Background & Aims
Many healthcare professionals (HCPs) believe in a strong relationship between pain and physical impairment, reflecting a lack of pain knowledge and overlooking the vital role of psychological and social factors [1]. It results partly from inadequate training in musculoskeletal chronic pain during the education [2]. As a consequence, lack of pain knowledge is one of the barriers for HCPs to adhere to clinical guidelines [3], resulting in mainly biomedical and guideline-discordant chronic pain management, characterized by overuse of medical imaging, pain medication, and advice to restrict work and physical activities [3,4]. Furthermore, it is associated with poorer patient outcomes. Therefore, this study aimed to assess the short and mid-term changes of an interdisciplinary training program (ITP) on HCPs’ knowledge and attitudes towards musculoskeletal pain about chronic pain and guideline-adherent recommendations regarding activity, sports, work, bed rest and opioids.
Methods
An ITP – including two e-learning modules and two 8-hour workshops – was developed in collaboration with Belgian chronic pain experts5. This ITP aimed to facilitate the implementation of biopsychosocial and patient-centred chronic pain management, including pain education in clinical practice with patients with chronic pain. The target groups were medical doctors, physiotherapists, psychologists, occupational therapists, nurses and pharmacists. The ITP was implemented in three areas in Belgium between 2021 and 2022. ITP participants were asked to participate in this cohort study. Pre-training, post-training, and six-month follow-up assessments were conducted using the KNowledge and Attitudes about Pain (KNAP) questionnaire [6] and two clinical vignettes to measure guideline-adherent recommendations. A linear mixed model was conducted to assess change in KNAP scores and its predicting factors. The remaining knowledge and attitudes were cross-sectionally assessed at six-month follow-up.
Results
A total of 267 out of 334 trained HCPs participated in this study. HCPs’ knowledge and attitudes of pain greatly improved towards modern pain science at post-training (? = 8.87, 95% CI [7.64, 10.09]) and at six-month follow-up (? = 7.17, 95% CI [5.54, 10.40]), a small reduction was found between post-training and follow-up (? = -1.69, 95% CI [-3.10, 0.27]). Higher age, male sex, and medical doctor, physiotherapist and psychologist professions were predictors for higher KNAP scores. However, some biomedical attitudes remained after six months, especially regarding the treatment of pain. The percentage of guideline-adherent recommendations improved significantly in all domains, although bed rest and opioids (79.3 – 83.8%) remained relatively lower compared to others (93.3 – 99.5%). Furthermore, participants reported high training satisfaction, yet, their satisfaction regarding the application of training content into clinical practice was relatively lower.
Conclusions
Our study demonstrated the positive impact of implementing an ITP about chronic pain management in various HCPs’ understanding of pain. This impact reflects stronger biopsychosocial knowledge and attitudes, embracing modern pain science and non-pharmaceutical treatments in both the short and mid-term. Yet, this impact differed between professions. Despite high participant satisfaction with the ITP, continued efforts are needed to refine their content for more effective translation into clinical practice and to improve traditional misconceptions, notably in the context of pain treatment. Translating acquired knowledge into clinical practice is challenging, highlighting the multifaceted nature of effective biopsychosocial chronic pain management.
References
[1] Grøn S, Bülow K, Jonsson TD, Degn J, Kongsted A. What do people believe to be the cause of low back pain? A scoping review. Brazilian Journal of Physical Therapy. 2023/11/01/ 2023;27(6):100562. doi:https://doi.org/10.1016/j.bjpt.2023.100562
[2] Shipton EE, Bate F, Garrick R, Steketee C, Shipton EA, Visser EJ. Systematic Review of Pain Medicine Content, Teaching, and Assessment in Medical School Curricula Internationally. Pain and Therapy. 2018/12/01 2018;7(2):139-161. doi:10.1007/s40122-018-0103-z
[3] Gardner T, Refshauge K, Smith L, McAuley J, Hubscher M, Goodall S. Physiotherapists’ beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. J Physiother. Jul 2017;63(3):132-143. doi:10.1016/j.jphys.2017.05.017
[4] Mafi JN, McCarthy EP, Davis RB, Landon BE. Worsening trends in the management and treatment of back pain. JAMA Intern Med. Sep 23 2013;173(17):1573-81. doi:10.1001/jamainternmed.2013.8992
[5] Munneke W, Demoulin C, Nijs J, et al. 2023;doi:10.21203/rs.3.rs-3246209/v1
[6] Munneke W, De Kooning M, Nijs J, et al. Cross-cultural adaptation and psychometric testing of the French version of the Knowledge and Attitudes of Pain (KNAP) questionnaire. Annals of Physical and Rehabilitation Medicine. 2023/10/01/ 2023;66(7):101757. doi:10.1016/j.rehab.2023.101757
Presenting Author
Wouter Munneke
Poster Authors
Wouter Munneke
MSc
VUB
Lead Author
Jo Nijs
PhD
Vrije Universiteit Brussel
Lead Author
Margot De Kooning
PhD
VUB
Lead Author
Anne Berquin
PhD
Université catholique de Louvain
Lead Author
Mira Meeus
PhD
University of Antwerp
Lead Author
Jan Hartvigsen
University of Southern Denmark
Lead Author
Christophe Demoulin
PhD
Université de Liège
Lead Author
Topics
- Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science