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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., Chronic pain is a highly prevalent and often disabling condition among older adults. (1-3) Prior research has demonstrated strong associations between chronic pain and substantial morbidity, including depression and functional [...]

Background and Purpose. Home health care is a rapidly growing form of practice for physical therapists. This study examined how physical therapists are providing these services in one metropolitan area of western New York. Subjects and Methods. By completing a log sheet, 19 home health physical therapists provided data on 737 home visits, indicating the number of minutes spent in 50 home health activities over a 2-week period. Visits were recorded for 279 patients with an average age of 64.3 years (SD=21.8, range=0-101). Results. Therapists reported that direct patient treatment was the most time-consuming portion of each home visit and that exercise was the most frequent and time-consuming type of treatment provided. Older patients received shorter treatments than younger patients received. Patients with neurological diagnoses received the longest treatments. Patient education was provided in 54% of all home visits. Conclusion and Discussion. This study provides data regarding the practice patterns of home health physical therapy in one community. Further research is needed to determine how these patterns compare with those in other parts of the country. Studies of the effectiveness of home health physical therapy are also necessary. [Collins J, Beissner KL, Krout J. Home health physical therapy: practice patterns in western New York. Phys Ther. 1998;78:170-179.], Home health care services are increasing in the United States. Data from the 1993 National Home and Hospice Care Survey show that there was a 33% increase in the number [...]

Background and Purpose. The purpose of this study, was to identify, factors that predict successful work hardening outcomes. Two measures of success were used: return to work and case closure (ie, resolution of medical treatment issues). Subjects. Persons with spine-related injuries who completed a work hardening program were the subjects. One hundred fifteen subjects participated in a 3-month follow-up survey, and 111 subjects participated in a 3-month follow-up survey. Methods. Data were collected on subject characteristics, treatment history, job factors, program payer, and program factors. Subjects were contacted by telephone at 3 and 12 months after program completion to determine work status. Logit analysis was used to Identify. predictors of successful versus unsuccessful outcomes. Results. Three months after program completion, 68% of the subjects had returned to work and 86% had successful case closure. Twelve months after program completion, 77% of the subjects had returned to work and 90% had successfull case closure. The more treatment subjects received prior to entering the program, the less likely they were to be working or achieving case closure following treatment. Subjects' work status and initial time off of work were factors predicting early return to work, but not 12 months after program completion. Subjects who were working with an attorney were less likely, to achieve case closure than those who were not working with an attorney. Subjects who were satisfied with the program were more likely to have achieved case closure or return to work than those who were not satisfied with the program. Conclusion and Discussion. Several factors have been identified that predict successful work hardening outcomes. This information can be used to identify clients who are unlikely to benefit from work hardening. [Beissner KL, Saunders RL, McManis BG. Factors related to successful work hardening outcomes. Phys Ther. 1996,76: 1188-1201., Work hardening programs are structured, multidisciplinary, work-oriented programs that are supposed to simulate or duplicate actual job tasks.[1] This job-specific type of rehabilitation program attempts to address the vocational and [...]

To the Editor: In the article by Beissner et al entitled "Muscle Force and Range of Motion as Predictors of Function in Older Adults" (June 2000), the use of the [...]

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. [Beissner KL, Collins JE, Holmes H. Muscle force and range of motion as predictors of function in older adults. Phys Ther. 2000;80:556-563.] Key Words: Functional training and activities; Geriatrics; Lower extremity, general; Muscle performance, lower extremity., About 10% of the nondisabled adult population aged 75 years and older lose independence in one or more basic activities of daily living (ADL) each year.[1] According to government data, [...]

May BJ. Philadelphia, PA 19103-1493, FA Davis Co, 1993, hardback, 381 pp, illus, $60. Despite an explosion in home health care over the past decade, there has been little written [...]