Implementing a Pain Self-Management Protocol in Home Care: A Cluster-Randomized Pragmatic Trial

Area of Science:

• Gerontology
• Rehabilitation Medicine
• Pain Management

Background:

• Activity-limiting pain is a significant issue for older adults receiving home care.
• Effective pain self-management strategies are crucial for maintaining functional independence in this population.

Purpose of the Study:

• To evaluate the effectiveness of a cognitive-behavioral pain self-management (CBPSM) protocol delivered by physical therapists (PTs) to older adults with activity-limiting pain in a home care setting.

Main Methods:

• A randomized pragmatic trial was conducted comparing the CBPSM intervention plus usual care with usual care alone.
• Participants were individuals aged 55 and older with activity-limiting pain (pain score >= 3/10) receiving home care physical therapy.
• Outcomes assessed at 60 days included pain-related disability, pain intensity, gait speed, and activities of daily living (ADL) deficits.

Main Results:

• Both the intervention and usual care groups showed significant reductions in pain-related disability, pain intensity, and ADL limitations, with improved gait speed.
• No statistically significant differences in primary outcomes were identified between the group receiving the CBPSM intervention and the usual care group.
• Subgroup analyses did not reveal consistent treatment differences.

Conclusions:

• The implementation of a CBPSM protocol by PTs in a home care setting did not demonstrate effectiveness in this pragmatic trial.
• Further research is warranted to explore successful implementation strategies for evidence-based pain management protocols in routine clinical practice for older adults.