Translating Evidence-Based Protocols Into the Home Healthcare Setting

Area of Science:

• Gerontology
• Rehabilitation Medicine
• Health Services Research

Background:

• Activity-limiting pain is prevalent in older home care patients, often complicated by frailty and multimorbidity.
• Effective pain self-management is crucial for this population but challenging to implement in home care settings.

Purpose of the Study:

• To examine the implementation and fidelity of an evidence-based pain self-management program delivered by physical therapists (PTs) in a home care setting.
• To assess PT training, reinforcement methods, and adherence to the program protocol.

Main Methods:

• A cluster randomized controlled trial involving 17 physical therapy teams (320 PTs) at a large urban home care agency.
• Intervention group PTs received interactive training, follow-up sessions, and additional support materials.
• Program fidelity was assessed via electronic health record documentation and PT feedback surveys.

Main Results:

• No significant between-group differences in documenting most program elements.
• Intervention therapists documented instruction in imagery more frequently (p = 0.002).
• PTs reported comfort with program content but identified time as the primary implementation barrier.

Conclusions:

• While PTs found the pain self-management program elements teachable, time constraints and other factors limited adherence.
• Top-down implementation, organizational priorities, program complexity, and patient factors may impede uptake.
• Findings offer insights into implementing complex interventions in home healthcare, emphasizing the need for tailored strategies.