Background & Aims

Private practice physiotherapists in Australia are first-contact healthcare providers (requiring no referral). Thus, they play a critical role in implementing guideline-driven care for pain management, including pain science education (PSE). PSE is an evidence-based intervention that aims to alter unhelpful/inaccurate knowledge and beliefs about pain, ultimately reconceptualising an individual’s understanding of their pain [1]. Data on PSE knowledge and application among Australian private practice physiotherapists are lacking. Identifying knowledge gaps and challenges in the application of PSE is crucial for shaping PSE training and developing effective educational aids. We aimed to investigate physiotherapists’ PSE knowledge, utilisation in private practice, understanding and application of key concepts, and awareness of educational strategies. We also examined variations based on work location (rural/remote vs. metropolitan), PSE training type, and years of clinical experience.

Methods

A nationwide online (Qualtrics) survey targeted Australian physiotherapists with current registration, recent private practice experience (last five years), and education/training in PSE. Recruitment occurred via email campaigns (via publicly available physiotherapist database), advertisements, websites, social media, and newsletters. Pain science knowledge was evaluated using the Revised Neurophysiology of Pain Questionnaire (rNPQ; 0-13) and agreement with key PSE concepts [2] (accurate and inaccurate concepts). Respondents rated (5-point Likert) their understanding and ease of explanation of PSE concepts and ranked the top three most and least beneficial concepts. Open-text responses explored educational strategies and difficulties experienced when explaining PSE concepts to patients. The effect of demographic variables (years of experience, work location, training type) on PSE knowledge, understanding and application was evaluated using linear and binary logistic regressions.

Results

278 physiotherapists (62.9% female, aged 39.4 SD11.8 years, 15.2 SD11.6 years of experience, 37.2% rural/remote) had available data. Clinicians reported typically providing PSE to 61% of their patients, with use heightened in those with university + course training (vs university only; p=0.047). University + course training (p=0.004) and course training only (vs university only; p<0.001) was associated with greater PSE knowledge (rNPQ). Clinicians rated their understanding of PSE concepts as adequate (4.1/5 SD0.6), yet 30% agreed with inaccurate concepts. Of PSE concepts, “All pain is real no matter what is causing it” was ranked most beneficial and rated easiest to explain. “Learning how pain works is an effective treatment” was considered the most difficult concept to explain. Metropolitan physiotherapists (vs rural/remote; p=0.002) reported greater ease of explaining PSE concepts. Clinicians had limited knowledge of educational strategies: 41% listed a strategy, with 79% mistakenly citing PSE resources.

Conclusions

While clinicians demonstrated satisfactory PSE knowledge, awareness of educational strategies (e.g., motivational interviewing) that promote effective PSE implementation via deep learning/reconceptualisation, was poor. Physiotherapists also found framing PSE as a standalone treatment to be difficult. Lack of knowledge of educational strategies may contribute to this difficulty and suggests that PSE courses may benefit from greater emphasis on educational theory. Clinicians who had received all or part of their PSE training via a post-graduate course exhibited modestly higher PSE use and knowledge than those with university training only, underscoring the importance of up-to-date continuing education, potentially supplemented by clinical experience. Otherwise, few demographic factors predicted overall understanding or ease of explaining PSE concepts, suggesting that challenges are universal across the physiotherapy cohort.

References

[1] Moseley GL, Butler DS. Fifteen Years of Explaining Pain: The Past, Present, and Future. J Pain 2015; 16: 807–13.
[2] Leake HB, Mardon A, Stanton TR, Harvie DS, Butler DS, Karran EL, Wilson D, Booth J, Barker T, Wood P, Fried K, Hayes C, Taylor L, Macoun M, Simister A, Moseley GL, Berryman C. Key Learning Statements for Persistent Pain Education: An Iterative Analysis of Consumer, Clinician and Researcher Perspectives and Development of Public Messaging. J Pain 2022; 11: 1989-2001.
[3] Watson JA, Ryan CG, Cooper L, et al. Pain Neuroscience Education for Adults With Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis. J Pain 2019; 20: 1140–1140.

Presenting Author

Monique Wilson

Poster Authors

Monique Wilson

OTHR

University of South Australia

Lead Author

Felicity Braithwaite

BPT (Hons)

University of South Australia

Lead Author

John Arnold

PhD

University of South Australia

Lead Author

Tasha Stanton

The University of South Australia

Lead Author

Topics

  • Education