Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20230045-en
Brazilian Journal of Pain
Original Article

Assessment of knowledge about the neurophysiology of pain and self-perception of skills to assist individuals with pain among undergraduate physiotherapy students in Brazil: cross-sectional study

Avaliação do conhecimento sobre neurofisiologia da dor e autopercepção de habilidades para atender indivíduos com dor em graduandos e graduados em fisioterapia no Brasil: estudo transversal

Anne Sofia Souza Pang Bilby; Fernanda Spiller Ceroni; Ione Jayce Ceola Schneider; Heloyse Uliam Kuriki; Alexandre Marcio Marcolino; Rafael Inacio Barbosa

Downloads: 0
Views: 284

Abstract

BACKGROUND AND OBJECTIVES: Approaches to coping with pain, such as patient education, are directly related to the professionals’ skill level. The identification of possible learning gaps in the different stages of training can contribute to the development of new teaching strategies and methods. This study aimed to evaluate and compare the level of knowledge about the neurophysiology of pain and the self-perception of abilities to care for individuals with pain in undergraduate and graduate students in physiotherapy in Brazil.
METHODS: This is a cross-sectional analytical observational study, in which the Neurophysiological Pain Questionnaire (QND) was applied to assess the level of knowledge about the neurophysiology of pain. A self-administered questionnaire was also used to collect sociodemographic data from the sample and to assess self-perception of abilities to care for individuals with pain. The characteristics of the study population were defined by descriptive statistics. For the analysis of QND score distribution and self-perception of abilities to care for individuals with pain, the Shapiro-Wilk test was used. In the bivariate analysis to compare the distribution of the QND score and self-perception of abilities to care for individuals with pain between the stages of undergraduates and schooling after graduation, the Kruskal-Wallis test was used, with a significance level of 5% and 95% confidence interval. The statement Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used as a guide for reporting the results of the study.
RESULTS: A total of 306 volunteers participated in the study, 208 undergraduate students (22.3 ± 3.2 years) and 98 physiotherapists (31.7± 8.7 years). The average QND score for undergraduate students was 6.17 and 8.56 for physiotherapists, considering a total of 12 points. There was a significantly higher difference in the scores obtained on the QND by undergraduates in the intermediate phase and in the last year (p<0.05), as well as in the self-perception of abilities to care for individuals with pain and perform a biopsychosocial approach to the patient, between the different phases of the course. However, among physiotherapists, no significant difference was observed in the total QND score, and in the self-perception of abilities to care for individuals with pain.
CONCLUSION: The findings of this study suggest that the level of knowledge about the neurophysiology of pain and self-perception of skills to care for individuals with pain differs between academics and physiotherapy professionals. However, the low QND score of physiotherapy undergraduates, as well as the absence of significant differences in the QND between the different levels of physiotherapist training, suggest that curricular implementation and specific training on pain may be indispensable to increase the level of knowledge and skills of physiotherapists in the treatment of individuals with pain.

Keywords

Health knowledge, Pain, Neurophysiology, Physiotherapy

Resumo

JUSTIFICATIVA E OBJETIVOS: Abordagens para o enfrentamento da dor, como educação do paciente, estão diretamente relacionadas ao nível de habilidades dos profissionais. A identificação de possíveis lacunas do aprendizado nas diferentes fases de formação pode contribuir para o desenvolvimento de novas estratégias e métodos de ensino. O objetivo deste estudo foi avaliar e comparar o nível de conhecimento sobre neurofisiologia da dor e a autopercepção de habilidades para atender indivíduos com dor em alunos de graduação e graduados em fisioterapia no Brasil. 
MÉTODOS: Trata-se de um estudo observacional analítico do tipo transversal, em que foi aplicado o Questionário Neurofisiológico de Dor (QND) para avaliar o nível de conhecimento sobre neurofisiologia da dor. Também foi utilizado um questionário autoaplicado para coletar os dados sociodemográficos da amostra e avaliar a autopercepção de habilidades para atender indivíduos com dor. As características da população do estudo foram definidas pela estatística descritiva. Para a análise da distribuição do escore QND e da autopercepção de habilidades para atender indivíduos com dor foi utilizado o teste Shapiro-Wilk. Na análise bivariada para a comparação de distribuição do escore QND e da autopercepção de habilidades para atender indivíduos com dor entre as fases dos graduandos e a escolaridade após a formação foi utilizado o teste de Kruskal-Wallis, nível de significância de 5% e intervalo de confiança de 95%. A declaração Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) foi utilizada como guia para relatar os resultados do estudo. 
RESULTADOS: Um total de 306 voluntários participaram do estudo, sendo 208 alunos de graduação (22,3 ± 3,2 anos) e 98 fisioterapeutas (31,7± 8,7 anos). A pontuação média do QND para os alunos de graduação foi 6,17 e de 8,56 para os fisioterapeutas, considerando um total de 12 pontos. Observou-se uma diferença significativamente superior na pontuação obtida no QND pelos graduandos da fase intermediária e do último ano (p<0,05), bem como na autopercepção de habilidades para atender indivíduos com dor e realizar uma abordagem biopsicossocial do paciente entre as diferentes fases do curso. Contudo, entre os fisioterapeutas, não foi observada diferença significativa na pontuação total do QND e na autopercepção de habilidades para atender indivíduos com dor. 
CONCLUSÃO: Por meio dos achados deste estudo, foi possível observar que o nível de conhecimento sobre neurofisiologia da dor e autopercepção de habilidades para atender indivíduos com dor difere entre acadêmicos e profissionais de fisioterapia. Entretanto, a pontuação baixa do QND dos graduandos de fisioterapia, bem como a ausência de diferenças significativas do QND entre os diferentes níveis de formação dos fisioterapeutas, sugere que a implementação curricular e capacitações específicas sobre dor são indispensáveis para ampliar o nível de conhecimento e habilidades dos fisioterapeutas no tratamento de indivíduos com dor.

Palavras-chave

Dor, Educação em saúde, Especialidade de Fisioterapia, Neurofisiologia.

References

1 O’Brien T, Christrup LL, Drewes AM, Fallon MT, Kress HG, McQuay HJ, Mikus G, Morlion BJ, Perez-Cajaraville J, Pogatzki-Zahn E, Varrassi G, Wells JC. European Pain Federation position paper on appropriate opioid use in chronic pain management. Eur J Pain. 2017;21(1):3-19.

2 de Souza JB, Grossmann E, Perissinotti DMN, de Oliveira Junior JO, da Fonseca PRB, Posso IP. Prevalence of chronic pain, treatments, perception, and interference on life activities: Brazilian Population-Based Survey. Pain Res Manag. 2017.2017:4643830.

3 Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Korwisi B, Kosek E, Lavand’homme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH, Svensson P, Vlaeyen JWS, Wang SJ. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019;160(1):19-27.

4 Glare P, Aubrey KR, Myles PS. Transition from acute to chronic pain after surgery. Lancet. 2019;393(10180):1537-46.

5 Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11:770.

6 Cheatle MD. Biopsychosocial approach to assessing and managing patients with chronic pain. Med Clin North Am. 2016;100(1):43-53.

7 Sereza TW, Dellaroza MSG. O que está sendo aprendido a respeito da dor na UEL? Semina: Ciências Biológicas e da Saúde. 2003;24(1):55-66.

8 Alves RC, Tavares JP, Funes RA, Gasparetto GA, Silva KC, Ueda TK. Análise do conhecimento sobre dor pelos acadêmicos do curso de Fisioterapia em centro universitário. Rev Dor. 2013;14(4):272-9.

9 Capellini VK, Daré MF, Castral TC, Christoffel MMC, Leite AM, Scochi CGS. Conhecimento e atitudes de profissionais de saúde sobre avaliação e manejo da dor neonatal. Rev Eletrônca Enferm. 2014;16(2):361-9.

10 Santos LT, Otávio RV, Junior JLMM, Correa LA, Nogueira LAC. Avaliação do nível de conhecimento sobre neurofisiologia da dor em estudantes de fisioterapia - um estudo observacional. Cad Educ Saúde Fisioter. 2018;5(10).

11 Gomes AS, de Sá Ferreira A, Reis FJJ, de Jesus-Moraleida FR, Nogueira LAC, Meziat-Filho N. Association between low back pain and biomedical beliefs in academics of physiotherapy. Spine. 2020;45(19):1354-9.

12 Marques ES, Xarles T, Antunes TM, Silva KK, Reis FJ, Oliveira LA, Nogueira LA. Evaluation of physiologic pain knowledge by physiotherapy students. Rev Dor. 2016;17(1):29-33.

13 DeSantana JM, Souza JB, Reis FJ, Gosling AP, Paranhos E, Barboza HF, Baptista AF. Currículo em dor para graduação em Fisioterapia no Brasil. Rev Dor. 2017;18(1):72-8.

14 Venturine JS, Reis FJJ. O ensino sobre dor nos cursos de fisioterapia do Brasil: identificação e análise dos currículos. Cad Educ Saúde Fisioter. 2016;3(6).

15 Hoeger Bement MK, Sluka KA. The current state of physical therapy pain curricula in the United States: a faculty survey. J Pain. 2015;16(2):144-52.

16 Springer S, Gleicher H, Hababou H. Attitudes and beliefs about musculoskeletal pain and its association with pain neuroscience knowledge among physiotherapy students in Israel. Isr J Health Policy Res. 2018;7(1):67.

17 George SZ, Fritz JM, Silfies SP, Schneider MJ, Beneciuk JM, Lentz TA, Gilliam JR, Hendren S, Norman KS. Interventions for the management of acute and chronic low back pain: revision 2021. J Orthop Sports Phys Ther. 2021;51(11):CPG1-CPG60.

18 King R, Robinson V, Elliott-Button HL, Watson JA, Ryan CG, Martin DJ. Pain reconceptualisation after pain neurophysiology education in adults with chronic low back pain: a qualitative study. Pain Res Manag. 2018:3745651.

19 Alhowimel A, Alodiabi F, Alamam D, Alotaibi M, Fritz J. Current understanding of pain neurophysiology among physiotherapists practicing in Saudi Arabia. Healthcare. 2021;9(9):1242.

20 Alodaibi F, Alhowimel A, Alsobayel H. Pain neurophysiology knowledge among physical therapy students in Saudi Arabia: a cross-sectional study. BMC Med Educ. 2018;18(1):228.

21 Adillón C, Lozano È, Salvat I. Comparison of pain neurophysiology knowledge among health sciences students: a cross-sectional study. BMC Res Notes. 2015;8:592.

22 Mukoka G, Olivier B, Ravat S. Level of knowledge, attitudes and beliefs towards patients with chronic low back pain among final year School of Therapeutic Sciences students at the University of the Witwatersrand - A cross-sectional study. S Afr J Physiother. 2019;75(1):683.

23 Colleary G, O’Sullivan K, Griffin D, Ryan CG, Martin DJ. 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. 2017;103(4):423-9.

24 Nogueira LAC, Chaves AO, Oliveira N, Almeida RS, Reis JFF, Andrade FG, Catley MJ. Cross-cultural adaptation of the Revised Neurophysiology of Pain Questioannaire into Brazilian Portuguese language. J Bras Psiquiatr. 2018;67(4):273-7.

25 Cox T, Louw A, Puentedura EJ. An abbreviated therapeutic neuroscience education session improves pain knowledge in first-year physical therapy students but does not change attitudes or beliefs. J Man Manip Ther. 2016;25(1):11-21.

26 Hush JM, Nicholas M, Dean CM. Embedding the IASP pain curriculum into a 3-year pre-licensure physical therapy program: redesigning pain education for future clinicians. Pain Rep. 2018;3(2):e645.

27 Bareiss SK, Nare L, McBee K. Evaluation of pain knowledge and attitudes and beliefs from a pre-licensure physical therapy curriculum and a stand-alone pain elective. BMC Med Educ. 2019;19(1)375.

28 Fitzgerald K, Vaughan B, Fleischmann M, Austin P. Pain knowledge, attitudes and beliefs of Australian osteopaths drawn from a nationally representative sample of the profession. J Bodyw Mov Ther. 2020;24(4):43-50.

29 Middleton SJ, Barry AM, Comini M, Li Y, Ray P, Shiers S, Themistocleous AC, Uhelski ML, Yang X, Dougherty PM, Price TJ, Bennett DL. Studying human nociceptors: from fundamentals to clinic. Brain. 2021;144(5):1312-35.

30 Ribeiro MC, Costa IN, Ribeiro CJ, Nunes MS, Santos B, DeSantana JM. Knowledge of health professionals about pain and analgesia. Rev Dor. 2015;16(3):204=9.
 


Submitted date:
10/11/2022

Accepted date:
07/18/2023

6555135da9539517d10edf73 brjp Articles

BrJP

Share this page
Page Sections