The Effect of Pain Neuroscience Education on Sports Therapy and Rehabilitation Students’ Knowledge, Attitudes, and Clinical Recommendations Toward Athletes With Chronic Pain

Context: Pain education is a fundamental part of a holistic approach to athlete injury management. Objective: Investigate the effect of Pain Neuroscience Education (PNE) on Sports Therapy and Rehabilitation (STR) students: 1) knowledge of persistent pain; 2) attitudes towards athletes with persistent pain; 3) clinical recommendations for athletes with persistent pain. Design: Parallel groups, single-blind randomised control trial. Setting: A UK University. Participants: Sixty-one undergraduate and postgraduate STR students. Interventions: The PNE session (intervention group) provided detailed information on the neuroscience of persistent pain, the modulating role of psychosocial factors on pain biology, and how this information could be used to inform clinical practice. The red flags (control group) session provided information on screening patients with persistent pain for serious/sinister pathologies. Each education session lasted 70 minutes. Outcome measures: (1). Knowledge - the Revised Pain Neuroscience Questionnaire; (2). Attitudes – the Health Care Pain Attitudes and Impairment Relationship Scale (HC-PAIRS); (3). Clinical recommendations – an athlete case vignette. Results: Post education, the PNE group had a greater increase in pain neuroscience knowledge (mean difference 3.2 [CI 2.1 to 4.3], p<0.01) and improved attitudes (mean difference -10.1 [CI -16.6 to -3.6], P<0.01). Additionally, students in the PNE group were more likely to make appropriate clinical recommendations (OR = odds ratio, CI = confidence interval) regarding return-to-work (OR 6.1 [CI 1.1 to 32.3], p=0.03), exercise (OR 10.7 [CI 2.6 to 43.7], p=<0.01), and bed rest (OR 4.3 [CI 1.5 to 12.8], p=0.01). Conclusions: A brief PNE session can, in the immediate term, increase STR students’ knowledge of pain neuroscience, improve attitudes towards athletes with pain and shift their clinical recommendations in line with current guidelines. Such changes could lead to enhanced rehabilitation for athletes with persistent pain.