The effect of Pain Neurophysiology Education on physiotherapy students’ understanding of chronic pain, clinical recommendations, and attitudes towards people with chronic pain: a randomised controlled trial.

Objective: To investigate the effect of Pain Neurophysiology Education (PNE) on student physiotherapists’: 1) knowledge of chronic pain; 2) attitudes towards patients with chronic pain and; 3) clinical recommendations for patients with chronic pain. Design: Multi-centred single-blind randomised controlled trial. Setting: One UK and one Irish University. Participants: Seventy-two student physiotherapists. Intervention: Participants received either a PNE (intervention) or a control education. Both were delivered in a 70-minute group lecture. Main Outcome Measures: 1) the Revised Pain Neurophysiology Quiz to assess knowledge; 2) the Health Care Pain Attitudes and Impairment Relationship Scale (HC-PAIRS) to assess attitudes; and 3) a case vignette to assess appropriateness of clinical recommendations. Results: Post education, the PNE group had a greater increase in pain neurophysiology knowledge 4.0 (3.2 to 4.7), p<0.01 [mean difference (95% Confidence Interval), p-value] and more improved attitudes -17.5 (-22.1 to -12.9), p<0.01. Post-education, students in the PNE group were more likely to make appropriate recommendations with respect to work (94% vs. 56%), exercise (92% vs. 56%), activity (94% vs. 67%) and bedrest (69% vs. 33%) compared to those in the control group (p<0.05). Conclusion: The improvements in knowledge, attitudes and recommendations for pain management show that PNE is a potentially valuable part of physiotherapy student education, which could be used on a more widespread basis. There is a need to investigate whether these findings can be replicated in other health care professions, and how well these reported changes lead to changes in actual clinical behaviour and the clinical outcomes of patients.