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Munneke W, Demoulin C, Nijs J, Morin C, Kool E, Berquin A, Meeus M, De Kooning M. Development of an interdisciplinary training program about chronic pain management with a cognitive behavioural approach for healthcare professionals: part of a hybrid effectiveness-implementation study. BMC MEDICAL EDUCATION 2024; 24:331. [PMID: 38519899 PMCID: PMC10960450 DOI: 10.1186/s12909-024-05308-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Many applied postgraduate pain training programs are monodisciplinary, whereas interdisciplinary training programs potentially improve interdisciplinary collaboration, which is favourable for managing patients with chronic pain. However, limited research exists on the development and impact of interdisciplinary training programs, particularly in the context of chronic pain. METHODS This study aimed to describe the development and implementation of an interdisciplinary training program regarding the management of patients with chronic pain, which is part of a type 1 hybrid effectiveness-implementation study. The targeted groups included medical doctors, nurses, psychologists, physiotherapists, occupational therapists, dentists and pharmacists. An interdisciplinary expert panel was organised to provide its perception of the importance of formulated competencies for integrating biopsychosocial pain management with a cognitive behavioural approach into clinical practice. They were also asked to provide their perception of the extent to which healthcare professionals already possess the competencies in their clinical practice. Additionally, the expert panel was asked to formulate the barriers and needs relating to training content and the implementation of biopsychosocial chronic pain management with a cognitive behavioural approach in clinical practice, which was complemented with a literature search. This was used to develop and adapt the training program to the barriers and needs of stakeholders. RESULTS The interdisciplinary expert panel considered the competencies as very important. Additionally, they perceived a relatively low level of healthcare professionals' possession of the competencies in their clinical practice. A wide variety of barriers and needs for stakeholders were formulated and organized within the Theoretical Domain Framework linked to the COM-B domains; 'capability', 'opportunity', and 'motivation'. The developed interdisciplinary training program, including two workshops of seven hours each and two e-learning modules, aimed to improve HCP's competencies for integrating biopsychosocial chronic pain management with a cognitive behavioural approach into clinical practice. CONCLUSION We designed an interdisciplinary training program, based on formulated barriers regarding the management of patients with chronic pain that can be used as a foundation for developing and enhancing the quality of future training programs.
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Affiliation(s)
- Wouter Munneke
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group (PiM)
- Department of Sport and Rehabilitation Sciences, University of Liège, Liege, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liège, Liege, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group (PiM)
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of rehabilitation medicine and physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Carine Morin
- Société Scientifique de Médecine Générale (SSMG), Brussels, Belgium
| | | | - Anne Berquin
- Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group (PiM)
- MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences and Medicine, University of Antwerp, Antwerp, Belgium
| | - Margot De Kooning
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
- Pain in Motion International Research Group (PiM), .
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Takeuchi R, Sugiura S, Miki T, Chiba H, Handa Y, Takasaki H. Cross-cultural adaptation of the pain understanding and confidence questionnaire into Japanese. J Phys Ther Sci 2023; 35:624-627. [PMID: 37670757 PMCID: PMC10475642 DOI: 10.1589/jpts.35.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/31/2023] [Indexed: 09/07/2023] Open
Abstract
[Purpose] This study aimed to develop a culturally adapted Japanese version of the Pain Understanding and Confidence Questionnaire (PUnCQ). The first-factor structure describes management from 12 perspectives for a case vignette of chronic pain and determines whether the management is based on a biomedical or biopsychosocial perspective. The second-factor structure evaluates the confidence level in management skills for the same case from 21 perspectives. [Participants and Methods] We conducted a cross-cultural adaptation based on five stages according to Beaton's guidelines (two forward translations, creation of an integrated forward translation version, two backward translations, creation of a provisional Japanese version, and a pilot test). In the pilot test, we asked 40 Japanese physical therapists to rate their understanding of the PUnCQ descriptions on a five-point Likert scale (1, not at all understandable; 5, completely understandable) and provide comments when they rated 1 to 3. We repeated revisions and pilot tests until less than 10% of the respondents rated 1 for all descriptions. [Results] By conducting two rounds of the pilot test, all items of descriptions satisfied the preestablished criteria. [Conclusion] A Japanese version of the PUnCQ was developed.
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Affiliation(s)
- Ritsuko Takeuchi
- Department of Physical Therapy, Saitama Prefectural
University: 820 Sannomiya, Koshigaya, Saitama 343-8540, Japan
| | - Shiro Sugiura
- Graduate School of Rehabilitation Science, Saitama
Prefectural University, Japan
- Nishikawa Orthopedics Clinic, Japan
| | - Takahiro Miki
- Graduate School of Rehabilitation Science, Saitama
Prefectural University, Japan
- Sapporo Maruyama Orthopedic Hospital, Japan
| | - Hiroki Chiba
- Graduate School of Rehabilitation Science, Saitama
Prefectural University, Japan
- Secomedic Hospital, Japan
| | - Yusuke Handa
- Graduate School of Rehabilitation Science, Saitama
Prefectural University, Japan
| | - Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural
University: 820 Sannomiya, Koshigaya, Saitama 343-8540, Japan
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Are Improvements in Pain Neurophysiology Knowledge Following Pain Science Education Associated With Improved Outcomes in People With Chronic Pain?: A Systematic Review and Meta-analysis. Clin J Pain 2023; 39:41-52. [PMID: 36524771 DOI: 10.1097/ajp.0000000000001086] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to determine the association between changes in patients' pain knowledge after pain science education (PSE) with treatment outcomes in people with chronic pain. METHODS Six electronic databases and 2 clinical trial registries were searched from inception to September 15, 2021 for studies where participants received PSE and had their pain knowledge and clinical outcomes assessed before and after PSE. Meta-analyses were performed for pain intensity, kinesiophobia, and pain catastrophizing. Physical function and quality of life outcomes were synthesized narratively. Risk of bias was assessed using the Cochrane tool for nonrandomized studies and the quality of evidence was assessed using GRADE. RESULTS Fourteen studies (n=1500 participants) were included. Meta-analyses revealed no significant associations between short-term (<12 wk) changes in pain neurophysiology knowledge with changes in pain intensity (n=1075, r=-0.01, 95% CI =-0.14 to 0.13, very low certainty), kinesiophobia (n=152, r=0.02, 95% CI =-0.27 to 0.24, very low certainty) and pain catastrophizing (n=976, r=-0.03, 95% CI=-0.18 to 0.11, low certainty). No significant associations were found between short-term changes in pain neurophysiology knowledge and physical function or quality of life either. DISCUSSION These findings do not support a short-term association between improvements in pain neurophysiology knowledge and better treatment outcomes in people with chronic pain. Increased understanding of how PSE works, as well as better ways to measure it, may help clinicians deliver more targeted education to help patients reconceptualize pain and promote engagement in active treatment strategies (eg, exercise).
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Lopes TDS, Ballas SK, Santana JERS, de Melo-Carneiro P, de Oliveira LB, Sá KN, Lopes LCD, Silva WDS, Lucena R, Baptista AF. Sickle cell disease chronic joint pain: Clinical assessment based on maladaptive central nervous system plasticity. Front Med (Lausanne) 2022; 9:679053. [PMID: 36203767 PMCID: PMC9530388 DOI: 10.3389/fmed.2022.679053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic joint pain (CJP) is among the significant musculoskeletal comorbidities in sickle cell disease (SCD) individuals. However, many healthcare professionals have difficulties in understanding and evaluating it. In addition, most musculoskeletal evaluation procedures do not consider central nervous system (CNS) plasticity associated with CJP, which is frequently maladaptive. This review study highlights the potential mechanisms of CNS maladaptive plasticity related to CJP in SCD and proposes reliable instruments and methods for musculoskeletal assessment adapted to those patients. A review was carried out in the PubMed and SciELO databases, searching for information that could help in the understanding of the mechanisms of CNS maladaptive plasticity related to pain in SCD and that presented assessment instruments/methods that could be used in the clinical setting by healthcare professionals who manage chronic pain in SCD individuals. Some maladaptive CNS plasticity mechanisms seem important in CJP, including the impairment of pain endogenous control systems, central sensitization, motor cortex reorganization, motor control modification, and arthrogenic muscle inhibition. Understanding the link between maladaptive CNS plasticity and CJP mechanisms and its assessment through accurate instruments and methods may help healthcare professionals to increase the quality of treatment offered to SCD patients.
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Affiliation(s)
- Tiago da Silva Lopes
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
- Adventist Neuromodulation and Neuroscience Laboratory, Bahia Adventist College, Cachoeira, Brazil
- NAPEN Network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, SP, Brazil
| | - Samir K. Ballas
- Department of Medicine, Jefferson Medical College, Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jamille Evelyn Rodrigues Souza Santana
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
- NAPEN Network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, SP, Brazil
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | - Pedro de Melo-Carneiro
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
| | - Lilian Becerra de Oliveira
- Adventist Neuromodulation and Neuroscience Laboratory, Bahia Adventist College, Cachoeira, Brazil
- Graduate program of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
| | - Katia Nunes Sá
- NAPEN Network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, SP, Brazil
- Graduate program of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
| | | | | | - Rita Lucena
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
| | - Abrahão Fontes Baptista
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
- NAPEN Network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, SP, Brazil
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
- Graduate program of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
- Laboratory of Medical Investigations 54 (LIM-54), Universidade de São Paulo, São Paulo, SP, Brazil
- *Correspondence: Abrahão Fontes Baptista
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Fitzgerald K, Vaughan B, Devonshire E, Schneider C, Denham R. No gain without pain education: Improving knowledge and biopsychosocial attitudes and beliefs in a predominantly non-health-related undergraduate target audience. Musculoskeletal Care 2022; 20:660-665. [PMID: 35278023 DOI: 10.1002/msc.1630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Chronic pain (CP) impacts individuals and society and is the leading cause of disability globally. Pain education interventions are often evaluated in patients and health professional students, but not in non-health student groups. Increasing knowledge of pain may facilitate shifts in attitudes and beliefs towards sufferers. We report on changes in pain knowledge, attitudes and beliefs of predominantly non-health-related tertiary degree students participating in online education. METHODS Quantitative cohort study design. Students reported demographics and completed the Chronic Pain Myth Scale and 12-item Neurophysiology of Pain Questionnaire (NPQ) before (T1) and after (T2) the 7-week online module at The University of Sydney in 2020. RESULTS Twenty-two students undertaking predominantly non-health-related bachelor's degrees (16.5% response rate, 90.9% female, mean = 19.5 years) participated. NPQ scores increased from 47.3% to 62.9%. Attitudes and beliefs towards biopsychosocial impact improved (p < 0.027) but not towards individuals suffering from CP or treatment of CP. A negative correlation was found between age and people suffering from CP (ρ = -0.437, p < 0.042) and age and towards treatment of CP; ρ = -0.556, p < 0.007) at T2. CONCLUSION Completing the elective online module resulted in improved knowledge and biopsychosocial attitudes towards CP in this predominantly non-health cohort, as reported in health and patient cohorts.
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Affiliation(s)
- Kylie Fitzgerald
- Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Brett Vaughan
- Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Devonshire
- Pain Education Unit, Sydney Medical School - Northern, The University of Sydney, Sydney, New South Wales, Australia
| | - Carl Schneider
- School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Denham
- Educational Innovation, The University of Sydney, Sydney, New South Wales, Australia
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Tanuma T, Takasaki H. Cross-cultural Adaptation of the Knowledge and Attitude of Pain into Japanese and Test–retest Reliability in Undergraduate Students. Prog Rehabil Med 2022; 7:20220030. [PMID: 35795655 PMCID: PMC9174340 DOI: 10.2490/prm.20220030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/24/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives: Pain neuroscience education (PNE) has been shown to be effective in reducing pain in
people with chronic musculoskeletal pain. Knowledge of pain physiology is necessary to
undertake PNE, and a measure for such knowledge is necessary. The Knowledge and
Attitudes of Pain (KNAP), a comprehensive assessment of knowledge, attitudes, and
beliefs regarding pain for healthcare practitioners, was developed in 2020 through the
assessment of construct validity, reliability, and responsiveness in Dutch and English.
This study aimed to conduct cross-cultural adaptation of the KNAP into Japanese and to
verify test–retest reliability among Japanese undergraduate physical therapy and
occupational therapy students. Methods: Cross-cultural adaptation was performed using Beaton’s five-step process. Subsequently,
the KNAP was completed by participants with a 2-week interval. The study included
second-, third-, and fourth-year undergraduate physical therapy and occupational therapy
students. Results: A total of 50 students participated in the pilot test and a Japanese version of KNAP
was created. Thirty-nine students completed the Japanese version of KNAP twice. Of the
30 items on the KNAP, the quadratic weighted kappa value was less than 0.4 for only one
item (item 15), but reliability was interpreted as sufficient for the overall score,
with an intraclass correlation coefficient (95% confidence interval) for the total score
of 0.89 (0.80–0.94). Conclusions: This study has developed the Japanese KNAP, which has shown preliminary evidence of
adequate test–retest reliability in Japanese undergraduate physical therapy and
occupational therapy students.
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Affiliation(s)
- Taro Tanuma
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Japan
| | - Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Japan
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Takasaki H. Rasch Analysis of Self-Reported Adherence to Patient-Centered Physical Therapy Scale among Japanese Physical Therapists: Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10282. [PMID: 34639583 PMCID: PMC8508273 DOI: 10.3390/ijerph181910282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
This study primarily aimed to develop a shorter version of the self-reported adherence to patient-centered physical therapy (s-SAPCPTS) by using Rasch analysis and secondarily aimed to preliminarily investigate the relationship between the s-SAPCPTS scores and demographics (i.e., age, sex, final academic degree (non-postgraduate degrees or postgraduate degrees), and practice environment). In an online anonymous survey, 110 Japanese physical therapists completed the self-reported adherence to patient-centered physical therapy and provided data on their demographics. Through the Rasch analysis, items were excluded in a stepwise manner, until certain pre-established criteria of the unidimensionality were satisfied. Subsequently, a conversion table for the Rasch score was developed. Furthermore, multiple regression analysis was conducted by using the independent variables age, sex, and final academic degree. Using the Kruskal-Wallis test, we compared the Rasch s-SAPCPTS scores among four practice environments. Consequently, the seven-item s-SAPCPTS was developed by excluding seven items through the Rasch analysis. Postgraduate degree was a statistically significant contributing factor for Rasch s-SAPCPTS scores (p = 0.038, β = 0.20). The Kruskal-Wallis test demonstrated statistically significant differences in the Rasch s-SAPCPTS scores among the four practice environments (p = 0.006). In conclusion, the seven-item s-SAPCPTS was developed with the preliminary evidence of construct validity. It was also found that the final academic degree and practice environment could be the contributing factors of s-SAPCPTS scores.
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Affiliation(s)
- Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya 343-8540, Japan
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Beetsma AJ, Reezigt RR, Reneman MF. Knowledge and attitudes toward musculoskeletal pain neuroscience of manual therapy postgraduate students in the Netherlands. Musculoskelet Sci Pract 2021; 52:102350. [PMID: 33640658 DOI: 10.1016/j.msksp.2021.102350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Health care practitioners' knowledge and attitudes influence patients' beliefs and health outcomes in musculoskeletal (MSK) pain. It is unclear to what extent physiotherapists undertaking a postgraduate master in manual therapy (MT students) possess the knowledge and attitudes toward pain neuroscience to be able to apply the biopsychosocial model in patients with MSK pain. OBJECTIVES The aim of this study was to assess the knowledge and attitudes toward pain neuroscience in MT students. DESIGN A cross-sectional study. METHOD Self-reported knowledge and attitudes were measured among students (n = 662) at baseline and in all years of the MT postgraduate programs in the Netherlands. The Knowledge and Attitudes of Pain questionnaire (KNAP) was used as a primary measure. Difference in KNAP-scores between baseline (0), year 1, year 2 and year 3 was tested using a one-way ANOVA (hypothesis: 0 < 1<2 < 3). A two factor ANOVA was used to determine the interaction effect of focused pain education and year in the curriculum with KNAP. RESULTS There was an overall significant difference of KNAP scores with a medium effect size (F(3, 218.18) = 13.56, p < .001, ω2 = 0.059). Differences between years ranged from small to medium. Interaction effect of knowledge and attitudes and focused pain education was significant with a small effect size (F(6) = 2.597, p = .017, ω2 = 0.012). Sensitivity analyses were consistent with the main results. CONCLUSIONS Positive differences in knowledge and attitudes toward pain neuroscience in MT students occur between the progressing years of the curriculum. Differences may be related to the provision of focused pain education.
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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; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, P.O. Box 30.002, 9750 RA, Haren, 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.
| | - 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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