The overall goal of the proposed real-world comparative effectiveness research (CER) study is to reduce disability among older home health patients by treating their pain more effectively. Pain is an underassessed and undertreated risk factor for disability among older persons and is a highly prevalent problem in home care. Currently, analgesic medications are by far the most widely administered pain therapy, but there are significant limitations to this treatment approach, especially among frail older adults who are the norm in home health care. Evidence-based non-pharmacological treatments to reduce pain and pain-related disability are available and used in other settings. In preliminary work, study investigators successfully translated their cognitive-behavioral pain self-management (CBPSM) protocol (found to be effective in reducing chronic back pain among individuals at senior centers) for use in home care targeting patients with activity-limiting pain. Physical therapists (PTs), given their academic exposure to these techniques and caseload of patients with activity-limiting pain, are in an ideal position to integrate CBPSM techniques into their practice. Pilot work demonstrated the feasibility and acceptability of the CBPSM protocol to home health PTs and their patients.
The specific aims of this CER application that will include sizeable numbers of Hispanic, non-Hispanic African Americans and non-Hispanic white patients ages 55 and older are:
Aim 1. To compare the effectiveness of usual care provided to older home health patients admitted with activity-limiting pain to usual care plus instruction by PTs in CBPSM techniques;
and Aim 2. To examine the heterogeneity of CBPSM treatment effects among patients with different pain conditions and minority group status. To achieve these aims, a strong interdisciplinary team with expertise in pain, disability, physical therapy, statistics, ad home health care research has been assembled to conduct the project. A manual for training home health clinicians and a standardized protocol for teaching patients how to use CBPSM techniques developed in pilot work constitute key resources in the proposed study. Patients ages 55 and older admitted to the Visiting Nurse Service of New York with activity-limiting pain who meet screening criteria will be invited to participate in a cluster randomized controlled trial A particular strength of the proposed study setting is the large number of minority patients admitted to the agency. We will be able to enroll sizeable numbers of important clinical and demographic groups and examine the extent to which any differences in treatment effects among groups are attributable to differences in PT fidelity to the intervention as well as acceptability to patients. Study results have the potential to transform pain management in home health care and greatly reduce the burden of disability among the large numbers of racially and ethnically diverse older Americans admitted with pain to home health care annually.

Public Health Relevance

The overall goal of the proposed study is to reduce disability among older home health patients by treating their pain more effectively. The study will compare the effectiveness of usual care provided to older home health patients with debilitating pain, to usual care plus instruction by physical therapists in a non-drug pain treatment program developed and widely employed in other health care settings. Project findings have the potential to directly benefit clinical decision makers and a significant share of the several million raciall and ethnically diverse older Americans admitted to home health care annually.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
1R01HS020648-01A1
Application #
8293565
Study Section
Health Care Quality and Effectiveness Research (HQER)
Program Officer
Amin, Shilpa
Project Start
2012-03-01
Project End
2014-12-31
Budget Start
2012-03-01
Budget End
2012-12-31
Support Year
1
Fiscal Year
2012
Total Cost
Indirect Cost
Name
Visiting Nurse Service of New York
Department
Type
DUNS #
078881778
City
New York
State
NY
Country
United States
Zip Code
10021
Makris, Una E; Abrams, Robert C; Gurland, Barry et al. (2014) Management of persistent pain in the older patient: a clinical review. JAMA 312:825-36