Table 3.

Summary of Program Changes

Change	Rationale
Program addresses general pain problems, not just back pain	Exercise and cognitive–behavioral therapies are beneficial for a wide range of pain problems. Pain of different etiologies contributes to decreased activity and functional limitations in the frail, older home health population. Effective pain self management is critical for preserving mobility and functional abilities.
Number of sessions reduced from 8 to 6	Number of program sessions needed to be reduced to fit within the usual number of physical therapy sessions in home care.
Deletion of content areas.	Reduction in number of sessions necessitates reduction in the amount of content delivered. Content deleted included: recognizing automatic thoughts and emotions, evaluating automatic thoughts, and use of positive thoughts.
Group exercise changed to individualized exercise prescription	Patients receiving home care have a variety of physical impairments, while those in the senior-center-based program all had lower back pain. Individualized exercise is a fundamental part of PT practice with therapists developing programs specific to each patient’s impairments and functional limitations.
Patient handouts modified	Eliminated content in areas deleted from program Modified writing for 4th grade readability Used color in diagrams to increase visual interest Added diagrams for breathing exercises Increased font size
Training program developed for home health PTs	Incorporated practice of techniques – deep breathing, muscle relaxation, visual imagery Developed video to demonstrate integration of content within a home care session Included training on patient clinical record documentation