The clinical impact of pain neuroscience continuing education on physical therapy outcomes for patients with low back and neck pain

• Published in: PloS one 2022-04, Vol.17 (4), p.e0267157-e0267157
• Main Authors: Louw, Adriaan, Puentedura, Emilio J, Denninger, Thomas R, Lutz, Adam D, Cox, Terry, Zimney, Kory, Landers, Merrill R
• Format: Article
• Language: English
• Subjects: Backache; Biology and Life Sciences; CAI; Care and treatment; Clinical outcomes; Complications and side effects; Computer assisted instruction; Continuing education; Education; Education, Continuing; Health sciences; Humans; Low back pain; Low Back Pain - therapy; Medicine and Health Sciences; Musculoskeletal Manipulations; Neck; Neck pain; Neck Pain - therapy; Nervous system; Neurosciences; Pain; Patient outcomes; Patients; Physical therapy; Physical training; Prospective Studies; Standard deviation; Therapeutics, Physiological; Therapists; Training
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0267157

Research suggests that attendance by physical therapists at continuing education (CE) targeting the management of low back pain (LBP) and neck pain does not result in positive impacts on clinical outcomes. The aim of this study was to determine if therapists attending a self-paced 3-hour online Pain Neuroscience Education (PNE) program was associated with any observed changes to patient outcomes and also clinical practice. Participants were 25 different physical therapists who treated 3,705 patients with low back pain (LBP) or neck pain before and after they had completed an online PNE CE course. Change in outcomes measures of pain and disability at discharge were compared for the patients treated before and after the therapist training. Clinical practice patterns of the therapists, including total treatment visits, duration of care, total units billed, average units billed per visit, percentage of 'active' billing units and percentage of 'active and manual' billing units, were also compared for the patient care episodes before and after the therapist training. There was no significant difference for change in pain scores at discharge for patients treated after therapist CE training compared to those treated before regardless of the condition (LBP or neck pain). However, patients with LBP who were treated after therapist CE training did report greater improvement in their disability scores. Also after CE training, for each episode of care, therapists tended to use less total visits, billed fewer units per visit, and billed a greater percentage of more 'active' and 'active and manual' billing units. Attending an online 3-hour CE course on PNE resulted in improved disability scores for patients with LBP, but not for those with neck pain. Changes in clinical behavior by the therapists included using less visits, billing fewer total units, and shifting to more active and manual therapy interventions. Further prospective studies with control groups should investigate the effect of therapist CE on patient outcomes and clinical practice.