Benefits of Enhanced Education on Biopsychosocial Pain Knowledge, Attitudes, and Clinical Behavior of Physical Therapist Students: A Cluster Randomized Trial

J Phys Ther Educ. 2026 Feb 12. doi: 10.1097/JTE.0000000000000473. Online ahead of print.

ABSTRACT

INTRODUCTION: Whether person-centered pain education approaches for Physical Therapist (PT) students elicit positive guideline-consistent changes in knowledge, attitudes, and clinical behavior is unknown. This study aims to evaluate the effects of enhanced-education compared to standard-education among entry-level PT students.

REVIEW OF LITERATURE: Many (future) PTs adhere poorly to evidence-based clinical guidelines and find it challenging to integrate biopsychosocial (BPS) elements in the management of persistent musculoskeletal pain.

SUBJECTS: The eligibility criteria included all first- and second-year students from the Dutch 4-year entry-level PT education program at Hanze University of Applied Sciences in Groningen, the Netherlands.

METHODS: A cluster-randomized controlled trial design was used. Primary outcomes-including BPS pain knowledge, attitudes, and self-reported clinical behaviors-were assessed by comparing enhanced-education with standard-education on 5 measures. Intervention duration was 8 weeks. Enhanced-education teachers were additionally trained. Students were blinded to group allocation. Data were analyzed using linear mixed models and responder description.

RESULTS: N = 187 students responded at baseline and n = 264 postintervention, 63% being paired measurements. Both groups improved significantly on all outcomes, with the enhanced-education group demonstrating greater improvement than the standard-education group in 4 out of 5 outcomes: Video Vignette score (P = <.001), Written Vignette score (P = .03), Knowledge and Attitude of Pain (KNAP) (P = .006), Pain Attitudes and Beliefs Scale for Physiotherapists biopsychosocial subscale (P = .064), and biomedical subscale (P = .019). Responder analysis demonstrated greater improvement in enhanced-education than in standard-education in all outcomes, with 48% of the enhanced-education group and 23.1% in the standard-education group exceeding the minimal clinically important change for KNAP.

DISCUSSION AND CONCLUSIONS: Implementation of enhanced-education lead to better guideline-consistent BPS pain knowledge, attitudes, and self-reported clinical behaviors in PT students. These findings could enhance professional PT programs by focusing on improving students' contemporary pain beliefs and clinical behaviors.

PMID:41673914 | DOI:10.1097/JTE.0000000000000473