Pain education for clinicians in geriatrics: a study into changes in clinician attitudes and beliefs

Authors

  • Audrey P Wang War Memorial Hospital, Waverley, NSW 2024 Australian Catholic University, North Sydney, NSW 2060
  • Georgia Fisher University of Technology Sydney
  • Jillian Hall Uniting War Memorial Hospital NSW Health - South Eastern Sydney Local Health District

Abstract

A lack of recognition of chronic pain in older adults has fundamental healthcare implications. A practice gap exists that affects evidence-based practice for chronic pain assessment and management specific to older adults. Psychologically informed practice (PIP) has been proposed as a method of enabling health professionals to deliver biopsychosocial pain assessment and management in their practice. The aim of this study was to test the feasibility of a single one-day structured educational program to both introduce the concept of PIP and to shift the attitudes, beliefs and orientation towards patients of clinicians working in the geriatric rehabilitation setting. An observational pre-post study design used two previously validated questionnaires: Pain Attitudes and Beliefs Scale (PABS) and the Patient-Practitioner Orientation Scale (PPOS). Eighteen clinicians from a sub-acute geriatric rehabilitation hospital participated in a one-day pain education training workshop run by an expert psychologist who trains health professionals in pain management skills. Participants completed the questionnaires pre and immediately post workshop. A significant shift (p < 0.001) away from the biomedical model ( = -9.33, 95% CI: -12.41 to -6.26) was detected in the PABS post-workshop, indicating a change towards a more biopsychosocial attitude in assessing and treating chronic pain. Nil significant change ( = 0.61, 95% CI: -2.44 to 3.66) was detected in the PPOS. In conclusion, a one-day structured educational program was feasible in providing foundational steps in implementing the concept of PIP in geriatric rehabilitation settings. This was sufficient to shift key therapist attitudes and beliefs towards a more biopsychosocial model of pain management in older adults, and to reduce the strength of their biomedical attitudes. Surprisingly, this attitudinal shift was not accompanied by a shift in practitioner orientation towards their patients. Practitioner-patient orientation represents a potential translational target to improve the implementation of biopsychosocial principles in the care of the older adult.

Downloads

Download data is not yet available.

Author Biography

Audrey P Wang, War Memorial Hospital, Waverley, NSW 2024 Australian Catholic University, North Sydney, NSW 2060

Senior  Physiotherapist, Physiotherapy Department, War Memorial Hospital, Waverley, NSW 2024. Lecturer, School of Physiotherapy, Australian Catholic University, North Sydney, NSW 2060.

References

References

ABDEL SHAHEED, C., GRAVES, J. & MAHER, C. 2017. The effects of a brief educational intervention on medical students’ knowledge, attitudes and beliefs towards low back pain. Scandinavian Journal of Pain, 16, 101-104.

ABDULLA, A., ADAMS, N., BONE, M., ELLIOTT, A. M., GAFFIN, J., JONES, D., KNAGGS, R., MARTIN, D., SAMPSON, L. & SCHOFIELD, P. 2013. Guidance on the management of pain in older people. Age Ageing, 42 Suppl 1, i1-57.

BISHOP, E. A., THOMAS, E. E. & FOSTER, E. N. 2007. Health care practitioners attitudes and beliefs about low back pain: A systematic search and critical review of available measurement tools. Pain, 132, 91-101.

BLYTH, F. M., CUMMING, R., MITCHELL, P. & WANG, J. J. 2007. Pain and falls in older people. Eur J Pain, 11, 564-71.

BLYTH, F. M., MARCH, L. M., BRNABIC, A. J. M., JORM, L. R., WILLIAMSON, M. & COUSINS, M. J. 2001. Chronic pain in Australia: a prevalence study. Pain, 89, 127-134.

BOND, S. J. & SOUNDY, A. 2012. The influence of perceptions and beliefs of civilian physiotherapist working for the Ministry of Defence in their management of back pain: an exploratory study using mixed methods. J R Army Med Corps, 158, 14-21.

BOOKER, S. Q. & HERR, K. A. 2016. Assessment and Measurement of Pain in Adults in Later Life. Clinics in Geriatric Medicine, 32, 677-692.

BOWEY-MORRIS, J., PURCELL-JONES, G. & WATSON, P. J. 2010. Test-retest reliability of the pain attitudes and beliefs scale and sensitivity to change in a general practitioner population. Clin J Pain, 26, 144-52.

CHOU, R., LOESER, J. D., OWENS, D. K., ROSENQUIST, R. W., ATLAS, S. J., BAISDEN, J., CARRAGEE, E. J., GRABOIS, M., MURPHY, D. R., RESNICK, D. K., STANOS, S. P., SHAFFER, W. O. & WALL, E. M. 2009. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine, 34, 1066.

COLLEARY, G., O’SULLIVAN, K., GRIFFIN, D., RYAN, C. G. & MARTIN, D. J. 2017. 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. Physiotherapy, 103, 423-429.

CURROW, D. C., AGAR, M., PLUMMER, J. L., BLYTH, F. M. & ABERNETHY, A. P. 2010. Chronic pain in South Australia - population levels that interfere extremely with activities of daily living. Aust N Z J Public Health, 34, 232-9.

DOMENECH, F. J., SÁNCHEZ-ZURIAGA, F. D., SEGURA-ORTÍ, F. E., ESPEJO-TORT, F. B. & LISÓN, F. J. 2011. Impact of biomedical and biopsychosocial training sessions on the attitudes, beliefs, and recommendations of health care providers about low back pain: A randomised clinical trial. Pain, 152, 2557-2563.

FISHMAN, S. M., YOUNG, H. M., LUCAS ARWOOD, E., CHOU, R., HERR, K., MURINSON, B. B., WATT-WATSON, J., CARR, D. B., GORDON, D. B., STEVENS, B. J., BAKERJIAN, D., BALLANTYNE, J. C., COURTENAY, M., DJUKIC, M., KOEBNER, I. J., MONGOVEN, J. M., PAICE, J. A., PRASAD, R., SINGH, N., SLUKA, K. A., ST. MARIE, B. & STRASSELS, S. A. 2013. Core Competencies for Pain Management: Results of an Interprofessional Consensus Summit. Pain Medicine, 14, 971-981.

FLUM, D. R., ALFONSO-CRISTANCHO, R., DEVINE, E. B., DEVLIN, A., FARROKHI, E., TARCZY-HORNOCH, P., KESSLER, L., LAVALLEE, D., PATRICK, D. L., GORE, J. L. & SULLIVAN, S. D. 2014. Implementation of a "real-world" learning health care system: Washington State's Comparative Effectiveness Research Translation Network (CERTAIN). Surgery, 155, 860-6.

GAGLIARDI, A. R. & DOBROW, M. J. 2016. Identifying the conditions needed for integrated knowledge translation (IKT) in health care organizations: qualitative interviews with researchers and research users. BMC Health Services Research, 16, 256.

GARDNER, T., REFSHAUGE, K., SMITH, L., MCAULEY, J., HÜBSCHER, M. & GOODALL, S. 2017. Physiotherapists’ beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. Journal of Physiotherapy, 63, 132-143.

GATCHEL, R. J. & OKIFUJI, A. 2006. Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. J Pain, 7, 779-93.

GEORGE, S. Z., TEYHEN, D. S., WU, S. S., WRIGHT, A. C., DUGAN, J. L., YANG, G., ROBINSON, M. E. & CHILDS, J. D. 2009. Psychosocial education improves low back pain beliefs: results from a cluster randomized clinical trial (NCT00373009) in a primary prevention setting. European Spine Journal, 18, 1050-1058.

GIBBS, V. 2011. An investigation into the challenges facing the future provision of continuing professional development for allied health professionals in a changing healthcare environment. Radiography, 17, 152-157.

GRILO, A. M., SANTOS, M. C., RITA, J. S. & GOMES, A. I. 2014. Assessment of nursing students and nurses' orientation towards patient-centeredness. Nurse Education Today, 34, 35-39.

HADJISTAVROPOULOS, T., HERR, K., TURK, D. C., FINE, P. G., DWORKIN, R. H., HELME, R., JACKSON, K., PARMELEE, P. A., RUDY, T. E., LYNN BEATTIE, B., CHIBNALL, J. T., CRAIG, K. D., FERRELL, B., FERRELL, B., FILLINGIM, R. B., GAGLIESE, L., GALLAGHER, R., GIBSON, S. J., HARRISON, E. L., KATZ, B., KEEFE, F. J., LIEBER, S. J., LUSSIER, D., SCHMADER, K. E., TAIT, R. C., WEINER, D. K. & WILLIAMS, J. 2007. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain, 23, S1-43.

HAIDET, P., DAINS, J. E., PATERNITI, D. A., CHANG, T., TSENG, E. & ROGERS, J. C. 2001. Medical students' attitudes toward patient-centered care and standardized patients' perceptions of humanism: a link between attitudes and outcomes. Acad Med, 76, S42-4.

HOUBEN, R. M. A., OSTELO, R. W. J. G., VLAEYEN, J. W. S., WOLTERS, P. M. J. C., PETERS, M. L. & STOMP-VAN DEN BERG, S. G. 2005. Health care providers' orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity. European Journal of Pain, 9, 173-183.

JEFFREY, J. E. & FOSTER, N. E. 2012. A qualitative investigation of physical therapists' experiences and feelings of managing patients with nonspecific low back pain. Phys Ther, 92, 266-78.

JONES, L. E. & HUSH, J. M. 2011. Pain education for physiotherapists: is it time for curriculum reform? J Physiother, 57, 207-8.

KAASALAINEN, S., ZACHARIAS, R., HILL, C., WICKSON-GRIFFITHS, A., HADJISTAVROPOULOS, T. & HERR, K. 2017. Advancing the pain management in older adults agenda forward through the development of key research and education priorities: A Canadian perspective. Canadian Journal of Pain, 1, 171-182.

KAMPER, S. J., APELDOORN, A. T., CHIAROTTO, A., SMEETS, R. J., OSTELO, R. W., GUZMAN, J. & VAN TULDER, M. W. 2014. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev, Cd000963.

KARP, J. F., REYNOLDS, C. F., 3RD, BUTTERS, M. A., DEW, M. A., MAZUMDAR, S., BEGLEY, A. E., LENZE, E. & WEINER, D. K. 2006. The relationship between pain and mental flexibility in older adult pain clinic patients. Pain Med, 7, 444-52.

KIM, H.-Y. 2013. Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restorative Dentistry & Endodontics, 38, 52-54.

KRUPAT, E., ROSENKRANZ, S. L., YEAGER, C. M., BARNARD, K., PUTNAM, S. M. & INUI, T. S. 2000. The practice orientations of physicians and patients: the effect of doctor–patient congruence on satisfaction. Patient Education and Counseling, 39, 49-59.

LEVEILLE, S. G., JONES, R. N., KIELY, D. K., HAUSDORFF, J. M., SHMERLING, R. H., GURALNIK, J. M., KIEL, D. P., LIPSITZ, L. A. & BEAN, J. F. 2009. Chronic musculoskeletal pain and the occurrence of falls in an older population. JAMA, 302, 2214-21.

LOURIDA, I., ABBOTT, R. A., ROGERS, M., LANG, I. A., STEIN, K., KENT, B. & THOMPSON COON, J. 2017. Dissemination and implementation research in dementia care: a systematic scoping review and evidence map. BMC Geriatrics, 17, 147.

MADAUS, S. M. & LIM, L. S. 2016. Teaching Pain Management in Interprofessional Medical Education: A Review of Three Portal of Geriatric Online Education Modules. J Am Geriatr Soc, 64, 2122-2125.

MAIN, C. J. & GEORGE, S. Z. 2011. Psychologically informed practice for management of low back pain: Future directions in practice and research. Physical Therapy, 91, 820-824.

MAIN, C. J., SOWDEN, G., HILL, J. C., WATSON, P. J. & HAY, E. M. 2012. Integrating physical and psychological approaches to treatment in low back pain: the development and content of the STarT Back trial's ‘high-risk’ intervention (StarT Back; ISRCTN 37113406). Physiotherapy, 98, 110-116.

MASTERS, K. S. 2013. Biopsychosocial Model. In: RUNEHOV, A. L. C. & OVIEDO, L. (eds.) Encyclopedia of Sciences and Religions. Dordrecht: Springer Netherlands.

MAYS, G. P., HOGG, R. A., CASTELLANOS-CRUZ, D. M., HOOVER, A. G. & FOWLER, L. C. 2013. Public health research implementation and translation: Evidence from practice-based research networks. American Journal of Preventive Medicine, 45, 752-762.

MCCLUSKEY, A. & LOVARINI, M. 2005. Providing education on evidence-based practice improved knowledge but did not change behaviour: a before and after study. BMC Med Educ, 5, 40.

MCKENNA, H., ASHTON, S. & KEENEY, S. Barriers to evidence based practice in primary care: a review of the literature. International Journal of Nursing Studies, 41, 369-378.

MELNYK, B. M., FINEOUT-OVERHOLT, E., GALLAGHER-FORD, L. & KAPLAN, L. 2012. The state of evidence-based practice in US nurses: critical implications for nurse leaders and educators. J Nurs Adm, 42, 410-7.

MENANT, J. C., WONG, A., STURNIEKS, D. L., CLOSE, J. C., DELBAERE, K., SACHDEV, P. S., BRODATY, H. & LORD, S. R. 2013. Pain and anxiety mediate the relationship between dizziness and falls in older people. J Am Geriatr Soc, 61, 423-8.

MONAGHAN, J., FOTHERGILL, M. & ADAMS, N. 2016. A pain education programme for physiotherapists in clinical practice: a mixed methods feasibility study. Physiotherapy, 102, e213-e214.

NICHOLAS, M. K., ASGHARI, A., BLYTH, F. M., WOOD, B. M., MURRAY, R., MCCABE, R., BRNABIC, A., BEESTON, L., CORBETT, M., SHERRINGTON, C. & OVERTON, S. 2017. Long-term outcomes from training in self-management of chronic pain in an elderly population: a randomized controlled trial. Pain, 158, 86-95.

NICHOLAS, M. K., ASGHARI, A., CORBETT, M., SMEETS, R. J. P., WOOD, B. M., OVERTON, S., PERRY, C., TONKIN, L. E. & BEESTON, L. 2012. Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic pain? European Journal of Pain, 16, 93-104.

NICHOLAS, M. K. & BLYTH, F. M. 2016. Are self-management strategies effective in chronic pain treatment? Pain Manag, 6, 75-88.

OSLUND, S., ROBINSON, R. C., CLARK, T. C., GAROFALO, J. P., BEHNK, P., WALKER, B., WALKER, K. E., GATCHEL, R. J., MAHANEY, M. & NOE, C. E. 2009. Long-term effectiveness of a comprehensive pain management program: strengthening the case for interdisciplinary care. Proceedings (Baylor University. Medical Center), 22, 211-214.

OVERMEER, T., BOERSMA, K., DENISON, E. & LINTON, S. J. 2011. Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes? a randomized controlled trial. Physical Therapy, 91, 804-819.

OVERMEER, T., BOERSMA, K., MAIN, C. J. & LINTON, S. J. 2009. Do physical therapists change their beliefs, attitudes, knowledge, skills and behaviour after a biopsychosocially orientated university course? J Eval Clin Pract, 15, 724-32.

PAIN, I. A. F. T. S. O. 2018. Education [Online]. Washington, USA: International Association for the Study of Pain. [Accessed 28/02/18 2018].

PORTER, S. 2017. Psychologically-informed physiotherapy : embedding psychosocial perspectives within psychologically-informed physiotherapy, Oxford, Edinburgh Elsevier.

QASEEM, A., WILT, T. J., MCLEAN, R. M. & FORCIEA, M. A. 2017. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med, 166, 514-530.

RAMASWAMY, R., LEIPZIG, R. M., HOWE, C. L., SAUVIGNE, K., USIAK, C. & SORIANO, R. P. 2015. The Portal of Geriatrics Online Education: A 21st-Century Resource for Teaching Geriatrics. Journal of the American Geriatrics Society, 63, 335-340.

REID, M. C., ECCLESTON, C. & PILLEMER, K. 2015. Management of chronic pain in older adults. BMJ : British Medical Journal, 350.

ROCHMAN, D. L., SHEEHAN, M. J. & KULICH, R. J. 2013. Evaluation of a pain curriculum for occupational therapists: experiences from a master’s-level graduate program over six years. Disability and Rehabilitation, 35, 1933-1940.

ROSS, E. F. & HAIDET, P. 2011. Attitudes of physical therapy students toward patient-centered care, before and after a course in psychosocial aspects of care. Patient Education and Counseling, 85, 529-532.

RUDY, T. E., WEINER, D. K., LIEBER, S. J., SLABODA, J. & BOSTON, J. R. 2007. The impact of chronic low back pain on older adults: a comparative study of patients and controls. Pain, 131, 293-301.

SCHOFIELD, P. 2018. The Assessment of Pain in Older People: UK National Guidelines. Age Ageing, 47, i1-i22.

SHARPE, L., MCDONALD, S., CORREIA, H., RAUE, P. J., MEADE, T., NICHOLAS, M. & AREAN, P. 2017. Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults. BMC Psychiatry, 17, 166.

SHAW, W. S., WOISZWILLO, M. J. & KRUPAT, E. 2012. Further validation of the Patient-Practitioner Orientation Scale (PPOS) from recorded visits for back pain. Patient Education and Counseling, 89, 288-291.

STUBBS, B., BINNEKADE, T., EGGERMONT, L., SEPEHRY, A. A., PATCHAY, S. & SCHOFIELD, P. 2014. Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis. Arch Phys Med Rehabil, 95, 175-187.e9.

SYNNOTT, A., O’KEEFFE, M., BUNZLI, S., DANKAERTS, W., O'SULLIVAN, P. & O'SULLIVAN, K. 2015. Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review. Journal of Physiotherapy, 61, 68-76.

TEODORCZUK, A., MUKAETOVA-LADINSKA, E., CORBETT, S. & WELFARE, M. 2013. Reconceptualizing models of delirium education: findings of a Grounded Theory study. Int Psychogeriatr, 25, 645-55.

TEODORCZUK, A., WELFARE, M., CORBETT, S. & MUKAETOVA-LADINSKA, E. 2009. Education, hospital staff and the confused older patient. Age and Ageing, 38, 252-253.

THOMAS, E., MOTTRAM, S., PEAT, G., WILKIE, R. & CROFT, P. 2007. The effect of age on the onset of pain interference in a general population of older adults: prospective findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain, 129, 21-7.

THOMPSON, K., MILLIGAN, J., JOHNSON, M. & BRIGGS, M. 2016. Pain education in professional health courses - a scoping review of standards, protocols and frameworks. Physiotherapy, 102, e37-e38.

TOWNSEND, O. C., KERKVLIET, L. J., BRUCE, K. B., ROME, D. J., HOOTEN, W. M., LUEDTKE, A. C. & HODGSON, E. J. 2008. A longitudinal study of the efficacy of a comprehensive pain rehabilitation program with opioid withdrawal: Comparison of treatment outcomes based on opioid use status at admission. Pain, 140, 177-189.

TSANG, A., VON KORFF, M., LEE, S., ALONSO, J., KARAM, E., ANGERMEYER, M. C., BORGES, G. L. G., BROMET, E. J., DE GIROLAMO, G., DE GRAAF, R., GUREJE, O., LEPINE, J.-P., HARO, J. M., LEVINSON, D., OAKLEY BROWNE, M. A., POSADA-VILLA, J., SEEDAT, S. & WATANABE, M. 2008. Common Chronic Pain Conditions in Developed and Developing Countries: Gender and Age Differences and Comorbidity With Depression-Anxiety Disorders. Journal of Pain, 9, 883-891.

UNG, A., SALAMONSON, Y., HU, W. & GALLEGO, G. 2015. Assessing knowledge, perceptions and attitudes to pain management among medical and nursing students: a review of the literature. British Journal of Pain, 10, 8-21.

Downloads

Published

2018-05-04

How to Cite

Wang, A. P., Fisher, G., & Hall, J. (2018). Pain education for clinicians in geriatrics: a study into changes in clinician attitudes and beliefs. ealth ducation in ractice: ournal of esearch for rofessional earning, 1(1). etrieved from https://openjournals.library.sydney.edu.au/HEP/article/view/12574

Issue

Section

Articles