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

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.