Combined Sections Meeting 2008 Section on Geriatrics Poster and Platform Presentations: PLATFORM PRESENTATIONS
Purpose/Hypothesis: The high prevalence of chronic pain among older adults, coupled with concerns over medication side-effects, lead to an increased interest in the non-pharmacological management of pain in this growing population. Physical therapy (PT) and cognitive behavioral therapy (CBT) are two commonly used approaches to pain management that have increasing research support. Some components of CBT, such as muscle relaxation, distraction techniques, and activity pacing, overlap with interventions used by physical therapists. We conducted a nationwide survey of physical therapists to determine a) the types and frequency of use of specific interventions employed by therapists when treating older patients with chronic pain and b) their level of interest in (and perceived barriers to) incorporating CBT approaches into PT treatment programs. Subjects: Of 184 APTA Geriatrics and Orthopaedic Section members contacted by telephone, 152 (82.6%) agreed to participate. Materials/Methods: Subjects completed a 10 minute telephone survey regarding treatments used with older adults with chronic pain. Initial questions addressed the frequency with which therapists use a variety of treatment options; additional items ascertained therapists' interest in, and barriers to use of specific CBT approaches. Data were analyzed with descriptive statistics. Results: Older adults with chronic pain comprised more than 50% of the patient case load for 28% of subjects. Frequently used active interventions for the treatment older adults with pain included the following types of exercise: joint stability (94.7%), joint mobility (94.1%), and general stretching/strengthening (90.8%). Most frequent passive techniques were thermal agents (69%), soft tissue techniques (55.9%), and electrical stimulation (45.4%). The most frequently used CBT interventions were activity pacing (80.3%), counseling on scheduling pleasurable activities (38.8%), and cognitive restructuring (23.1%). Interest in CBT was high, with greatest interest in activity pacing (98%), cognitive restructuring (94.1%), and muscle relaxation (91.4%). The most common barriers to using CBT include lack of knowledge/skill in the technique (59.2%), reimbursement concerns (30.9%) and lack of time (27.0%). Conclusions: While some passive therapeutic modalities are used regularly by physical therapists, treatments emphasize active exercise. Many therapists are interested incorporating CBT into their therapeutic programs, but concerns with their knowledge about the techniques, time constraints, and reimbursement concerns currently limit use of CBT by physical therapists. Clinical Relevance: In February 2007 the American Heart Association recommended non-pharmacologic interventions as the first line therapy for older adults with chronic pain. If these guidelines are followed, increasing numbers of patients with chronic pain conditions will be referred to PT. This study identifies the preferred interventions used by therapists to treat patients with pain, and highlights interest in and barriers to incorporating elements of CBT into PT practice.