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Randomized Controlled Trial
. 2016 Apr 1;17(4):348-56.
doi: 10.1016/j.jamda.2016.01.001. Epub 2016 Feb 17.

Pain Management Algorithms for Implementing Best Practices in Nursing Homes: Results of a Randomized Controlled Trial

Mary Ersek  1 , Moni Blazej Neradilek  2 , Keela Herr  3 , Anita Jablonski  4 , Nayak Polissar  2 , Anna Du Pen  5
Affiliations
Randomized Controlled Trial

Pain Management Algorithms for Implementing Best Practices in Nursing Homes: Results of a Randomized Controlled Trial

Mary Ersek et al. J Am Med Dir Assoc. .

Abstract

Objective: To enhance pain practices in nursing homes (NHs) using pain assessment and management algorithms and intense diffusion strategies.

Design: A cluster, randomized controlled trial. The intervention consisted of intensive training and support for the use of recommended pain assessment and management practices using algorithms (ALGs). Control facilities received pain education (EDU) only.

Setting: Twenty-seven NHs in the greater Puget Sound area participated. Facilities were diverse in terms of size, quality, and ownership.

Participants: Data were collected from 485 NH residents; 259 for the intervention and 226 for the control group.

Measurements: Resident outcomes were nursing assistant (proxy) report and self-reported resident pain intensity. Process outcomes were adherence to recommended pain practices. Outcomes were measured at baseline, completion of the intervention (ALG) or training (EDU), and again 6 months later.

Results: Among 8 comparisons of outcome measures between ALG and EDU (changes in 4 primary pain measures compared at 2 postintervention time points) there was only 1 statistically significant but small treatment difference in proxy- or self-reported pain intensity. Resident-reported worst pain decreased by an average of 0.8 points from baseline to 6 months among the EDU group and increased by 0.2 points among the ALG (P = .005), a clinically nonsignificant difference. There were no statistically significant differences in adherence to clinical guideline practice recommendations between ALG and EDU following the intervention.

Conclusions: Future research needs to identify and test effective implementation methods for changing complex clinical practices in NHs, including those to reduce pain.

Trial registration: ClinicalTrials.gov NCT01399567.

Keywords: Pain; algorithm; clinical trial; diffusion of innovations; evidence-based practice; nursing homes; older adults; palliative care.

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Figures

Fig. 1
Fig. 1. Schematic of the study activities
Figure 2
Figure 2. CONSORT diagram of participant recruitment and retention
aReasons: death (46), moved/hospitalized (6), dropped due to illness (4) bReasons: death (36), moved/hospitalized (7), dropped due to illness (2)
See this image and copyright information in PMC

Comment in

  • Pain Management in the Elderly.
    Sanford AM. Sanford AM. J Am Med Dir Assoc. 2016 Aug 1;17(8):678-9. doi: 10.1016/j.jamda.2016.04.013. Epub 2016 May 24. J Am Med Dir Assoc. 2016. PMID: 27233491 No abstract available.

References

    1. Sengupta M, Bercovitz A, Harris-Kojetin LD. Prevalence and management of pain, by race and dementia among nursing home residents: United States, 2004. NCHS Data Brief. 2010:1–8. - PubMed
    1. Pimentel CB, Briesacher BA, Gurwitz JH, Rosen AB, Pimentel MT, Lapane KL. Pain management in nursing home residents with cancer. J Am Geriatr Soc. 2015;63:633–641. - PMC - PubMed
    1. Lapane KL, Quilliam BJ, Chow W, Kim M. The association between pain and measures of well-being among nursing home residents. J Am Med Dir Assoc. 2012;13:344–349. - PubMed
    1. Cadogan MP, Edelen MO, Lorenz KA, et al. The relationship of reported pain severity to perceived effect on function of nursing home residents. J Gerontol A Biol Sci Med Sci. 2008;63:969–973. - PubMed
    1. Tosato M, Lukas A, van der Roest HG, et al. Association of pain with behavioral and psychiatric symptoms among nursing home residents with cognitive impairment: results from the SHELTER study. Pain. 2012;153:305–310. - PubMed

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