Beissner Katherine L, Bach Eileen, Murtaugh Christopher M, Trifilio MaryGrace, Henderson Charles R, Barrón Yolanda, Trachtenberg Melissa A, Reid M Carrington
Katherine L. Beissner, PT, PhD, is a Professor at Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, New York. Eileen Bach, DPT, MEd, COS-C, CHC, is a Provider and Corporate Compliance Specialist at Compliance and Regulatory Affairs, Visiting Nurse Service of NY, New York, New York. Christopher M. Murtaugh, PhD, is an Associate Director at Center for Home Care Policy & Research, Visiting Nurse Service of NY, New York, New York. MaryGrace Trifilio, BA, is a Research Analyst I at Center for Home Care Policy & Research, Visiting Nurse Service of NY, New York, New York. Charles R. Henderson, Jr., PhD, is a Senior Research Associate at Department of Human Development, Cornell University, Ithaca, New York. Yolanda Barrón, MS, is a Senior Statistical Analyst at Center for Home Care Policy & Research, Visiting Nurse Service of NY, New York, New York. Melissa A. Trachtenberg, BA, is a Research Project Manager at Center for Home Care Policy & Research, Visiting Nurse Service of NY, New York, New York. M. Carrington Reid, MD, is an Associate Professor at Department of Medicine, Weill Cornell Medical Center, New York, New York.
Home Healthc Now. 2017 Feb;35(2):105-112. doi: 10.1097/NHH.0000000000000486.
Activity-limiting pain is common among older home care patients and pain management is complicated by the high prevalence of physical frailty and multimorbidity in the home care population. A comparative effectiveness study was undertaken at a large urban home care agency to examine an evidence-based pain self-management program delivered by physical therapists (PTs). This article focuses on PT training, methods implemented to reinforce content after training and to encourage uptake of the program with appropriate patients, and therapists' fidelity to the program. Seventeen physical therapy teams were included in the cluster randomized controlled trial, with 8 teams (155 PTs) assigned to a control and 9 teams (165 PTs) assigned to a treatment arm. Treatment therapists received interactive training over two sessions, with a follow-up session 6 months later. Additional support was provided via emails, e-learning materials including videos, and a therapist manual. Program fidelity was assessed by examining PT pain documentation in the agency's electronic health record. PT feedback on the program was obtained via semistructured surveys. There were no between-group differences in the number of PTs documenting program elements with the exception of instruction in the use of imagery, which was documented by a higher percentage of intervention therapists (p = 0.002). PTs felt comfortable teaching the program elements, but cited time as the biggest barrier to implementing the protocol. Possible explanations for study results suggesting limited adherence to the program protocol by intervention-group PTs include the top-down implementation strategy, competing organizational priorities, program complexity, competing patient priorities, and inadequate patient buy-in. Implications for the implementation of complex new programs in the home healthcare setting are discussed.
活动受限性疼痛在老年居家护理患者中很常见，而居家护理人群中身体虚弱和多种疾病的高患病率使疼痛管理变得复杂。在一家大型城市居家护理机构进行了一项比较有效性研究，以检验由物理治疗师（PT）提供的基于证据的疼痛自我管理项目。本文重点关注物理治疗师培训、培训后强化内容以及鼓励合适患者采用该项目所实施的方法，以及治疗师对该项目的忠诚度。17个物理治疗团队纳入了整群随机对照试验，8个团队（155名物理治疗师）被分配到对照组，9个团队（165名物理治疗师）被分配到治疗组。治疗组的治疗师接受了为期两节的互动培训，6个月后进行了一次随访。通过电子邮件、包括视频的电子学习材料以及治疗师手册提供了额外支持。通过检查该机构电子健康记录中的物理治疗师疼痛记录来评估项目忠诚度。通过半结构化调查获得了物理治疗师对该项目的反馈。除了意象使用指导外，记录项目内容的物理治疗师数量在组间没有差异，干预组治疗师记录意象使用指导的比例更高（p = 0.002）。物理治疗师对教授项目内容感到自在，但认为时间是实施该方案的最大障碍。干预组物理治疗师对项目方案的依从性有限，研究结果的可能解释包括自上而下的实施策略、相互竞争的组织优先事项、项目复杂性、相互竞争的患者优先事项以及患者参与度不足。讨论了在家庭医疗环境中实施复杂新方案的意义。
