Although only a minority of physical therapists reported use of some CBT techniques when treating older patients with chronic pain, their interest in incorporating these techniques into practice is substantial. Concerns with their skill level using the techniques, time constraints, and reimbursement constitute barriers to use of the interventions.

Purpose To determine the feasibility and potential efficacy of a self-management program that combines cognitive-behavioral strategies with exercise for use by seniors with chronic back pain, and to assess for possible race/ethnicity differences in program impact. Design/Methods Sixty-nine participants attending senior centers in New York City enrolled in the 8-week group-based program, with approximately equal numbers of African Americans (n=24), Hispanics (n=25), and non-Hispanic whites (n=20) enrolling. Participants provided weekly input on their perceived understanding and usefulness of program components. Efficacy outcomes included pain-related disability, as measured by the Roland Morris Disability Questionnaire (RMDQ), pain intensity, pain self-efficacy, depressive symptom score, social activity, and functional status. Results Eighty percent of enrollees completed the program, and 84% of program participants indicated they did the weekly practice/homework exercises. Program content was rated as understandable and highly useful to participants. Significant decreases in RMDQ scores were found for non-Hispanic white (adjusted change score −3.53), African American (−3.89), and Hispanic (−8.45), participants. Significant improvements in all other efficacy outcomes (pain intensity, social activity, activities of daily living, depressive symptoms) were observed, but only for Hispanic participants. Conclusions These results confirm that implementation of the protocol in urban senior centers is feasible, and the program shows potential efficacy in affecting pain-related disability among a diverse population of older adults. The race/ethnicity differences observed in the current study merit further investigation.

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.

Objective Prior to testing the feasibility/potential efficacy of a newly developed self-management pain program for seniors with back pain, this study sought to: 1) determine prospective consumers’ prior exposure to self-management pain programs, 2) determine their willingness to participate in the new program; and 3) ascertain perceived barriers/facilitators to program participation. Design Cross-sectional survey. Setting Six senior centers located in New York City. Participants We enrolled a race/ethnicity stratified (African American, Hispanic, or non-Hispanic White) sample of 90 subjects who were ages 60 years or older and had chronic back pain. Results While 60% of non-Hispanic Whites reported prior participation in a self-management pain program, fewer Hispanic (23%) and African Americans (20%) participants reported prior participation. Most participants (80%) were strongly willing to participate in the new program. Multivariate analyses revealed that only pain intensity had a trend toward significance (p=.07), with higher pain scores associated with greater willingness to participate. Few barriers to participation were identified, however, respondents felt that tailoring the course to best meet the needs of those with physical disabilities, providing flexibility in class timing, and informing individuals about program benefits prior to enrollment could help maximize program reach. No race/ethnicity differences were identified with respect to willingness to participate or program participation barriers. Conclusions These data support efforts to disseminate self-management pain programs in older populations, particularly minority communities. The recommendations made by participants can help to guide implementation efforts of the newly developed pain program and may help to enhance both their reach and success.

Background and Purpose. Musculoskeletal impairments and functional limitations are linked to disability in older adults. The purposes of this study were to identify the extremity musculoskeletal impairments that best predict functional limitations in older adults and to assess the validity of measurements obtained for the Physical Performance Test (PPT) as a predictor of disability. Subjects and Methods. Eighty-one older adults residing in independent and dependent care facilities were tested for extremity muscle force, range of motion, and function. Data were analyzed using multiple regression analysis to identify extremity impairments that predicted function scores and logistic regression analysis to determine whether PPT scores predicted subjects' living situation as dependent versus independent. Results. Subject age, lower-extremity muscle force, and lower-extremity range of motion explained 77% of the variance in function as measured by the PPT. Results differed when analysis was done by the subjects' living situation, with a higher percentage of the variance in function scores explained by musculoskeletal measures for the dependent living group as compared with the independent living group. Conclusion and Discussion. Extremity musculoskeletal impairments have a strong relationship to function, especially in older adults living in dependent care settings. The results of this study can be used to design interventions to address the musculoskeletal disorders most related to function in the older population.