Background & Aims
Chronic pain is a significant burden causing personal suffering and reduced quality of life. Inadequate pain management education can lead to healthcare providers feeling ill-equipped to address pain. National strategies advocate for the development of pain management competencies to guide the education of future healthcare providers. Presently, there is a lack of profession-specific competencies tailored to local contexts. Our team focused on establishing pain management competencies for entry-level physical therapy (PT) programs in Canada. We developed the Pain Education in Physiotherapy (PEP) profile that delineates the necessary competencies required to manage pain upon entry-to-practice for Canadian PT students. The primary aim of this project is to assess the current adoption of this novel standard within Canadian entry-level PT programs. This study aims to bridge the gap between the developed competency profile and its current status in PT education.
Methods
Employing a rigorous two-phase exploratory sequential design, Phase A used qualitative interviews with purposively selected PT pain educators to understand variations in curricular structures. The findings informed the development of a comprehensive national survey (Phase B), evaluating the alignment of PT curricula with the PEP competency profile. The survey encompassed curriculum content, teaching and assessment strategies, as well as educators’ perceptions of program effectiveness in preparing future clinicians. Our survey aimed to sample all PT programs in the country (n=15). Sampling all 15 PT programs ensured a comprehensive representation, capturing variations in curricular structures nationwide. This approach aimed to avoid biases, enhance generalizability, and explore potential regional or program-specific nuances in pain management education. A dedicated steering group supervised the study, ensuring methodological rigor and robustness in data collection and analysis.
Results
A total of five participants were recruited for the qualitative interviews (Phase A – 100% response rate). This phase revealed a high variability in pain education structures among PT programs, emphasizing the need for targeted competencies. With regards to the national survey (Phase B), 14 Canadian entry-level PT programs participated (93%). All participants completed the survey. The results showed that 11/15 PEP competencies were covered in all programs. However, reported hours varied widely, especially for interpersonal competencies. Teaching methods predominantly included didactic (85%) and problem-based approaches (77%), with reliance on clinical rotations (68%), leading to potential variability in the education of future clinicians. Most programs perceived their students as fully prepared for eight competencies. More than 50% of the programs selected “not prepared” or “partially prepared” for the remaining seven competencies.
Conclusions
The study highlights variations in pain management education across Canadian PT programs. While most competencies are covered, inconsistencies in hours, reliance on clinical rotations, and perceived inadequacies in student preparedness suggest areas for improvement. Our findings shed light on challenges and successes, emphasizing the need for strategic improvements in translating the competency profile into effective educational practices. The perceived preparedness gap underscores the necessity for targeted enhancements in PT education, ensuring students not only meet but exceed entry-to-practice standards, aligning with the innovative national competency profile. Profession-specific competencies tailored to local contexts are crucial for enhancing pain education in PT programs. Their full integration in every PT program in the country would be a necessary next step to improve the competencies of future clinicians.
References
Augeard N, Bostick G, Miller J, et al. Development of a National Pain Management Competency Profile to Guide Entry-level Physiotherapy Education in Canada. Canadian Journal of Pain. 2021;0(ja):null. doi:10.1080/24740527.2021.2004103
Bement MKH, Sluka KA. The Current State of Physical Therapy Pain Curricula in the United States: A Faculty Survey. The Journal of Pain. 2015;16(2):144-152. doi:10.1016/j.jpain.2014.11.001
Bradshaw C, Atkinson S, Doody O. Employing a Qualitative Description Approach in Health Care Research. Glob Qual Nurs Res. 2017;4:2333393617742282. doi:10.1177/2333393617742282
Creswell J, Clark V. Designing and Conducting Mixed Methods Research. 3rd ed. SAGE Publications Inc; 2022. Accessed May 24, 2022. https://us.sagepub.com/en-us/nam/designing-and-conducting-mixed-methods-research/book241842
De Ruddere L, Craig KD. Understanding stigma and chronic pain: a-state-of-the-art review. Pain. 2016;157(8):1607-1610. doi:10.1097/j.pain.0000000000000512
Doyle L, McCabe C, Keogh B, Brady A, McCann M. An overview of the qualitative descriptive design within nursing research. J Res Nurs. 2020;25(5):443-455. doi:10.1177/1744987119880234
Dwyer CP, McKenna-Plumley PE, Durand H, et al. Factors Influencing the Application of a Biopsychosocial Perspective in Clinical Judgement of Chronic Pain: Interactive Management with Medical Students. Pain Physician. 2017;20(6):E951-E960.
Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11(1):770. doi:10.1186/1471-2458-11-770
Government of Canada. Canadian Pain Task Force Report: March 2021. Published May 5, 2021. Accessed November 25, 2021. https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2021.html
Government of Canada. Chronic Pain in Canada: Laying a Foundation for Action. Canadian Pain Task Force Report: June 2019. Published August 8, 2019. Accessed November 25, 2021. https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019.html
Hogan ME, Taddio A, Katz J, Shah V, Krahn M. Incremental health care costs for chronic pain in Ontario, Canada: a population-based matched cohort study of adolescents and adults using administrative data. Pain. 2016;157(8):1626-1633. doi:10.1097/j.pain.0000000000000561
Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. National Academies Press (US); 2011. Accessed July 26, 2022. https://www.ncbi.nlm.nih.gov/books/NBK91497/
Lalonde L, Leroux-Lapointe V, Choinière M, et al. Knowledge, attitudes and beliefs about chronic noncancer pain in primary care: A Canadian survey of physicians and pharmacists. Pain research & management. Published online 2014. doi:10.1155/2014/760145
Lang JJ, Alam S, Cahill LE, et al. Global Burden of Disease Study trends for Canada from 1990 to 2016. CMAJ. 2018;190(44):E1296-E1304. doi:10.1503/cmaj.180698
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. 2022;23(1):1-24. doi:10.1016/j.jpain.2021.06.010
Mezei L, Murinson BB, Johns Hopkins Pain Curriculum Development Team. Pain education in North American medical schools. J Pain. 2011;12(12):1199-1208. doi:10.1016/j.jpain.2011.06.006
Moseley GL, Butler DS. Fifteen Years of Explaining Pain: The Past, Present, and Future. J Pain. 2015;16(9):807-813. doi:10.1016/j.jpain.2015.05.005
Moulin DE, Clark AJ, Speechley M, Morley-Forster PK. Chronic Pain in Canada – Prevalence, Treatment, Impact and the Role of Opioid Analgesia. Pain Research and Management. 2002;7(4):179-184. doi:10.1155/2002/323085
Nicholas MK, George SZ. Psychologically informed interventions for low back pain: an update for physical therapists. Phys Ther. 2011;91(5):765-776. doi:10.2522/ptj.20100278
Nijs J, Meeus M, Cagnie B, et al. A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training. Phys Ther. 2014;94(5):730-738. doi:10.2522/ptj.20130258
Pearson AC, Moman RN, Moeschler SM, Eldrige JS, Hooten WM. Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey. JPR. 2017;10:1395-1400. doi:10.2147/JPR.S136478
Rice A, Smith B, Blyth F. Pain and the global burden of disease?: PAIN. Accessed July 26, 2022. https://journals.lww.com/pain/Citation/2016/04000/Pain_and_the_global_burden_of_disease.6.aspx
Schopflocher D, Taenzer P, Jovey R. The prevalence of chronic pain in Canada. Pain Res Manag. 2011;16(6):445-450.
Slade SC, Kent P, Patel S, Bucknall T, Buchbinder R. Barriers to Primary Care Clinician Adherence to Clinical Guidelines for the Management of Low Back Pain: A Systematic Review and Metasynthesis of Qualitative Studies. Clin J Pain. 2016;32(9):800-816. doi:10.1097/AJP.0000000000000324
Synnott A, O’Keeffe M, Bunzli S, Dankaerts W, O’Sullivan P, O’Sullivan K. Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review. J Physiother. 2015;61(2):68-76. doi:10.1016/j.jphys.2015.02.016
The National Institutes of Health. National Pain Strategy – A Comprehensive Population Health-Level Strategy for Pain. Published online 2016.
Toye F, Seers K, Hannink E, Barker K. A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain. BMC Medical Research Methodology. 2017;17(1):116. doi:10.1186/s12874-017-0392-7
Turk DC, Wilson HD, Cahana A. Treatment of chronic non-cancer pain. Lancet. 2011;377(9784):2226-2235. doi:10.1016/S0140-6736(11)60402-9
Watt-Watson J, McGillion M, Hunter J, et al. A Survey of Prelicensure Pain Curricula in Health Science Faculties in Canadian Universities. Pain Research and Management. 2009;14(6):439-444. doi:10.1155/2009/307932
Watt-Watson J, Peter E, Clark AJ, et al. The ethics of Canadian entry-to-practice pain competencies: How are we doing? Pain Res Manag. 2013;18(1):25-32.
Wideman TH, Edwards RR, Walton DM, Martel MO, Hudon A, Seminowicz DA. The Multimodal Assessment Model of Pain: A Novel Framework for Further Integrating the Subjective Pain Experience Within Research and Practice. Clin J Pain. 2019;35(3):212-221. doi:10.1097/AJP.0000000000000670
Wideman TH, Miller J, Bostick G, Thomas A, Bussières A, Wickens RH. The current state of pain education within Canadian physiotherapy programs: a national survey of pain educators. Disability and Rehabilitation. 2020;42(9):1332-1338. doi:10.1080/09638288.2018.1519044
Presenting Author
Nathan Augeard
Poster Authors
Nathan Augeard
MSc
McGill University
Lead Author
Timothy Wideman
McGill University
Lead Author
Geoffrey Bostick (Phd)
University of Alberta
Lead Author
Jordan Miller
BSc
Queen’s University
Lead Author
Yannick Tousignant-Laflamme
PhD
Université Sherbrooke
Lead Author
David Walton
PhD
University of Western Ontario
Lead Author
Aliki Thomas
PhD
McGill University
Lead Author
Anne Hudon
PhD
School of rehabilitation, Faculty of medicine, Université de Montréal, Canada
Lead Author
Topics
- Education