Physical Therapists' Knowledge of and Attitudes Towards Treating Chronic Pain

Abstract

Physical Therapists’ Knowledge of and Attitudes Towards Treating Chronic Pain is an investigation into physical therapists’ knowledge and perceptions of treating patients with chronic pain. Chronic pain is a major health issue affecting nearly 100 million Americans and costing between $560 and $635 billion per year (Smith & Hillner, 2019). Chronic pain has been linked to restrictions in functional daily activities, dependence on opioid medications, anxiety, depression, and poor quality of life (Redfield et al., 2018). The National Institute on Drug Abuse reports that deaths due to opioid overdose have sharply risen in recent years, with 21,089 deaths reported in 2010 and increasing to 80,411 deaths reported in 2021 (National Institute on Drug Abuse, 2023). In 2020, the rate of overdose deaths in the United States was 31% higher than in 2019 (Hedegaard et al., 2020). In 2017, the U.S. Department of Health and Human Services declared that opioid misuse had progressed to become an epidemic. While the causes of this epidemic are multifactorial, this problem has developed in response to high patient demand for medications and quick fixes, limited reimbursement for alternative treatment options, and poor treatment outcomes in pain management (Wenger et al., 2018). The American Physical Therapy Association (APTA) has developed an initiative to reach those patients suffering from chronic pain, offering physical therapy as viable alternative to opioid medication use (American Physical Therapy Association, 2023a). Very little research has been conducted to examine physical therapists’ knowledge or attitudes towards treating patients with chronic pain. A study conducted in 1991 by Wolff, Michel, Krebs, and Watts purported that only 49.6% of physical therapists met the knowledge criterion score on the Chronic Pain Knowledge/Attitude Test and only 7.8% met the attitudes criterion score. This research indicated that physical therapists’ knowledge and attitudes towards treating chronic pain were poor at the time of the study (Wolff et al., 1991). Since that time, the profession of physical therapy has undergone significant changes, including doctoring of the profession as well as advances in research regarding pain science. This study was conducted to examine the current knowledge and attitudes of physical therapists towards treating patients with chronic pain. Current practicing physical therapists who were members of the Academy of Orthopedic Physical Therapists, a section of the American Physical Therapy Association, were invited to participate in a research survey. Each subject completed a 41-item questionnaire testing their knowledge and attitudes towards treating patients with chronic pain. All participating subjects (n=266) received a knowledge and attitude score. Total scores, means, and frequencies were calculated for each pain knowledge and attitude objective. Frequencies were calculated for demographic and pain education information questions. Correlations between responses for select demographic and test questions were also tabulated. This data was compared to the information gathered in the 1991 study by Wolf, et al. In the 1991 study, physical therapists’ knowledge scores were below the adequate score (mean = 77.8%). However, the current study showed an increase in knowledge scores (mean = 80%), demonstrating a 2.2% overall increase. When comparing the attitude scores of the participants in the original study with those of the participants in the current study, it was found that attitude scores improved but were still significantly lower than the passing threshold as set by the original authors. The original attitude scores were very low (mean = 56.9%) but in the current study those scores improved by 8.1% (mean = 65%). While the more updated score demonstrated a large increase, attitude scores were still 15% below the passing threshold of 80% as determined by Wolf et al. in 1991. The results of this study indicate that while attitudes related to treating patients with chronic pain conditions are improving, there is still much progress to make in this area. Participants’ degree level and years of experience treating patients had no bearing on their knowledge or attitude scores. Overwhelmingly, participants did not believe that their entry level physical therapy education prepared them to treat patients with chronic pain, however the majority of subjects were satisfied with their current level of chronic pain knowledge. Interestingly, those participants with higher knowledge scores were less satisfied with their current level of pain knowledge. However, these same subjects had much poorer attitude scores than subjects who rated themselves as more satisfied with their current knowledge of pain. Overall, continuing education continues to be the most utilized method for increasing knowledge of chronic pain for physical therapists, although use of scholarly research increased by 8.9% compared to the original study. This research provides insight into the current knowledge levels and attitudes of physical therapists who treat patients with chronic pain. While average knowledge scores have improved to an acceptable level, the research is clear that attitudes continue to be poor and there are many reasons for physical therapists’ frustrations when managing patients with complex pain issues.