Rethinking pain education from the perspectives of people experiencing pain: a meta-ethnography to inform physiotherapy training

BackgroundPain is a complex, global and multidimensional phenomena that impacts the lives of millions of people. Chronic pain (lasting more than 3 months) is particularly burdensome for individuals, health and social care systems. Physiotherapists have a fundamental role in supporting people who are experiencing pain. However, the appropriateness of pain education in pre-registration physiotherapy training programmes has been questioned.Recent research reports identify the need to integrate the voice of patients to inform the development of the pre-registration curriculum. The aim of this meta-ethnography was to develop new conceptual understanding of patients' needs when accessing physiotherapy for pain management. The concepts were viewed through an educational lens to create a patient needs-based model to inform physiotherapy training.MethodsNoblit and Hare’s seven-stage meta-ethnography was used to conduct this qualitative systematic review. Five databases (MEDLINE, CINAHL Complete, ERIC, PsycINFO and AMED) were searched with eligibility criteria: qualitative methodology, reports patient experience of physiotherapy, adult participants with musculoskeletal pain, reported in English. Databases were searched to January 2018. Emerge reporting guidelines guided the preparation of this manuscript.ResultsA total of 366 citations were screened, 43 full texts retrieved and 18 studies included in the final synthesis. Interpretive qualitative synthesis resulted in six distinct categories that represent patients’ needs when in pain. Analysing categories through an education lens resulted in three overall lines of argument to inform physiotherapy training. The categories and lines of argument are represented in a ‘needs-based’ model to inform pre-registration physiotherapy training.DiscussionThe findings provide new and novel interpretations of qualitative data in an area of research that lacks patient input. This is a valuable addition to pain education research. Findings support the work of others relative to patient centredness in physiotherapy.

Feasibility of delivering and evaluating stratified care integrated with telehealth (‘Rapid Stratified Telehealth’) for patients with low back pain: protocol for a feasibility and pilot randomised controlled trial

IntroductionLong waiting time is an important barrier to accessing recommended care for low back pain (LBP) in Australia’s public health system. This study describes the protocol for a randomised controlled trial (RCT) that aims to establish the feasibility of delivering and evaluating stratified care integrated with telehealth (‘Rapid Stratified Telehealth’), which aims to reduce waiting times for LBP.Methods and analysisWe will conduct a single-centre feasibility and pilot RCT with nested qualitative interviews. Sixty participants with LBP newly referred to a hospital outpatient clinic will be randomised to receive Rapid Stratified Telehealth or usual care. Rapid Stratified Telehealth involves matching the mode and type of care to participants’ risk of persistent disabling pain (using the Keele STarT MSK Tool) and presence of potential radiculopathy. ‘Low risk’ patients are matched to one session of advice over the telephone, ‘medium risk’ to telehealth physiotherapy plus App-based exercises, ‘high risk’ to telehealth physiotherapy, App-based exercises, and an online pain education programme, and ‘potential radiculopathy’ fast tracked to usual in-person care. Primary outcomes include the feasibility of delivering Rapid Stratified Telehealth (ie, acceptability assessed through interviews with clinicians and patients, intervention fidelity, appointment duration, App useability and online pain education programme usage) and evaluating Rapid Stratified Telehealth in a future trial (ie, recruitment rates, consent rates, lost to follow-up and missing data). Secondary outcomes include waiting times, number of appointments, intervention and healthcare costs, clinical outcomes (pain, function, quality of life, satisfaction), healthcare use and adverse events (AEs). Quantitative analyses will be descriptive and inform a future adequately-powered RCT. Interview data will be analysed using thematic analysis.Ethics and disseminationThis study has received approval from the Ethics Review Committee (RPAH Zone: X21-0221). Results will be published in peer-reviewed journals and presented at conferences.Trial registration numberACTRN12621001104842.

Back2Action: effectiveness of physiotherapy blended with eHealth consisting of pain education and behavioural activation versus physiotherapy alone—protocol for a pragmatic randomised clinical trial for people with subacute or persistent spinal pain

IntroductionPsychosocial factors predict recovery in patients with spinal pain. Several of these factors are modifiable, such as depression and anxiety. However, primary care physiotherapists who typically manage these patients indicate that they do not feel sufficiently competent and equipped to address these factors optimally. We developed an eHealth intervention with a focus on pain education and behavioural activation to support physiotherapists in managing psychosocial factors in patients with spinal pain. This paper describes the protocol for a pragmatic randomised clinical trial, which evaluates the effectiveness of this eHealth intervention blended with physiotherapy compared with physiotherapy alone.Methods and analysisParticipants with non-specific low back pain and/or neck pain for at least 6 weeks who also have psychosocial risk factors associated with the development or maintenance of persistent pain will be recruited in a pragmatic multicentre cluster randomised clinical trial. The experimental intervention consists of physiotherapy blended with six online modules of pain education and behavioural activation. The control intervention consists of usual care physiotherapy. The primary outcomes are disability (Oswestry Disability Index for low back pain and Neck Disability Index for neck pain) and perceived effect (Global Perceived Effect). Outcomes will be assessed at baseline and at 2, 6 and 12 months after baseline. The results will be analysed using linear mixed models.Ethics and disseminationThe study is approved by the Medical Ethical Committee of VU Medical Center Amsterdam, The Netherlands (2017.286). Results will be reported in peer-reviewed journals, at national and international conferences, and in diverse media to share the findings with patients, clinicians and the public.Trial registration numberNL 5941; The Netherlands Trial Register.

The Needs and Experiences of Patients on Pain Education and the Clinical Reasoning of Physical Therapists Regarding Cancer-Related Pain. A Qualitative Study

Objective: This study offers direction for interaction between physical therapists and patients about cancer-related pain during physical training. The study may increase awareness of rehabilitation strategies for cancer-related pain during and after cancer treatment.Methods: Qualitative study, evaluating results of two qualitative studies. Data has been collected using semi-structured interviews, in which topics were discussed with patients and physical therapists. Respondents were adult patients with cancer in the Northern Netherlands with moderate to severe pain who followed physical training with a (oncologic) physical therapist. The physical therapists were respondents specialized in oncology and working with patients with cancer in a primary care setting in in the Netherlands. Data were analyzed using thematic analysis.Results: Eighteen patients and fifteen physical therapists were interviewed. Data was categorized in statements regarding “patients' needs”, “patients' experiences” and “clinical reasoning of the physical therapist”. “Patients' needs” for education were personal and included needs for information about the cause, course and effect of pain in relation to cancer and/or medical treatment, needs for practical tools for reducing pain, needs for strategies dealing with pain in daily activities, and needs for information about additional treatment and care options. When discussing ‘patients’ experiences', patients mentioned that physical therapists are cautious to express their expectations of the progress of pain and to offer pain education with respect to the cause of pain, dealing with pain and limitations in daily life, exercising, posture, learning self-care and information about additional treatment and care options in cancer-related pain. Patients provided insight into their educational, mental, and social support relative to experiences with physical therapists. Additionally, when discussing the communication they experienced with physical therapists, patients used descriptors such as accessibility, empathy, trust, knowledge and eliminating uncertainties. Interviews with physical therapists regarding their clinical reasoning process in cancer-related pain described that they identified pain from anamnesis (medical history review) and performed screening and analysis for pain secondary to cancer (treatment), as type of pain and pain influencing factors. Thoughts and experiences about pain, the use of pain clinometry, the establishment of objectives and interventions for physical therapy and multidisciplinary treatment of cancer-related pain were also described.Conclusion: Patients with cancer-related pain during physical training have personal needs regarding pain education and experience that specialized oncologic physical therapists focus on patient-centered information and self-management support. Specialized oncologic physical therapists analyze pain in the anamnesis and keep in mind the origin and impact of pain for the patient during screening and treatment. Different methods of pain management are used. It is recommended that physical therapists who give physical training take the initiative to repeatedly discuss pain.

Post-Operative Pain Management Knowledge and Attitude of Paediatric Nurses: a New Zealand Regional View

<p><b>Pain and fear of pain are major concerns for many hospitalised patients. Nurses need to understand this pain, and be able to assess and manage it effectively. Despite advances in knowledge and an increased amount of nursing research related to pain management, literature continues to identify that infants, children and adolescents continue to experience unrelieved pain post surgery. Contemporary literature suggests that nurses’ knowledge and attitudes towards pain affects their pain management practices. Nurses in small regional hospitals often don’t have the support of paediatric pain specialists and therefore rely on their own knowledge, education and experience to manage the pain of the infants, children and adolescents in their care.</b></p> <p>This research explored the knowledge and attitudes towards paediatric post-operative pain, within the New Zealand context of small regional hospitals. It established how nurses working in these areas obtain and update their paediatric pain management knowledge, and what is it that influences their paediatric post-operative pain management practices. A questionnaire survey of registered nurses working in three small paediatric units (5 to 12 beds), in regional secondary service hospitals was undertaken. The questionnaire developed was based on the Paediatric Nurses Knowledge and Attitude Survey (PNKAS). The survey had a 79% (n=33) response rate. Findings corroborate many findings in previously published literature including that nurses do well in questions related to assessment. However pharmacological knowledge continues to be lacking. Results also indicated that while nurses have a good understanding about who is the best person to rate pain, this wasn’t carried through in the clinical scenarios provided. Education is clearly an important factor in improving the knowledge and attitudes needed in clinical practice.</p> <p>While this survey was somewhat limited, both in size and in that a clear correlation between the results and actual clinical practice could not be made, results are significant for the areas surveyed and for the development of pain education for nurses. Wider research into both pain education and clinical practice is needed. - II -Some of the first steps could be to survey the knowledge and attitude of those who instruct in undergraduate programs related to pain, and review what is being provided in the course programs, and then examine what is being offered within the clinical environments. Research, incorporating chart review and utilising open written questions and/or interviews, or group discussions would provide far more information on which to base recommendations for practice.</p>

Post-Operative Pain Management Knowledge and Attitude of Paediatric Nurses: a New Zealand Regional View

<p><b>Pain and fear of pain are major concerns for many hospitalised patients. Nurses need to understand this pain, and be able to assess and manage it effectively. Despite advances in knowledge and an increased amount of nursing research related to pain management, literature continues to identify that infants, children and adolescents continue to experience unrelieved pain post surgery. Contemporary literature suggests that nurses’ knowledge and attitudes towards pain affects their pain management practices. Nurses in small regional hospitals often don’t have the support of paediatric pain specialists and therefore rely on their own knowledge, education and experience to manage the pain of the infants, children and adolescents in their care.</b></p> <p>This research explored the knowledge and attitudes towards paediatric post-operative pain, within the New Zealand context of small regional hospitals. It established how nurses working in these areas obtain and update their paediatric pain management knowledge, and what is it that influences their paediatric post-operative pain management practices. A questionnaire survey of registered nurses working in three small paediatric units (5 to 12 beds), in regional secondary service hospitals was undertaken. The questionnaire developed was based on the Paediatric Nurses Knowledge and Attitude Survey (PNKAS). The survey had a 79% (n=33) response rate. Findings corroborate many findings in previously published literature including that nurses do well in questions related to assessment. However pharmacological knowledge continues to be lacking. Results also indicated that while nurses have a good understanding about who is the best person to rate pain, this wasn’t carried through in the clinical scenarios provided. Education is clearly an important factor in improving the knowledge and attitudes needed in clinical practice.</p> <p>While this survey was somewhat limited, both in size and in that a clear correlation between the results and actual clinical practice could not be made, results are significant for the areas surveyed and for the development of pain education for nurses. Wider research into both pain education and clinical practice is needed. - II -Some of the first steps could be to survey the knowledge and attitude of those who instruct in undergraduate programs related to pain, and review what is being provided in the course programs, and then examine what is being offered within the clinical environments. Research, incorporating chart review and utilising open written questions and/or interviews, or group discussions would provide far more information on which to base recommendations for practice.</p>