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Physical Therapists' Use of Cognitive-Behavioral Therapy for Older Adults With Chronic Pain: A Nationwide Survey

K Beissner, PT, PhD, is Professor, Department of Physical Therapy, Ithaca College, 953 Danby Rd, Ithaca, NY 14850 (USA).
CR Henderson Jr, PhD, is Senior Research Associate, Cornell University, Ithaca, New York.
M Papaleontiou, MD, is Physician, Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey.
Y Olkhovskaya, MD, PhD, is Physician, Department of Medicine, Weill Cornell Medical College, New York, New York.
J Wigglesworth, PhD, is Interim Assistant Provost, Ithaca College.
MC Reid, MD, PhD, is Associate Professor, Department of Medicine, Weill Cornell Medical College.

beissner{at}ithaca.edu

Background: Increasing evidence supports the use of cognitive-behavioral therapy (CBT) for patients with chronic pain.

Objective: This study determined whether physical therapists incorporate CBT techniques (eg, relaxation, activity pacing) when treating older patients with chronic pain, ascertained their interest in and barriers to using CBT, and identified participant-related factors associated with interest in CBT.

Design: This cross-sectional study used a telephone survey.

Methods: One hundred fifty-two members of the Geriatrics and Orthopaedics sections of the American Physical Therapy Association completed the survey. Associations between participant-related factors and interest in CBT were assessed in statistical general linear models.

Results: Commonly used CBT interventions included activity pacing and pleasurable activity scheduling, frequently used by 81% and 30% of the respondents, respectively. Non-CBT treatments included exercises focusing on joint stability (94%) and mobility (94%), and strengthening and stretching programs (91%). Respondents' overall interest in CBT techniques was 12.70 (SD=3.4, scale range=5–20). Barriers to use of CBT included lack of knowledge of and skill in the techniques, reimbursement concerns, and time constraints. Practice type and the interaction of percentage of patients with pain and educational degree of the physical therapist were independently associated with provider interest in CBT in a general linear model that also included 6 other variables specified a priori.

Limitations: Data are based on self-report without regard to treatment emphasis.

Conclusions: 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.

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This article has been cited by other articles:

				K. A Sluka and D. C Turk Invited Commentary Physical Therapy, May 1, 2009; 89(5): 470 - 472. [Full Text] [PDF]

				K. Beissner and M. Reid Author Response Physical Therapy, May 1, 2009; 89(5): 472 - 473. [Full Text] [PDF]