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Smart KM. The biopsychosocial model of pain in physiotherapy: past, present and future. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2023.2177792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Keith M. Smart
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
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Mankelow J, Ryan CG, Taylor PC, Casey MB, Naisby J, Thompson K, McVeigh JG, Seenan C, Cooper K, Hendrick P, Brown D, Gibson W, Travers M, Kennedy N, O'Riordan C, Martin D. International, multi-disciplinary, cross-section study of pain knowledge and attitudes in nursing, midwifery and allied health professions students. BMC MEDICAL EDUCATION 2022; 22:547. [PMID: 35840942 PMCID: PMC9284700 DOI: 10.1186/s12909-022-03488-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Persistent pain is a highly prevalent, global cause of disability. Research suggests that many healthcare professionals are not well equipped to manage pain, and this may be attributable at least in part to undergraduate education. The primary aim of this study was to quantify and compare first and final year nursing, midwifery and allied health professional (NMAHP) students' pain related knowledge and attitudes. The secondary aim was to explore what factors influence students' pain related knowledge and attitudes. METHODS In this cross-sectional study, 1154 first and final year healthcare students, from 12 universities in five different countries completed the Revised Neurophysiology of Pain Quiz (RNPQ) [knowledge] and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) [attitudes]. RESULTS Physiotherapy was the only student group with statistically and clinically improved pain related knowledge [mean difference, 95% CI] (3.4, 3.0 to 3.9, p = 0.01) and attitudes (-17.2, -19.2 to 15.2, p = 0.01) between first and final year. Pain education teaching varied considerably from course to course (0 to 40 h), with greater levels of pain related knowledge and attitudes associated with higher volumes of pain specific teaching. CONCLUSIONS There was little difference in pain knowledge and attitudes between all first and final year NMAHP students other than physiotherapy. This suggests that for most NMAHP disciplines, undergraduate teaching has little or no impact on students' understanding of pain. There is an urgent need to enhance pain education provision at the undergraduate level in NMAHPs. TRIAL REGISTRATION The study protocol was prospectively registered at ClinicalTrials.Gov NCT03522857 .
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Affiliation(s)
- Jagjit Mankelow
- Teesside University, Middlesbrough, England.
- University of Limerick, Limerick, Ireland.
| | | | | | | | | | | | | | - Chris Seenan
- Glasgow Caledonian University, Glasgow, Scotland
| | - Kay Cooper
- Robert Gordon University, Aberdeen, Scotland
| | | | - Donna Brown
- University of Ulster, Belfast, Northern Ireland
| | - William Gibson
- The University of Notre Dame Australia, Fremantle, Australia
| | - Mervyn Travers
- The University of Notre Dame Australia, Fremantle, Australia
- Curtin University, Perth, Australia
| | | | | | - Denis Martin
- Teesside University, Middlesbrough, England
- Applied Research Collaboration for the North East and North Cumbria, National Institute for Health and Care Research, Newcastle Upon Tyne, England
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Mescouto K, Olson RE, Hodges PW, Costa N, Patton MA, Evans K, Walsh K, Lonergan K, Setchell J. Physiotherapists Both Reproduce and Resist Biomedical Dominance when Working With People With Low Back Pain: A Qualitative Study Towards New Praxis. QUALITATIVE HEALTH RESEARCH 2022; 32:902-915. [PMID: 35341400 DOI: 10.1177/10497323221084358] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Despite recommendations to incorporate physical and psychosocial factors when providing care for people with back pain, research suggests that physiotherapists continue to focus on biological aspects. This study investigated how interpersonal and institutional norms influence this continued enactment of the biological aspects of management. We used theoretically-driven analysis, drawing from Foucauldian notions of power, to analyse 28 ethnographic observations of consultations and seven group discussions with physiotherapists. Analysis suggested that physiotherapy training established expectations of what a physiotherapist 'should' focus on, and institutional circumstances strongly drew the attention of physiotherapists towards biological aspects. Resistance to these forces was possible when, for example, physiotherapists reflected upon their practice, used silences and pauses during consultations, and actively collaborated with patients. These circumstances facilitated use of non-biomedical management approaches. Findings may assist physiotherapists to rework the enduring normative focus on biomedical aspects of care when providing care for patients with back pain.
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Affiliation(s)
- Karime Mescouto
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Rebecca E Olson
- School of Social Science, 144911The University of Queensland, Brisbane, QLD, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Nathalia Costa
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, QLD, Australia
- 4334The University of Sydney, Sydney, NSW, Australia
| | - Mary Anne Patton
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Kerrie Evans
- 4334The University of Sydney, Sydney, NSW, Australia
- Healthia Limited, Brisbane, QLD, Australia
| | - Kelly Walsh
- Persistent Pain Management Service, 157829Metro South Health, Brisbane, QLD, Australia
| | | | - Jenny Setchell
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, QLD, Australia
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Caneiro JP, Smith A, Bunzli S, Linton S, Moseley GL, O'Sullivan P. From Fear to Safety: A Roadmap to Recovery From Musculoskeletal Pain. Phys Ther 2022; 102:6480889. [PMID: 34971393 DOI: 10.1093/ptj/pzab271] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 11/12/2022]
Abstract
Contemporary conceptualizations of pain emphasize its protective function. The meaning assigned to pain drives cognitive, emotional, and behavioral responses. When pain is threatening and a person lacks control over their pain experience, it can become distressing, self-perpetuating, and disabling. Although the pathway to disability is well established, the pathway to recovery is less researched and understood. This Perspective draws on recent data on the lived experience of people with pain-related fear to discuss both fear and safety-learning processes and their implications for recovery for people living with pain. Recovery is here defined as achievement of control over pain as well as improvement in functional capacity and quality of life. Based on the common-sense model, this Perspective proposes a framework utilizing Cognitive Functional Therapy to promote safety learning. A process is described in which experiential learning combined with "sense making" disrupts a person's unhelpful cognitive representation and behavioral and emotional response to pain, leading them on a journey to recovery. This framework incorporates principles of inhibitory processing that are fundamental to pain-related fear and safety learning.
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Affiliation(s)
- J P Caneiro
- Curtin University, School of Allied Health, Faculty of Health Sciences, Perth, Western Australia, Australia.,Body Logic Physiotherapy Perth, Western Australia, Australia
| | - Anne Smith
- Curtin University, School of Allied Health, Faculty of Health Sciences, Perth, Western Australia, Australia
| | - Samantha Bunzli
- University of Melbourne Department Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Steven Linton
- Örebro University, Center for Health and Medical Psychology (CHAMP), Örebro, Sweden
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Peter O'Sullivan
- Curtin University, School of Allied Health, Faculty of Health Sciences, Perth, Western Australia, Australia.,Body Logic Physiotherapy Perth, Western Australia, Australia
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Mescouto K, Olson RE, Hodges PW, Setchell J. A critical review of the biopsychosocial model of low back pain care: time for a new approach? Disabil Rehabil 2020; 44:3270-3284. [PMID: 33284644 DOI: 10.1080/09638288.2020.1851783] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Low back pain (LBP) is the leading cause of disability worldwide. Clinical research advocates using the biopsychosocial model (BPS) to manage LBP, however there is still no clear consensus regarding the meaning of this model in physiotherapy and how best to apply it. The aim of this study was to investigate how physiotherapy LBP literature enacts the BPS model. MATERIAL AND METHODS We conducted a critical review using discourse analysis of 66 articles retrieved from the PubMed and Web of Science databases. RESULTS Analysis suggest that many texts conflated the BPS with the biomedical model [Discourse 1: Conflating the BPS with the biomedical model]. Psychological aspects were almost exclusively conceptualised as cognitive and behavioural [Discourse 2: Cognition, behaviour, yellow flags and rapport]. Social context was rarely mentioned [Discourse 3: Brief and occasional social underpinnings]; and other broader aspects of care such as culture and power dynamics received little attention within the texts [Discourse 4: Expanded aspects of care]. CONCLUSION Results imply that multiple important factors such as interpersonal or institutional power relations, cultural considerations, ethical, and social aspects of health may not be incorporated into physiotherapy research and practice when working with people with LBP.IMPLICATIONS FOR REHABILITATIONWhen using the biopsychosocial model with patients with low back pain, researchers narrowly focus on biological and cognitive behavioural aspects of the model.Social and broader aspects such as cultural, interpersonal and institutional power dynamics, appear to be neglected by researchers when taking a biopsychosocial approach to the care of patients with low back pain.The biopsychosocial model may be inadequate to address complexities of people with low back pain, and a reworking of the model may be necessary.There is a lack of research conceptualising how physiotherapy applies the biopsychosocial model in research and practice.
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Affiliation(s)
- Karime Mescouto
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rebecca E Olson
- School of Social Science, The University of Queensland, Brisbane, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Beetsma AJ, Reezigt RR, Paap D, Reneman MF. Assessing future health care practitioners' knowledge and attitudes of musculoskeletal pain; development and measurement properties of a new questionnaire. Musculoskelet Sci Pract 2020; 50:102236. [PMID: 32927256 DOI: 10.1016/j.msksp.2020.102236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/16/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Healthcare practitioner beliefs influence patients' beliefs and health outcomes in musculoskeletal (MSK) pain. A validated questionnaire based on modern pain neuroscience assessing Knowledge and Attitudes of Pain (KNAP) was unavailable. OBJECTIVES The aim of this study was to develop and test measurement properties of KNAP. DESIGN Phase 1; Development of KNAP reflecting modern pain neuroscience and expert opinion. Phase 2; a cross-sectional and longitudinal study among Dutch physiotherapy students. METHOD In the cross-sectional study (n = 424), internal consistency, structural validity, hypotheses testing, and Rasch analysis were examined. Longitudinal designs were applied to analyse test-retest reliability (n = 156), responsiveness, and interpretability (n = 76). RESULTS A 30-item KNAP was developed in 4 stages. Test-retest reliability: ICC (2,1) 0.80. Internal consistency: Cronbach's α 0.80. Smallest Detectable Difference 90%: 4.99 (4.31; 5.75). Structural validity: exploratory factor analysis showed 2 factors. Hypotheses testing: associations with the Pain Attitudes and Beliefs Scale for Physiotherapists biopsychosocial subscale r = 0.60, with biomedical subscale r = -0.58, with the Neurophysiology of Pain Questionnaire r = 0.52. Responsiveness: 93% improved on KNAP after studying pain education. Minimal Important Change: 4.84 (95%CI: 2.77; 6.91). CONCLUSIONS The KNAP has adequate measurement properties. This new questionnaire could be useful to evaluate physiotherapy students' knowledge and attitudes of modern pain neuroscience that could help to create awareness and evaluate physiotherapy education programs, and ultimately provide better pain management.
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Affiliation(s)
- Anneke J Beetsma
- Department of Health Care Studies, School for Physiotherapy, Hanze University of Applied Sciences Groningen, P.O. Box 70030, 9714, CA, the Netherlands.
| | - Roland R Reezigt
- Department of Health Care Studies, School for Physiotherapy, Hanze University of Applied Sciences Groningen, P.O. Box 70030, 9714, CA, the Netherlands.
| | - Davy Paap
- University Medical Center Groningen, Department of Rehabilitation Medicine and Department for Reumatology and Immunology, University of Groningen, P.O. Box 300.001, 9700, RB, Groningen, Netherlands.
| | - Michiel F Reneman
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, P.O. Box 30.002, 9750, RA, Haren, the Netherlands.
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Aikman K, Burtt L, Ronde OD, Lim DKW, Stratton P, Wong MH, Grainger R, Devan H. Mass media campaigns for chronic pain: a scoping review to inform design of future campaigns. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1832711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kelda Aikman
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Lyndie Burtt
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Olivia de Ronde
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Dave K. W. Lim
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Paige Stratton
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Man Hon Wong
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
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Daluiso-King G, Hebron C. Is the biopsychosocial model in musculoskeletal physiotherapy adequate? An evolutionary concept analysis. Physiother Theory Pract 2020; 38:373-389. [DOI: 10.1080/09593985.2020.1765440] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Clair Hebron
- School of Health Sciences, University of Brighton, Eastbourne, England
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