The impact of pain neuroscience education on physical therapy students' pain knowledge, attitudes, beliefs, and clinical recommendations: a randomized controlled trial.
- 1Department of Physical Therapy, Faculty of Applied Medical Sciences, The Hashemite University, P.O box 330127, Zarqa, 13133, Jordan. [email protected].
- 2Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
Abstract
Background
Pain neuroscience education (PNE) promotes a biopsychosocial understanding of pain among health-professional students, yet evidence for its long-term effects outside high-income countries remains limited. This study evaluated the immediate and six-month effects of a single PNE lecture on pain knowledge, attitudes, beliefs, and clinical recommendations in Jordanian physiotherapy students.Methods
A parallel-group randomized controlled trial was conducted with first- and second-year physiotherapy students. Students were randomized (1:1; 60 per group) to a 70-minute PNE lecture or an attention-matched musculoskeletal red flags lecture. Primary outcomes were pain knowledge (Revised Neurophysiology of Pain Questionnaire [RNPQ]) and pain-related attitudes (modified Health Care Providers' Pain and Impairment Relationship Scale [HC-PAIRS]). The secondary outcome was guideline-concordant recommendations assessed using a validated vignette. Analyses included linear and logistic mixed-effects models, with responder analyses using minimal clinically important difference thresholds to estimate numbers needed to treat (NNTs).Results
All students (N = 120) completed the study with no attrition. Significant group × time interactions were observed for pain knowledge and attitudes (both p < 0.001). Post-intervention, the PNE group demonstrated higher pain knowledge scores than the control group (adjusted mean difference = 2.46, 95% CI 1.68-3.24) and more favorable attitudes (adjusted mean difference = - 7.54, 95% CI - 10.62 to - 4.46). At six months, knowledge gains remained statistically significant (1.20, 95% CI 0.25-2.15; p = 0.020), while the between-group difference for attitudes was no longer statistically significant (-3.60, 95% CI - 7.25 to 0.05; p = 0.060). Guideline-concordant clinical recommendations improved immediately after PNE (adjusted ORs 2.95-6.18) but were not sustained at follow-up (all p > 0.05). Responder analyses demonstrated substantial immediate educational benefit (NNT 2.7 for knowledge, 3.6 for attitudes), which decreased at six months, consistent with attenuation of intervention effects over time.Conclusion
A single 70-minute PNE session produced significant and clinically meaningful immediate improvements in pain knowledge, attitudes, and guideline-concordant clinical recommendations. At six months, pain knowledge remained significantly improved, whereas the remaining effects attenuated. These findings support consideration of embedding PNE early within pre-licensure physiotherapy curricula. Future research should determine whether recursive reinforcement improves longer-term retention of educational gains.Trial registration
The study protocol was prospectively registered at ClinicalTrials.gov (NCT06821022) on February 6, 2025.
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BibTeX
@article{muhsen2026impact,
title = {{The impact of pain neuroscience education on physical therapy students' pain knowledge, attitudes, beliefs, and clinical recommendations: a randomized controlled trial.}},
author = {Ahmad Muhsen and Bodor Bin Sheeha},
journal = {BMC medical education},
year = {2026},
month = jul,
doi = {10.1186/s12909-026-09994-y},
url = {https://europepmc.org/article/MED/42919241},
note = {CC BY},
}
RIS
TY - JOUR
TI - The impact of pain neuroscience education on physical therapy students' pain knowledge, attitudes, beliefs, and clinical recommendations: a randomized controlled trial.
AU - Ahmad Muhsen
AU - Bodor Bin Sheeha
PY - 2026
DA - 2026/07/01
JO - BMC medical education
DO - 10.1186/s12909-026-09994-y
UR - https://europepmc.org/article/MED/42919241
AB - Background Pain neuroscience education (PNE) promotes a biopsychosocial understanding of pain among health-professional students, yet evidence for its long-term effects outside high-income countries remains limited. This study evaluated the immediate and six-month effects of a single PNE lecture on pain knowledge, attitudes, beliefs, and clinical recommendations in Jordanian physiotherapy students.Methods A parallel-group randomized controlled trial was conducted with first- and second-year physiotherapy students. Students were randomized (1:1; 60 per group) to a 70-minute PNE lecture or an attention-matched musculoskeletal red flags lecture. Primary outcomes were pain knowledge (Revised Neurophysiology of Pain Questionnaire [RNPQ]) and pain-related attitudes (modified Health Care Providers' Pain and Impairment Relationship Scale [HC-PAIRS]). The secondary outcome was guideline-concordant recommendations assessed using a validated vignette. Analyses included linear and logistic mixed-effects models, with responder analyses using minimal clinically important difference thresholds to estimate numbers needed to treat (NNTs).Results All students (N = 120) completed the study with no attrition. Significant group × time interactions were observed for pain knowledge and attitudes (both p < 0.001). Post-intervention, the PNE group demonstrated higher pain knowledge scores than the control group (adjusted mean difference = 2.46, 95% CI 1.68-3.24) and more favorable attitudes (adjusted mean difference = - 7.54, 95% CI - 10.62 to - 4.46). At six months, knowledge gains remained statistically significant (1.20, 95% CI 0.25-2.15; p = 0.020), while the between-group difference for attitudes was no longer statistically significant (-3.60, 95% CI - 7.25 to 0.05; p = 0.060). Guideline-concordant clinical recommendations improved immediately after PNE (adjusted ORs 2.95-6.18) but were not sustained at follow-up (all p > 0.05). Responder analyses demonstrated substantial immediate educational benefit (NNT 2.7 for knowledge, 3.6 for attitudes), which decreased at six months, consistent with attenuation of intervention effects over time.Conclusion A single 70-minute PNE session produced significant and clinically meaningful immediate improvements in pain knowledge, attitudes, and guideline-concordant clinical recommendations. At six months, pain knowledge remained significantly improved, whereas the remaining effects attenuated. These findings support consideration of embedding PNE early within pre-licensure physiotherapy curricula. Future research should determine whether recursive reinforcement improves longer-term retention of educational gains.Trial registration The study protocol was prospectively registered at ClinicalTrials.gov (NCT06821022) on February 6, 2025.
SN - 1472-6920
ER -