Purpose The prevalence of pain in older adults receiving home health care is high, yet safety concerns for analgesic therapy point to a need for non-pharmacologic 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. Methods Thirty-one PTs volunteered to participate, completed two 4-hour training sessions, and recruited twenty-one patients with activity-limited pain who consented to participate in the study. PTs completed pre- and post-test assessments of CBPSM knowledge at the first training session, provided structured survey feedback after the second training session, and responded to a phone survey three 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. Results Participating PTs were experienced in physical therapy (average 16.5 years) and in home health care (average 11.0 years). Analysis of pre- and post-test data showed that PTs’ CBPSM knowledge increased from a pre-test mean of 60.9% to a post-test mean of 85.9%. Audiotape analysis indicated 77.7% therapist adherence to the protocol. At three-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 percent of patients finding a technique helpful for pain management ranged from 71.4% to 81.2%. Conclusion This study offers preliminary data on use of non-pharmacologic 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.

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.