Visiting Nurse Service of New York VNSNY Home Care, New York, NY 10001, USA.
J Geriatr Phys Ther. 2013 Jul-Sep;36(3):130-7. doi: 10.1519/JPT.0b013e31826ef84d.
The prevalence of pain in older adults receiving home health care is high, yet safety concerns for analgesic therapy point to a need for nonpharmacologic approaches to pain management in this population. The purpose of this study was to determine the feasibility and acceptability to physical therapists (PTs) and patients of a cognitive-behavioral pain self-management (CBPSM) program.
Thirty-one PTs volunteered to participate, completed two 4-hour training sessions, and recruited 21 patients with activity-limited pain who consented to participate in the study. Physical therapists completed pre- and posttest assessments of CBPSM knowledge at the first training session, provided structured survey feedback after the second training session, and responded to a phone survey 3 months after training. Patients provided feedback during weekly phone interviews, while receiving the CBPSM program. Treatment sessions were audiotaped during delivery of the self-management pain protocol. Audiotapes were evaluated by independent raters for program fidelity.
Participating PTs were experienced in physical therapy (average 16.5 years) and in home health care (average 11.0 years). Analysis of pre- and posttest data showed that PTs' CBPSM knowledge increased from a pretest mean of 60.9% to a posttest mean of 85.9%. Audiotape analysis indicated 77.7% therapist adherence to the protocol. At 3-month follow-up, 24.0% of therapists continued to use the entire protocol with their patients presenting with activity-limiting pain. Patient data show high rates of patient recall of being taught protocol components, trying components at least once (ranging from 84.4% to 100.0%) and daily use of protocol components (ranging from 47.3% to 68.4%). The percentage of patients finding a technique helpful for pain management ranged from 71.4% to 81.2%.
This study offers preliminary data on the use of nonpharmacologic pain self-management strategies by PTs in home health setting. Positive feedback from PTs and patients suggests that the translated protocol is both feasible and acceptable.
在接受家庭保健的老年人中，疼痛的发生率很高，但由于对镇痛治疗的安全性的担忧，这一人群需要采用非药物方法来进行疼痛管理。本研究的目的是确定认知行为疼痛自我管理（CBPSM）方案对物理治疗师（PTs）和患者的可行性和可接受性。
31 名 PT 自愿参加，完成了两次 4 小时的培训课程，并招募了 21 名同意参加研究的活动受限疼痛患者。PT 在第一次培训课程前和后评估 CBPSM 知识，在第二次培训课程后提供结构化调查反馈，并在培训后 3 个月进行电话调查。患者在接受 CBPSM 方案的同时，每周通过电话访谈提供反馈。治疗过程通过录音，治疗师在提供自我管理疼痛方案时进行录音。独立评估者对录音带进行评估，以确定方案的一致性。
参与的 PT 在物理治疗方面经验丰富（平均 16.5 年），在家庭保健方面经验丰富（平均 11.0 年）。对前测和后测数据的分析表明，PT 的 CBPSM 知识从 60.9%增加到 85.9%。录音带分析显示，治疗师对方案的依从性为 77.7%。在 3 个月的随访中，24.0%的治疗师继续在患有活动受限性疼痛的患者中使用整个方案。患者数据显示，患者对所学方案内容的回忆率很高，至少尝试过一次方案内容（范围为 84.4%至 100.0%），每天使用方案内容（范围为 47.3%至 68.4%）。患者认为某种技术对疼痛管理有帮助的百分比范围为 71.4%至 81.2%。
本研究提供了关于物理治疗师在家庭保健环境中使用非药物性疼痛自我管理策略的初步数据。PT 和患者的积极反馈表明，翻译后的方案既可行又可接受。
