanic whites and others. Racial/ethnic minority group patients also have a higher prevalence of adverse psychosocial factors than others, with evidence that race/ethnicity interacts with pain self-efficacy and depressive symptoms in their association with mean pain intensity and pain-related disability, respectively.

Discussion: The substantial racial/ethnic difference in the psychosocial profiles of older adults with activity-limiting pain highlights the importance of screening for these modifiable risk factors and tailoring interventions accordingly. Direct attention to the psychosocial needs of patients could help to address racial/ethnic disparities in pain outcomes.

*Center for Home Care Policy & Research

Department of Compliance & Regulatory Affairs, Visiting Nurse Service of NY

Division of Geriatrics & Palliative Medicine, Weill Cornell Medical Center, New York

Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse

§Department of Human Development, Cornell University, Ithaca, NY

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

This project was supported by grant number R01HS020648 from the Agency for Healthcare Research and Quality, Rockville, MD. The authors declare no conflict of interest.

Reprints: Christopher M. Murtaugh, PhD, Center for Home Care Policy & Research, Visiting Nurse Service of NY, 1250 Broadway, 7th floor, NY, NY 10001 (e-mail:

Received December 8, 2015

Received in revised form July 16, 2016

Accepted June 22, 2016

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