The Impact of Pain Neuroscience Education on Physical Therapy Students' Knowledge, Attitudes, Beliefs, and Behaviors Towards Pain: A Randomized Controlled Trial

This study investigates the effect of pain neuroscience education (PNE) on pain knowledge, attitudes, beliefs and behaviors among undergraduate physiotherapy students in Jordan

Study Overview

• Status: Completed
• Conditions: Healthy Subjects
• Intervention / Treatment: Other: Pain Neuroscience Education; Other: Red Flags Education

Detailed Description

Physiotherapy students at the Hashemite University will be randomly assigned into either pain neuroscience education or control lectures groups. Both groups will receive a 70-min didactic group-lecture. The control group will receive education about red-flags which are special screening questions for serious pathology. The red-flags education will discuss tissue pathology and triage for back pain classification. Neurophysiology and the biopsychosocial mode will not be discussed. The intervention group will receive a PNE lecture. All primary and secondary outcome measures consist of validated questionnaires (e.g., RNPQ, HC-PAIRS), except for the study-specific red-flags knowledge test; the study-specific case vignette assessing guideline-concordant low back pain recommendations underwent validation testing before participant recruitment.

• Study Type: Interventional
• Enrollment (Actual): 120
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Jordan
  • Zarqa Governorate
    • Zarqa, Zarqa Governorate, Jordan, 13133
      • The Hashemite University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Physiotherapy undergraduate students at the Hashemite University

Exclusion Criteria:

• Previous formal pain education
• Enrolled in a clinical practice module

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Pain Neuroscience Education	Other: Pain Neuroscience Education; The intervention group will receive a lecture of 70min duration on pain neuroscience. The objective of this educational session is to educate students that pain can be overprotective, and that nociceptive transmission can be heavily influenced by central sensitisation (sensitivity of the central nervous system) as well as the thoughts and beliefs of the individual. The session used drawings, stories and metaphors to depict the underlying neuroscience of pain, and current pain theory.
Active Comparator: Red Flags Education	Other: Red Flags Education; The control group received an education session of red flags. Red flags form part of routine subjective practice for therapists as a process of screening serious or potentially sinister pathologies. Sign and symptoms for such pathologies include history of cancer, systemic symptoms such as fever or unexplained weight loss, and saddle analgesia. The red flag session will not include the neuroscience of pain.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Revised Pain Neurophysiology Questionnaire (RNPQ)	The 12-item RNPQ will be used to assess knowledge of pain neurophysiology. Responses are marked yes, no or undecided. One point is awarded for correct answers. Scores range from 0 to 12, with high scores indicating good knowledge.	Before and immediately after and 6 months after the education session
The modified HC-PAIRS	The modified HC-PAIRS (Health Care Providers' Pain and Impairment Relationship Scale will be used to measure attitudes and beliefs towards patients with chronic pain and their ability to function. This 13-item questionnaire uses a 7-point Likert scale (strongly disagree to strongly agree). Scores range from 13 to 91 with lower scores suggesting more positive attitudes.	Prior to and immediately and 6 months after the education session

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Guideline-concordant low back pain recommendations assessed using a case vignette	A case vignette will be used to assess participants' vignette-based clinical recommendations for a patient with non-specific low back pain. Participants will answer four multiple-choice questions addressing recommendations regarding usual daily activities, work, exercise, and bed rest. Each domain will be scored as guideline-concordant or non-guideline-concordant according to contemporary low back pain guideline recommendations. The total number of guideline-concordant recommendations will be calculated, with possible scores ranging from 0 to 4; higher scores indicate more guideline-concordant recommendations. The percentage of guideline-concordant recommendations may also be reported. The vignette was developed for this study and psychometrically evaluated before participant recruitment and before its use as a trial outcome, including expert review for content validity, cognitive pretesting, construct validity assessment, test-retest reliability, and measurement error analysis.	Baseline, immediately after the education session, and 6 months after the education session.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
LBP Red-Flags Knowledge Quiz (10-item)	It is a 10-item quiz, with yes/no answers that assesses knowledge of red-flags. Scores range from 0 to 10. This questionnaire was developed within our team. This is to provide attention-matched control content and to support participant blinding to the vignette outcome. This tool is developed de novo to provide attention-matched control content and to evaluate knowledge of red-flag indicators of serious spinal pathology. This is a de novo instrument developed and face validated for this trial. The face validation process, conducted prior to participant recruitment.	Baseline, Post, and 6 months after lecture control session

Collaborators and Investigators

• Sponsor: The Hashemite University

Publications and helpful links

General Publications

• 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 Dec;103(4):423-429. doi: 10.1016/j.physio.2017.01.006. Epub 2017 Mar 22.

Study record dates

Study Major Dates

• Study Start (Actual): February 15, 2024
• Primary Completion (Actual): May 13, 2026
• Study Completion (Actual): May 13, 2026

Study Registration Dates

• First Submitted: February 6, 2025
• First Submitted That Met QC Criteria: February 6, 2025
• First Posted (Actual): February 11, 2025

Study Record Updates

• Last Update Posted (Actual): May 15, 2026
• Last Update Submitted That Met QC Criteria: May 13, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Pain; Pain Neuroscience Education (PNE); Education; Attitudes; Physiotherapy students; The Revised Neurophysiology of Pain Questionnaire (RNPQ); The 13-item Modified Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS); Guideline-Concordant Low Back Pain Vignette (GCLBP-V)
• Additional Relevant MeSH Terms: Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Behavior
• Other Study ID Numbers: 33/1/2024/2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: After completion of the data collection, it will be analysed and then interpreted. I will provide you with the study results and recommendations upon completion.
• IPD Sharing Time Frame: After being published, the dataset and/or the statistical analyses will be made available for interested researchers upon reasonable request.
• IPD Sharing Access Criteria: After being published, the dataset and/or the statistical analyses will be made available for interested researchers upon reasonable request.
• IPD Sharing Supporting Information Type: SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No