title: Implementing a Pain Self-Management Protocol in Home Care: A Cluster-Randomized Pragmatic Trial.
abstract: OBJECTIVE
  To determine the effectiveness of a cognitive-behavioral pain self-management (CBPSM) protocol delivered by physical therapists (PTs) for use by older adults with activity-limiting pain receiving home care.
  
  
  METHODS
  A randomized pragmatic trial comparing delivery of the intervention plus usual care with usual care alone.
  
  
  METHODS
  Community.
  
  
  METHODS
  Individuals aged 55 and older admitted with orders for physical therapy who endorsed activity-limiting pain and reported pain scores of 3 or greater on a scale from 0 to 10 (N = 588).
  
  
  METHODS
  A CBPSM protocol delivered by PTs.
  
  
  METHODS
  Primary outcomes were assessed at 60 days using validated measures of pain-related disability, pain intensity, gait speed, and number of activity of daily living (ADL) deficits.
  
  
  RESULTS
  Of 588 participants, 285 received care from a PT randomized to the intervention and 303 from a PT randomized to the usual care group. Both groups had significant reductions in pain-related disability, pain intensity, and ADL limitations and improved gait speed. No significant treatment differences were identified. There were no consistent treatment differences when interactions and subgroups were examined.
  
  
  CONCLUSIONS
  This real-world pragmatic trial found no effect of implementation of a pain self-management intervention in a home care setting. Despite the lack of positive findings, future studies are indicated to determine how similar protocols that have been found to be effective in efficacy studies can be successfully implemented in routine clinical care.
authors.affiliation: Department of Medicine, Weill Cornell Medical Center, New York, New York.
authors.forename: M Carrington
authors.initials: MC
authors.lastname: Reid
authors.affiliation: Department of Human Development, Cornell University, Ithaca, New York.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Henderson
authors.affiliation: Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Trachtenberg
authors.affiliation: Department of Physical Therapy Education, State University of New York Upstate Medical University, Syracuse, New York.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Beissner
authors.affiliation: Department of Compliance, Visiting Nurse Service of New York, New York, New York.
authors.forename: Eileen
authors.initials: E
authors.lastname: Bach
authors.affiliation: Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Barrón
authors.affiliation: Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York.
authors.forename: Sridevi
authors.initials: S
authors.lastname: Sridharan
authors.affiliation: Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Murtaugh
mesh_terms: D000203:Activities of Daily Living; D006699:Home Care Services; D006801:Humans; D059408:Pain Management / Q000379:methods*; D026741:Physical Therapy Modalities; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires
keywords: home care; nonpharmacological treatment; older adults; pain; randomized trial