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  • Many PT Programs Describe Their Pain Management Education as Not 'Adequate'

    While it appears that physical therapist (PT) education programs have increased the amount of time spent on pain education over the years, only 63% of faculty respondents to a recent survey believe that today's students are receiving adequate instruction in pain management, according to study published recently in The Journal of Pain (abstract only available for free).

    Authors Marie Hoeger Bement, PT, PhD, and Kathleen Sluka, PT, PhD, surveyed accredited PT programs on a range of issues around pain education, including how much time is spent on pain instruction, whether that instruction is delivered in a standalone course, what areas were covered, and whether the education reflected Institute of Medicine (IOM) and International Association for the Study of Pain (IASP) recommendations and guidelines for curriculum development. The survey was conducted between October 2012 and January 2013, and was sent to all PT programs listed in APTA's Physical Therapist Centralized Application Service.

    In the end, 167 programs (76%) answered the first portion of the 10-part survey—the section that focused on time spent in pain education—while 137 (62%) completed the remaining sections, which focused on specific content covered and respondent perceptions about the adequacy of instruction.

    Among the findings:

    • On average, programs spent about 31 hours on pain, but this average accounted for a wide range of reporting, from 5 to 115 hours. The most-frequently cited time estimate (modal) was 10 hours.
    • Only 11 of 167 programs (6%) reported having an independent pain course; all other programs reported that content was integrated into courses through blocks of time devoted to pain issues. At the time of the survey, 2 programs reported plans to create an independent pain course within the next year.
    • Most time was devoted to interventions and management (average of 27.2 hours), followed by the science of pain (9.5 hours) and assessment (4 hours).
    • Within intervention, manual therapy and "electrical agents" for pain control were reported to receive the most attention, with averages of 4.4 hours and 4.9 hours, respectively. Other topics, including exercise therapy, thermal agents, psychological management, and multidisciplinary management, received less time, ranging from averages of 2.2 hours (physician management) to 3.9 hours (both exercise therapy and thermal agents).
    • Nearly all programs responding (99%) teach various subjective pain intensity rating scales.
    • Only 68% of programs responding covered pain assessment across the lifespan.

    Authors describe a lack of data on how pain curriculum has evolved in PT programs, but they cite a 2001 survey that reported a modal of 4 hours. Although the current and earlier studies are not directly comparable, they write, the recent results "appear to be an improvement."

    Still, despite increased hours and range of topics covered, only about 6 in 10 respondents felt that their programs offered sufficient instruction in pain management (63%), with 69% reporting that their programs provided inadequate education on pain across the lifespan. "These results suggest that not all PT programs adequately provide pain education in their curriculum, especially pain assessment and management in the young and old," authors write.

    Authors also reported that less than half of the respondents were aware of IASP curriculum guidelines, or an IOM report calling for increased education on pain across health disciplines. Among the elements in the IASP guidelines is the recommendation that pain curriculum be taught as a freestanding course.

    "Ensuring that PT students receive adequate instruction in pain mechanisms and management would likely result in improved patient outcomes and lower health care costs," authors write. "To stay current in pain education, PT programs should be aware of the latest educational advancements, including the IOM report, IASP guidelines, and pain competencies."

    APTA has been a strong advocate for the ways in which physical therapy can be a transformative agent in the treatment of chronic pain. The APTA Orthopaedic Section sponsors a special interest group in pain management, and the PT's role in chronic pain management was featured in the September 2014 issue of PT in Motion magazine.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    • For those interested in getting "up to speed" on your knowledge about pain, come to the Section on Research Retreat "Piecing Together the Pain Puzzle: The Biopsychosocial Model" July 26-30, 2015 in Smithfield, RI. For more information please visit the SOR website at www.ptresearch.org and click on Meetings--> SOR Retreat. It's going to be FABULOUS!

      Posted by Katy Rudolph on 3/3/2015 9:59 PM

    • I think it is time to move to adding a specialization of a Clinical Pain Specialist, such as Canada has for their Physio program. It is critical that PTs understand the biology of pain and be able to reduce the fear, increase the independence of their patients and exceed international standards.

      Posted by Sandra Hilton on 3/3/2015 11:44 PM

    • I agree with Sandra, it is time for the APTA to stop dragging their feet. Science and reimbursement are changing the landscape of patient care. Pain is the primary complaint that patient's visit outpatient PT. How can we not have an independent course devoted to this and a specialist post grad program.

      Posted by Eric Kruger on 3/5/2015 9:20 AM

    • I second the sentiments of Sandra and Eric. This needs to happen sooner rather than later.

      Posted by Marcos lopez on 3/12/2015 11:20 PM

    • Unfortunately, physiotherapy remains antiquated in its approach to health by compartmentalizing it and then selecting the 'safe', non-psychoemotional content as if biological science is an adequate approach. It isn't, yet the profession hasn't evolved. I suspect that deep down, the profession doesn't want to admit that it doesn't really know what it is talking about, or doing. Dear PT, the DPT has been a bust. Perhaps time to consider client-centredness as the focus rather than your own ego needs of feeling important?

      Posted by David on 4/23/2019 10:21 AM

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