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Jones L1,2, Heng H3, Heywood S4, Kent S5, Amir L2,6
1Singapore Institute of Technology, Physiotherapy, Singapore, Singapore, 2La Trobe University, Judith Lumley Centre, Melbourne, Australia, 3Northern Health, Physiotherapy, Melbourne, Australia, 4St. Vincent's Hospital Melbourne, Physiotherapy, Melbourne, Australia, 5La Trobe University, Psychology and Public Health, Melbourne, Australia, 6Royal Women's Hospital, Melbourne, Australia
Background: Embracing the biopsychosocial paradigm for the assessment and treatment of pain is necessary to facilitate the most effective outcomes. While some clinical groups within physiotherapy have enthusiastically taken up contemporary pain concepts, the knowledge of pain and the attitudes and beliefs that guide the management of people with pain, remain inconsistent. Anecdotal evidence suggests training in the use of the Pain and Movement Reasoning Model (PMRM) can influence knowledge, attitudes and beliefs about pain and this requires evaluation.
Purpose: To measure changes in knowledge, attitudes and beliefs about pain following participation in an education intervention based on the PMRM.
Methods: A pretest-posttest mixed methods design was employed. The project recruited physiotherapists with a range of experience, working across a range of clinical areas in two public health networks in Melbourne, Australia. Primary outcome measures were Neurophysiology of Pain Questionnaire (NPQ), Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and Patient Practitioner Orientation Scale (PPOS). Focus groups and interviews were used to enhance the questionnaire data.
The education intervention consisted of:
(1) an online resource presenting current concepts of pain requiring 30 minutes to complete. This was accessed by participants through a link sent via workplace email;
(2) a 30 minute face-to-face session introducing the PMRM. This session was delivered in small to medium sized groups on-site at a time agreed by the participant and their manager. Some one-to-one presentations were necessary due to individual clinical demands;
(3) a second online resource with information on the application of the PMRM again designed to be completed in 30 minutes;
(4) consolidation of learning by completing Pain Reasoning Record templates, which included the PMRM, in the clinical context.
Comparisons of pre- and post-intervention mean scores were performed using paired t-tests along with regression analyses to assess contribution of personal and professional characteristics.
Results: Sixty participants completed pre- and post-questionnaires. Most participants reported some prior formal pain education, but 20 participants (32%) reported none. Two participants had completed a pain-specific postgraduate qualification. The main findings were improvement in scores on the NPQ (t(59) = 2.673, p 0.05) and reduction on PABS-PT biomedical subscale (t(58) = -3.502, p 0.01) following the intervention and for those with high biomedical attitudes at pre-intervention this change in the PABS-PT biomedical subscale was even more significant (t(32) = -5.032, p 0.001). While statistically significant, the changes in mean scores were small. There was no significant difference on the PABS-PT biopsychosocial subscale or the PPOS subscales.
Conclusion(s): An on-site blended learning pain education package incorporating the Pain and Movement Reasoning Model can improve knowledge, attitudes and beliefs in physiotherapists working in different clinical contexts. Further research using an enhanced education package, including a focus on strategies to optimise engagement with the online components and the practice-based application, is needed to confirm the value of this approach.
Implications: The PMRM can be integrated into pain education for physiotherapists. It may be especially useful for those yet to embrace a biopsychosocial paradigm to guide the management of pain.
Keywords: Pain education, blended learning, clinical reasoning
Funding acknowledgements: This project was supported by internal funding from La Trobe University's Social Research Assistance Platform.
Purpose: To measure changes in knowledge, attitudes and beliefs about pain following participation in an education intervention based on the PMRM.
Methods: A pretest-posttest mixed methods design was employed. The project recruited physiotherapists with a range of experience, working across a range of clinical areas in two public health networks in Melbourne, Australia. Primary outcome measures were Neurophysiology of Pain Questionnaire (NPQ), Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and Patient Practitioner Orientation Scale (PPOS). Focus groups and interviews were used to enhance the questionnaire data.
The education intervention consisted of:
(1) an online resource presenting current concepts of pain requiring 30 minutes to complete. This was accessed by participants through a link sent via workplace email;
(2) a 30 minute face-to-face session introducing the PMRM. This session was delivered in small to medium sized groups on-site at a time agreed by the participant and their manager. Some one-to-one presentations were necessary due to individual clinical demands;
(3) a second online resource with information on the application of the PMRM again designed to be completed in 30 minutes;
(4) consolidation of learning by completing Pain Reasoning Record templates, which included the PMRM, in the clinical context.
Comparisons of pre- and post-intervention mean scores were performed using paired t-tests along with regression analyses to assess contribution of personal and professional characteristics.
Results: Sixty participants completed pre- and post-questionnaires. Most participants reported some prior formal pain education, but 20 participants (32%) reported none. Two participants had completed a pain-specific postgraduate qualification. The main findings were improvement in scores on the NPQ (t(59) = 2.673, p 0.05) and reduction on PABS-PT biomedical subscale (t(58) = -3.502, p 0.01) following the intervention and for those with high biomedical attitudes at pre-intervention this change in the PABS-PT biomedical subscale was even more significant (t(32) = -5.032, p 0.001). While statistically significant, the changes in mean scores were small. There was no significant difference on the PABS-PT biopsychosocial subscale or the PPOS subscales.
Conclusion(s): An on-site blended learning pain education package incorporating the Pain and Movement Reasoning Model can improve knowledge, attitudes and beliefs in physiotherapists working in different clinical contexts. Further research using an enhanced education package, including a focus on strategies to optimise engagement with the online components and the practice-based application, is needed to confirm the value of this approach.
Implications: The PMRM can be integrated into pain education for physiotherapists. It may be especially useful for those yet to embrace a biopsychosocial paradigm to guide the management of pain.
Keywords: Pain education, blended learning, clinical reasoning
Funding acknowledgements: This project was supported by internal funding from La Trobe University's Social Research Assistance Platform.
Topic: Pain & pain management; Education: clinical; Education: methods of teaching & learning
Ethics approval required: Yes
Institution: Austin Health
Ethics committee: Human Research Ethics Committee
Ethics number: HREC/17/Austin/105
All authors, affiliations and abstracts have been published as submitted.
