Department of Physical Therapy, Ithaca College, Ithaca, New York, New York, USA.
J Geriatr Phys Ther. 2013 Jul-Sep;36(3):123-9. doi: 10.1519/JPT.0b013e31826ef67b.
Pain is highly prevalent among older adults receiving home care, contributing to disability, increased health care utilization, nursing home placement, and diminished quality of life. Pain is a particular problem in the home care setting, where current approaches are often inadequate, resulting in persistent high levels of pain and disability in this vulnerable population. Cognitive-behavioral approaches to pain management have demonstrated effectiveness in reducing pain intensity and associated disability but have not been systematically implemented in home health care. The purpose of this project was to adapt a community-based, cognitive-behavioral pain self-management program designed for patients with persistent back pain for implementation by physical therapists (PTs) to use with patients with activity-limiting pain in the home care setting.
In this observational study, 2 groups of PTs practicing in home care were trained in the community-based program and completed surveys and participated in discussions during the training workshops to gather input on the program components perceived to be most helpful for their patients with pain; modifications to the program and the patient education materials for use in home care; and recommendations concerning program training and support required for successful implementation. Data collected during the workshops were summarized and presented to 2 expert panels for additional input and final decisions regarding program adaptations.
Seventeen PTs with an average of 16.6 years of practice as a PT received the training and provided input on the community-based program. Program modifications based upon PT and expert panel review included reduction in the number of sessions, deletion of content, modification of the exercise component of the program, revision of patient materials, and modification of therapist training.
DISCUSSION/CONCLUSIONS: This study successfully adapted a group-based pain management program for implementation by health care providers in a home care setting. The process described here may be useful for other groups planning to implement evidence-based programs in new settings. Part 2 of this study, a companion article in this issue, describes the field-testing of this home-care adapted program.
接受家庭护理的老年人普遍存在疼痛，这导致残疾、增加医疗保健利用、入住疗养院和降低生活质量。疼痛是家庭护理环境中的一个特殊问题，目前的方法往往不够充分，导致这一脆弱人群持续存在高疼痛水平和残疾。认知行为疗法在疼痛管理方面已被证明可有效降低疼痛强度和相关残疾，但尚未在家庭健康护理中得到系统实施。本项目的目的是改编一个基于社区的、针对持续性背痛患者的认知行为疼痛自我管理计划，使其适用于家庭护理环境中活动受限疼痛的患者，并由物理治疗师（PT）实施。
在这项观察性研究中，两组在家庭护理中执业的 PT 接受了基于社区的方案培训，并在培训研讨会期间完成了调查和参与讨论，以收集有关对他们的疼痛患者最有帮助的方案组成部分的意见；针对家庭护理中使用的方案和患者教育材料进行修改；以及关于成功实施所需的方案培训和支持的建议。研讨会期间收集的数据进行了总结，并提交给两个专家小组，征求他们对方案改编的进一步意见和最终决策。
17 名平均有 16.6 年 PT 执业经验的 PT 接受了培训，并对基于社区的方案提供了意见。基于 PT 和专家小组审查的方案修改包括减少疗程、删除内容、修改方案的运动部分、修订患者材料和修改治疗师培训。
讨论/结论：本研究成功改编了一个基于小组的疼痛管理方案，以便在家庭护理环境中由医疗保健提供者实施。这里描述的过程可能对其他计划在新环境中实施基于证据的方案的小组有用。本研究的第二部分，即本期的一篇配套文章，描述了这个家庭护理改编方案的现场测试。
