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Jenkins HJ, Brown BT, O'Keeffe M, Moloney N, Maher CG, Hancock M. Development of low back pain curriculum content standards for entry-level clinical training. BMC MEDICAL EDUCATION 2024; 24:136. [PMID: 38347486 PMCID: PMC10863179 DOI: 10.1186/s12909-024-05086-x] [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: 07/24/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The management of low back pain (LBP) is highly variable and patients often receive management that is not recommended and/or miss out on recommended care. Clinician knowledge and behaviours are strongly influenced by entry-level clinical training and are commonly cited as barriers to implementing evidence-based management. Currently there are no internationally recognised curriculum standards for the teaching of LBP content to ensure graduating clinicians have the appropriate knowledge and competencies to assess and manage LBP. We formed an international interdisciplinary working group to develop curriculum content standards for the teaching of LBP in entry-level clinical training programs. METHODS The working group included representatives from 11 countries: 18 academics and clinicians from healthcare professions who deal with the management of LBP (medicine, physiotherapy, chiropractic, osteopathy, pharmacology, and psychology), seven professional organisation representatives (medicine, physiotherapy, chiropractic, spine societies), and one healthcare consumer. A literature review was performed, including database and hand searches of guidelines and accreditation, curricula, and other policy documents, to identify gaps in current LBP teaching and recommended entry-level knowledge and competencies. The steering group (authors) drafted the initial LBP Curriculum Content Standards (LBP-CCS), which were discussed and modified through two review rounds with the working group. RESULTS Sixty-two documents informed the draft standards. The final LBP-CCS consisted of four broad topics covering the epidemiology, biopsychosocial contributors, assessment, and management of LBP. For each topic, key knowledge and competencies to be achieved by the end of entry-level clinical training were described. CONCLUSION We have developed the LBP-CCS in consultation with an interdisciplinary, international working group. These standards can be used to inform or benchmark the content of curricula related to LBP in new or existing entry-level clinical training programs.
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Affiliation(s)
- Hazel J Jenkins
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Benjamin T Brown
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, The University of Sydney, Sydney Musculoskeletal Health, Sydney, Australia
| | - Niamh Moloney
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Chris G Maher
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, Australia
| | - Mark Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Furlan AD, Harbin S, Vieira FF, Irvin E, Severin CN, Nowrouzi-Kia B, Tiong M, Adisesh A. Primary Care Physicians' Learning Needs in Returning Ill or Injured Workers to Work. A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:591-619. [PMID: 35511378 DOI: 10.1007/s10926-022-10043-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
Primary care physicians are uniquely positioned to assist ill and injured workers to stay-at-work or to return-to-work. Purpose The purpose of this scoping review is to identify primary care physicians' learning needs in returning ill or injured workers to work and to identify gaps to guide future research. Methods We used established methodologies developed by Arksey and O'Malley, Cochrane and adapted by the Systematic Review Program at the Institute for Work & Health. We used Distiller SR©, an online systematic review software to screen for relevance and perform data extraction. We followed the PRISMA for Scoping Reviews checklist for reporting. Results We screened 2106 titles and abstracts, 375 full-text papers for relevance and included 44 studies for qualitative synthesis. The first learning need was related to administrative tasks. These included (1) appropriate record-keeping, (2) time management to review occupational information, (3) communication skills to provide clear, sufficient and relevant factual information, (4) coordination of services between different stakeholders, and (5) collaboration within teams and between different professions. The second learning need was related to attitudes and beliefs and included intrinsic biases, self-confidence, role clarity and culture of blaming the patient. The third learning need was related to specific knowledge and included work capacity assessments and needs for sick leave, environmental exposures, disclosure of information, prognosis of certain conditions and care to certain groups such as adolescents and pregnant workers. The fourth learning need was related to awareness of services and tools. Conclusions There are many opportunities to improve medical education for physicians in training or in continuing medical education to improve care for workers with an illness or injury that affect their work.
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Affiliation(s)
- Andrea D Furlan
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada.
- KITE, University Health Network, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Shireen Harbin
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Fabricio F Vieira
- Faculty of Medicine, State University of Maringa, Avenida Colombo, 5790, CEP 87020-900, Maringa, PR, Brazil
| | - Emma Irvin
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Colette N Severin
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Margaret Tiong
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Anil Adisesh
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Occupational Medicine, St Michael's Hospital, Toronto, ON, Canada
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Ashton S, Kilby M, Wu J, Lo K. Teaching pain management to health professional students: A systematic review and meta-analysis. Br J Pain 2022; 16:379-403. [PMID: 36032342 PMCID: PMC9411754 DOI: 10.1177/20494637211063384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Background Satisfactory pain management can have a significant impact on clients' activities of daily living. We questioned what types of pain management education might improve health professional students' knowledge, skills and perceptions? Method From inception until 30th July 2020, we searched MEDLINE, EBM Reviews, CINAHL Plus, ERIC, EMBASE, Cochrane database and Monash University library. Inclusion criteria were controlled trials of health professional students' pain education compared to alternative education, usual curriculum or no intervention. Studies were limited to English. Data were synthesised using meta-analysis. Results Fourteen articles were included in this review. For continuous data, meta-analysis demonstrated a clear effect favouring the intervention for knowledge SMD 1.47 [95% CI 1.18, 1.77], skills 0.93 [0.58, 1.28] or perceptions 0.69 [0.31, 1.08]. For dichotomous data, results showed no effect for knowledge 4.21 [0.65, 27.41], skills 2.26 [0.47, 11.01] or perceptions 1.96 [0.66, 5.76]. However, the overall result showed an effect 2.82 [1.20, 6.59] favouring the intervention. Conclusions In summary, short theoretical interventions are sufficient to change students' knowledge and perceptions. Longer interventions incorporating interactivity improve skills. Further research is required to indicate the best method, outcome measure, length of intervention and follow-up in delivering these pain courses and assessing the cost and long-term retention of information.
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Affiliation(s)
| | | | | | - Kristin Lo
- Kristin Lo, Department of Physiotherapy, Monash University, Lo 180 Sandhurst Boulevard Sandhurst, Victoria 3977, Australia ,
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Rhon DI, Mayhew RJ, Greenlee TA, Fritz JM. The influence of a MOBile-based video Instruction for Low back pain (MOBIL) on initial care decisions made by primary care providers: a randomized controlled trial. BMC FAMILY PRACTICE 2021; 22:200. [PMID: 34627152 PMCID: PMC8502287 DOI: 10.1186/s12875-021-01549-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adherence to guidelines for back pain continues to be a challenge, prompting strategies focused on improving education around biopsychosocial frameworks. OBJECTIVE Assess the influence of an interactive educational mobile app for patients on initial care decisions made for low back pain by the primary care provider. The secondary aim was to compare changes in self-reported pain and function between groups. METHODS This was a randomized controlled trial involving patients consulting for an initial episode of low back pain. The intervention was a mobile video-based education session (Truth About Low Back Pain) compared to usual care. The app focused on addressing maladaptive beliefs typically associated with higher risk of receiving low-value care options. The primary outcome was initial medical utilization decisions made by primary care practitioners (x-rays, MRIs, opioid prescriptions, injections, procedures) and secondary outcomes included PROMIS pain interference and physical function subscales at 1 and 6 months, and total medical costs. RESULTS Of 208 participants (71.2% male; mean age 35.4 years), rates of opioid prescriptions, advanced imaging, analgesic patches, spine injections, and physical therapy use were lower in the education group, but the differences were not significant. Total back-related medical costs for 1 year (mean diff = $132; P = 0.63) and none of the 6-month PROMIS subscales were significantly different between groups. Results were no different in opioid-naïve subjects. Instead, prior opioid use and high-risk of poor prognosis on the STarT Back Screening Tool predicted 1-year back pain-related costs and healthcare utilization, regardless of intervention. CONCLUSION Factors that influence medical treatment decisions and guideline-concordant care are complex. This particular patient education approach directed at patients did not appear to influence healthcare decisions made by primary care providers. Future studies should focus on high-risk populations and/or the impact of including the medical provider as an active part of the educational process. TRIAL REGISTRATION clinicaltrials.gov NCT02777983 .
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Affiliation(s)
- Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA. .,Uniformed Services University of the Health Sciences , Bethesda, MD, USA.
| | - Rachel J Mayhew
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA
| | - Tina A Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA
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Mankelow J, Ryan C, Taylor P, Atkinson G, Martin D. A Systematic Review and Meta-Analysis of the Effects of Biopsychosocial Pain Education upon Health Care Professional Pain Attitudes, Knowledge, Behavior and Patient Outcomes. THE JOURNAL OF PAIN 2021; 23:1-24. [PMID: 34237464 DOI: 10.1016/j.jpain.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/09/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
Pain is a significant health burden globally and its management frequently fails to comply with evidence based, biopsychosocial guidelines. This may be partly attributable to inadequate biopsychosocial focussed pain education for students and clinicians. We aimed to undertake a systematic review, using Cochrane methodology, of randomized controlled trials with meta-analysis to quantify the effects of biopsychosocial education strategies in changing student/qualified health care professionals (HCPs) pain related attitudes, knowledge, clinical behaviour or patient outcomes. A systematic search of the literature was undertaken using CINAHL, AMED, PEDro, Cochrane Central Library, MEDLINE, ScienceDirect, Rehabdata, SportDiscus, EMBASE, ASSIA, Dentistry and Oral Science, Psycinfo, Education Research Complete and OpenGrey from 1977 to November 2020. Pooled effect sizes were quantified in random effects meta-analyses for attitudes, knowledge, and clinical behaviors. From a sample of 1812 records, 6 were narratively analysed and 15 were included in the meta-analyses. These studies represented 3022 patients and 3163 HCPs and students. Education improved attitudes by 11.3% (95% confidence interval: 2.2-20.4%, P = .02), and knowledge by 18.8% (12.4-25.3%, P = .01). The effects of education on clinical behavior favoured a clinically relevant improvement (OR = 2.4, 0.9-5.9, P = .06). Narrative analysis of the effect of biopsychosocial education for student HCPs/HCPs upon patient outcomes was inconclusive. These findings demonstrate that biopsychosocial focussed pain education strategies can improve student/qualified HCPs' pain related knowledge and attitudes and increase the likelihood that they will behave more in keeping with evidence-based practice. This should result in improved patient outcomes, however, evidence to support or refute this is lacking. PROSPERO systematic review record number, CRD42018082251. Perspective: We outline the effectiveness of biopsychosocial pain education for health care professionals and students in improving pain knowledge, attitudes, and evidence-based behaviors. These improvements should enhance clinical outcomes in patients with pain but further evidence is needed to confirm this.
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Affiliation(s)
- Jagjit Mankelow
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK.
| | - Cormac Ryan
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Paul Taylor
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Greg Atkinson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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