Khoa học và thực hành đau như một ‘khái niệm ngưỡng’ trong giáo dục vật lý trị liệu đại học và tiền đăng ký: một viên ngọc trong chương trình giảng dạy?

Keith M. Smart1,2,3
1UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
2Physiotherapy Department, St. Vincent’s University Hospital, Dublin, Ireland
3UCD Centre for Translational Pain Research, Dublin, Ireland

Tóm tắt

Các khái niệm ngưỡng mô tả những trải nghiệm học tập biến đổi sự hiểu biết của chúng ta về một khái niệm nào đó. Các khái niệm ngưỡng có thể được coi là: gây rắc rối, mang tính biến chuyển, không thể đảo ngược, tích hợp và có giới hạn. Mục tiêu của bài đánh giá tường thuật này là xem xét khả năng xác định khoa học và thực hành đau như một khái niệm ngưỡng trong giáo dục vật lý trị liệu đại học và tiền đăng ký. Bài viết này xem xét các nguyên tắc cơ bản của các khái niệm ngưỡng liên quan đến giảng dạy và học tập, cũng như những lợi ích và hạn chế tương đối của việc xác định khoa học và thực hành đau như một khái niệm ngưỡng trong giáo dục vật lý trị liệu đại học và tiền đăng ký từ cả góc độ sư phạm và dịch tễ học. Bằng cách đánh giá cơn đau, khi liên quan đến giáo dục và thực hành vật lý trị liệu, theo năm đặc điểm định nghĩa của một khái niệm ngưỡng, sau đó trình bày dữ liệu liên quan đến dịch tễ học và tác động của cơn đau, giá trị của việc xác định khoa học và thực hành đau như một khái niệm ngưỡng sẽ được thảo luận và thêm vào tranh luận.

Từ khóa

#khoa học đau #thực hành đau #khái niệm ngưỡng #giáo dục vật lý trị liệu #giáo dục đại học

Tài liệu tham khảo

Land R, Cousin G, Meyer JHF, Davies P. Threshold concepts and troublesome knowledge (3): implications for course design and evaluation. In: Rust C, editor. Improving Student Learning - diversity and inclusivity, Proceedings of the 12th Improving Student Learning Conference. Oxford: Oxford Centre for Staff and Learning Development (OCSLD); 2005, p. 53–64. Barry DS, Littlewood KE. Threshold concepts for anaesthesiologists. Anesth Analg. 2017;125:1386–93. Meyer J, Land R. Threshold concepts and troublesome knowledge: Linkages to ways of thinking and practising within the disciplines. ETL Project Occasional Report 4. Edinburgh; 2003. Reeping D. Threshold concepts as ‘jewels of the curriculum’: rare as diamonds or plentiful as cubic zirconia? Int J Acad Dev. 2020;25:58–70. Kent S. Threshold Concepts. Taylor Institute for Teaching and Learning Guide Series. Calgary, AB: Taylor Institute for Teaching and Learning at the University of Calgary, April 2016. http://www.ucalgary.ca/taylorinstitute/guides [Accessed 30th June 2022]. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161:1976–82. Melzack R. The Puzzle of Pain. Harmondsworth: Penguin; 1973. Kiverstein J, Kirchhoff M, Thacker M. An embodied predictive processing theory of pain experience. Rev Phil Psych. 2022. https://doi.org/10.1007/s13164-022-00616-2. Dekkers W. Pain as a subjective and objective phenomenon. In: Schramme T, Edwards S, editors. Handbook of the philosophy of Medicine. Dordrecht: Springer; 2017. p.169 – 87. Quintner JL, Cohen ML, Buchanan D, Katz JD, Williamson OD. Pain medicine and its models: helping or hindering? Pain Med. 2008;9:824–34. Cohen M, Weisman A, Quintner J. Pain is not a thing: how that error affects Language and Logic in Pain Medicine. J Pain. 2022;23:1283–93. Ahluwalia SC, Giannitrapani KF, Dobscha SK, Cromer R, Lorenz KA. Sometimes you wonder, is this really true? Clinician assessment of patients’ subjective experience of pain. J Eval Clin Pract. 2020;26:1048–53. Smart KM, O’Connell NE, Doody C. Towards a mechanisms-based classification of pain in musculoskeletal physiotherapy? Phys Ther Rev. 2008;13:1–10. International Association for the Study of Pain., 2018 Published https://www.iasp-pain.org/education/curricula/iasp-curriculum-outline-on-pain-for-physical-therapy/ [Accessed 21st June 2022]. European Pain Federation (EFIC). 2017. Published https://europeanpainfederation.eu/education/pain-exams/edpp/ [Accessed 21st June 2022]. Ng W, Slater H, Starcevich C, Wright A, Mitchell T, Beales D. Barriers and enablers influencing healthcare professionals’ adoption of a biopsychosocial approach to musculoskeletal pain: a systematic review and qualitative evidence synthesis. Pain. 2021;162:2154–85. Holopainen R, Simpson P, Piirainen A, Karppinen J, Schütze R, Smith A, et al. Physiotherapists’ perceptions of learning and implementing a biopsychosocial intervention to treat musculoskeletal pain conditions: a systematic review and metasynthesis of qualitative studies. Pain. 2020;161:1150–68. Synnott A, O’Keeffe M, Bunzli S, Dankaerts W, O’Sullivan P, O’Sullivan K. Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review. J Physiother. 2015;61:68–76. Gray H, Howe T. Physiotherapists’ assessment and management of psychosocial factors yellow and blue flags) in individuals with back pain. Phys Ther Rev. 2013;18:379–94. Parker R, Madden VJ. State of the art: what have the pain sciences brought to physiotherapy? S Afr J Physiother. 2020;76:a1390. Mankelow J, Ryan C, Taylor P, Atkinson G, Martin D. A systematic review and Meta-analysis of the Effects of Biopsychosocial Pain Education upon Health Care Professional Pain Attitudes, Knowledge, Behavior and Patient Outcomes. J Pain. 2022;23:1–24. Saracoglu I, Aksoy CC, Afsar E, Arik MI. Does pain neuroscience education improve pain knowledge, beliefs and attitudes in undergraduate physiotherapy students? Physiother Res Int. 2021;26:e1898. Talmage H, Wilmarth H, Guffey JS. Pain Neuroscience Education for Physical Therapy Students. J Allied Health. 2020;49:e63–8. Bareiss SK, Nare L, McBee K. Evaluation of pain knowledge and attitudes and beliefs from a pre-licensure physical therapy curriculum and a stand-alone pain elective. BMC Med Educ. 2019;19:375. 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. Physiother. 2017;103:423–29. Mine K, Gilbert S, Tsuchiya J, Nakayama T. The short-term effects of a single lecture on undergraduate physiotherapy students’ understanding regarding pain neurophysiology: a prospective case series. J Musculoskelet Disord Treat. 2017;3:041. Glare P, Overton S, Aubrey K. Transition from acute to chronic pain: where cells, systems and society meet. Pain Manag. 2020;10:421–36. Gilam G, Gross JJ, Wager TD, Keefe FJ, Mackey SC. What is the relationship between Pain and emotion? Bridging Constructs and Communities. Neuron. 2020;107:17–21. Khera T, Rangasamy V. Cognition and Pain: a review. Front Psychol. 2021;12:673962. Moore KL. Pain is enough: Chronic Pain as disability. Buff L Rev. 2021;69:1471–540. Turner JA, Franklin G, Heagerty PJ, Wu R, Egan K, Fulton-Kehoe D, Gluck JV, Wickizer TM. The association between pain and disability. Pain. 2004;112:307–14. Sturgeon JA, Zautra AJ. Social pain and physical pain: shared paths to resilience. Pain Manag. 2016;6:63–74. Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019;123:e273–83. Garland EL. Pain processing in the human nervous system: a selective review of nociceptive and biobehavioral pathways. Prim Care. 2012;39:561–71. Baral P, Udit S, Chiu IM. Pain and immunity: implications for host defence. Nat Rev Immunol. 2019;19:433–47. Tennant F. The physiologic effects of pain on the endocrine system. Pain Ther. 2013;2:75–86. Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and Pain: a psychoneuroendocrine rationale for stress management in Pain Rehabilitation. Phys Ther. 2014;94:1816–25. Chapman CR, Tuckett RP, Song CW. Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. J Pain. 2008;9:122–45. Fayaz A, Ayis S, Panesar SS, Langford RM, Donaldson LJ. Assessing the relationship between chronic pain and cardiovascular disease: a systematic review and meta-analysis. Scand J Pain. 2016;13:76–90. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. IMMPACT. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113:9–19. Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54:79–86. Faculty of Pain Medicine of the Royal College of Anaesthetists. Core Standards for Pain Management Services in the UK. Second Edition 2021 [Published https://fpm.ac.uk/sites/fpm/files/documents/2022-01/FPM-Core-Standards-Dec-2021_0.pdf; [Accessed 6th September 2022]. Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: the IASP classification of Chronic Pain for the International classification of Diseases (ICD-11). Pain. 2019;160:19–27. Breivik H, Eisenberg E, O’Brien T, OPENMinds. The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC Public Health. 2013;13:1229. van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology and its clinical relevance. Br J Anaesth. 2013;111:13–8. Fayaz A, Croft P, Langford RM, et al. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. 2016;6:e010364. Yong RJ, Mullins PM, Bhattacharyya N. Prevalence of chronic pain among adults in the United States. Pain. 2022;163:e328–32. Vos T, Allen C, Arora M. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the global burden of Disease Study 2016. Lancet. 2017;390:1211–59. Finley CR, Chan DS, Garrison S, Korownyk C, Kolber MR, Campbell S, Eurich DT, Lindblad AJ, Vandermeer B, Allan GM. What are the most common conditions in primary care? Systematic review. Can Fam Physician. 2018;64:832–40. Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457–67. Pitcher MH, Von Korff M, Bushnell MC, Porter L. Prevalence and Profile of High-Impact Chronic Pain in the United States. J Pain. 2019;20:146–60. Carr DB. Pain is a public health problem —what does that mean and why should we care? Pain Med. 2016;17:626–27. Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11:770. Croft P, van der Blyth FM. Chronic Pain Epidemiology: from aetiology to Public Health. Oxford University Press; 2010. Wassinger CA. Pain knowledge, attitudes and beliefs of doctor of physical therapy students: changes across the curriculum and the role of an elective pain science course. J Man Manip Ther. 2021;9:288–96. Ehrström J, Kettunen J, Salo P. Physiotherapy pain curricula in Finland: a faculty survey. Scand J Pain. 2018;18:593–601. Hoeger Bement MK, Sluka KA. The current state of physical therapy pain curricula in the United States: a faculty survey. J Pain. 2015;16:144–52. Leegaard M, Valeberg BT, Haugstad GK, Utne I. Survey of Pain Curricula for Healthcare Professionals in Norway. Nord J Nur Res. 2014;34:42–5. Doorenbos AZ, Gordon DB, Tauben D, Palisoc J, Drangsholt M, Lindhorst T, et al. A blueprint of pain curriculum across prelicensure health sciences programs: one NIH Pain Consortium Center of Excellence in Pain Education (CoEPE) experience. J Pain. 2013;14:1533–8. Briggs EV, Carr ECJ, Whittaker MS. Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. Eur J Pain. 2011;15:789–95. British Pain Society. A Practical Guide to Incorporating Pain Education into Pre-Registration Curricula for Healthcare Professionals in the UK. 2018. Published https://www.britishpainsociety.org/static/uploads/resources/files/BPS_Pre-registration_Practical_Guide_Feb_2018_1wsCBZo.pdf [Accessed 21st June 2022]. Institute of Medicine (US). Committee on advancing Pain Research, Care, and Education. Relieving Pain in America: a blueprint for transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. Jones LE, Hush JM. Pain education for physiotherapists: is it time for curriculum reform? J Physiother. 2011;57:207–8. 2021; Academy of Orthopaedic Physical Therapy. Pain Education Manual For Physical Therapist Professional Degree Programs, Published. https://www.orthopt.org/uploads/content_files/files/Pain_Manual_Draft_FINAL_6.25.2021%281%29.pdf [Accessed 21st June 2022]. Hush JM, Nicholas M, Dean CM. Embedding the IASP pain curriculum into a 3-year pre-licensure physical therapy program: redesigning pain education for future clinicians. Pain Rep. 2018;3:e645. Barradell S. The identification of threshold concepts: a review of theoretical complexities and methodological challenges. High Educ. 2013;65:265–76. O’Donnell R. A critique of the threshold concept hypothesis and an application in economics (Working Paper 164); 2010. Published http://www.finance.uts.edu.au/research/wpapers/wp164.pdf [Accessed 30th September 2022}. Rowbottom DP. Demystifying threshold concepts. J Philos of Educ. 2007;41:263–70. Timmermans JA, Meyer JHF. A framework for working with university teachers to create and embed ‘Integrated threshold Concept Knowledge’ (ITCK) in their practice. Int J Acad Dev. 2019;24:354–68.