Dissertation preparation Flashcards
(34 cards)
What are the key findings of Shipton et al 2018?
- 4-40 hours pain education across international medical schools
- 96% of UK and US medical degrees do not have compulsory pain lecture series or modules
What are the key findings of Briggs et al 2015?
- Pain education across 15 European countries for healthcare students varied from 9-12 hours on average
- Only 18% of courses had compulsory pain modules
What are the key findings of Mankelow et al 2022?
- MCID for pain knowledge across 11 studies was 7.3%
- MCID for pain attitudes across 6 studies was 4.3%
What are the key findings of Briggs et al 2011?
Across 74 degree programmes representing medicine, nursing, physiotherapy, occupational therapy, pharmacy and dentistry there was an average of 13 hours of pain education
What are the key findings of Grommi et al 2023?
A systematic review found that pain education interventions reduced adverse drug events by 17%
What are the key findings of Colleary et al 2017?
- A 70 minute lecture increased pain knowledge (NPQ) by 33%
- Attitudes were made 17% less biomedical
- Resulted in more guidline-adherent practice in relation to work, exercise, activity and bed rest
What are the key findings of Carroll et al 2021?
- Physiotherapy student had significantly better pain understanding and more biopsychosocial attitudes than nursing, OT or podiatry students
What are the key findings of Cox et al 2017?
A 3 hour neurobiology lecture improved NPQ scores by 45%
What are the key findings of Seenanet al 2017?
- In 133 Scottish physiotherapy students, >50% got each question correct except relating to red flags and further investigations
- Confidence was moderate (4-7) but lowest in neurophysiology of pain, theories of pain and WHO analgesic ladder
Why did you choose to use PUnCQ?
- It is the only pain understanding outcome measure developed in alignment with IASP undergraduate curriculum
- It is case study-based and more realistic use of clinical judgement
- It also assess confidence in pain management situations which is a valuable metric not present in any other measure
What are some of the potential down sides to PUnCQ?
Despite being based on IASP undergraduate curriculum, it does not address:
* Epidemiology of pain
* Barriers to effective assessment and management
* Monitoring treatment efficacy
* The role of the MDT
* The importance of goal setting
Also it has minimal psychometric validation.
Why did you choose HC-PAIRS?
- It is the most widely used measure of pain attitudes
- It has high internal consistency (0.7-0.9 Cronbach’s alpha across studies)
- Mean test-retest reliability is 0.81 (very good) in the literature
- It has fair-to-good convergent validity with PABS-PT and TSK-HC
What are the potential negatives of using HC-PAIRS?
It was developed for back pain specifically but we removed the word back to make it more generic but it has not been psychometrically tested with this alteration
Why did you choose 2 years as newly qualified?
Across various trusts the average time frame to move to band 6 was 18-24 months and so 2 years would likely capture the majority of band 5 physiotherapists.
Why did you choose an anonymous survey design?
For two reasons:
* To have less challenges in data management from a protection point of view
* To encourage people to take part so they were not embarrassed if they performed poorly
How could you have improved recruitment?
- Attending different universities in person
- Altering ethics to be able to personally message people through LinkedIn or email to encourage participation
What did you find in terms of internal consistency for PUnCQ?
- Around 0.5-0.6 for understanding domain in our study and Carroll 2021
- Around 0.9-1.0 for confidence domain in our study and Carroll 2021
- Likely due to the vast breadth of knowledge required in pain management, supported by poor internal consistency of NPQ
Which guidelines are adhered to currently in the management of chronic pain?
There are NICE guidelines for non-neuropathic and neuropathic chronic pain which vary slightly in their medication components but are broadly similar in their non-medical elements e.g., CBT, exercise etc
How did you decide which statistical tests to use?
- Shapiro-Wilk over Kolmogorov-Smirnov as sample size was less than 50
- Independent sample t-test (Cohen’s d) and one-way ANOVA with Tukey’s post-hoc (eta squared and Cohen’s d, respectively) for normally distributed data
- Mann-Whitney U (rank biserial correlation) and Kruskall-Wallis with Dunn’s post-hoc (eta squared and rank biserial correlation, respectively) for non-normally distributed data
Key was reporting effect sizes as this is a more valuable output than significance
Do you feel that the sample was representative?
- Sample was very small which indicates that it would not be representative
- Wide geographic representation provides a good starting point for understanding pain knowledge and attitudes at a national level
How was internal consistency of HC-PAIRS?
- 0.62 so below 0.7 threshold for acceptance in literature
- Hard to tell if it was due to alteration with removal of “back” or whether it is just this population where internal consistency was lower
How was test-retest reliability?
- PUnCQ understanding = 0.68 (moderate)
- PUnCQ confidence = 0.87 (good)
- HC-PAIRS = 0.78 (good)
What were the differences between students and newly qualified physiotherapists?
- Understanding = Small effect size in favour of students
- Confidence = Negligible difference
- Attitudes = Small effect size in favour of newly qualifieds
Also on individual items, newly qualified scores much better on the value of changing medications, starting neuropathic pain medication and encouraging exercise.
What were the differences in those who had undertaken a pain clinic placement compared to no previous pain experience?
- Understanding = Small increase
- Confidence = Small increase
- Attitudes = Negligible difference
