Transformative Learning to Virtual Inter-Professional Education in Musculoskeletal Pain

NCT05589311 | Unknown

• 1 other identifier: 2022/2048
• Study Type: interventional
• Target: 300
• Locations: 1 country
• Sites: 1

Brief Summary

Musculoskeletal (MSK) pain is amongst the leading reasons for people seeking medical attention in local primary care, accounting for 6-28% of principal diagnoses. Patient education is one of the important treatment strategies to ease pain, reduce suffering and disability. However, from our anecdotal experience, patients often report there is an inconsistency in the information being provided by healthcare professionals. This can be due to the existence of different MSK pain frameworks as the understanding of pain sciences evolves. Hence, there is a need for regular Continuous Medical Education (CME) to update and improve healthcare staff knowledge and skills on this aspect in Singapore. The conventional teaching method is typically used in SingHealth Polyclinics (SHP) CME sessions. It focuses on lecture-based instruction as the teaching centre, emphasizing the delivery of syllabus and concept. The conventional teaching method has been shown to be less effective than other teaching strategies (e.g. Case based learning) in practical application and critical thinking abilities. Mezirow proposed the use of Transformative Learning to enhance adult learning. We aim to conduct an RCT to investigate whether this teaching method is superior to the conventional teaching method in improving MSK pain knowledge, management advice, attitudes and beliefs of healthcare professionals in primary care. This randomised multi-centre, prospective study will be conducted across all SHP polyclinics. Healthcare professionals working in SHP will be invited to participate in the study. Participants in both the intervention and control groups will be asked to complete the questionnaires at 3 time-points: before and after the lecture, as well as 1 month later. The anonymised data collected will then be analysed using descriptive and inferential statistics.

Conditions

Musculoskeletal Pain

Keywords

Pain education; Healthcare professionals; Interprofessional education; Transformative Learning

Outcome Measures

Primary Outcomes (5)

• Learner's reactions and reflection form (LRRF)

  This self-developed evaluation form was developed to gather participants' feedback on the lecture and the learning experience. Participants are required to answer 18 questions using a 1 to 10 scale where 1 is strongly disagree and 10 is strongly agree.

  after the intervention (lecture)

• Change in Neurophysiology of Pain Questionnaire (NPQ)

  NPQ will be used to evaluate the participants' understanding of pain neurophysiology. It is a 12-item validated questionnaire. Each item has three response options: true, false, undecided. The NPQ uses the number-correct scoring method, whereby the total number of correct answers is added to create an overall score. 1 point is awarded for each correct response. A score of 0 is attributed to incorrect responses and those marked as undecided. Comparison of pre-intervention and post-intervention (immediate and 1 month follow up) NPQ scores (assessed through number of correct answers).

  Up to 1 month pre-intervention, immediate post-intervention (lecture) and 1 month follow up

• Change in Clinical Assessment Vignette (CAV)

  6 Common MSK conditions Assessment Questions, modified from Moroz (2017). It is a quiz to test the knowledge of the participants on the common MSK conditions. A short description is provided on the patient's signs and symptoms and the participant is required to identify the correct diagnosis. Comparison of pre-intervention and post-intervention (immediate and 1 month follow up) CAV scores (assessed through number of correct answers).

  Up to 1 month pre-intervention, immediate post-intervention (lecture) and 1 month follow up

• Change in Health care Pain Attitudes and Impairment Relationship Scale (HC-PAIRS)

  HC-PAIRS is derived by altering Pain and Impairment Relationship scale (PAIRS) developed by Riley et al. Items are scored by the location of responses on the Likert scales following each question, with items 1, 6, and 14 scored by reversing the numbers. Items 10 and 13 were omitted from the original version, as recommended by Houben et al., to improve the construct of the scale. Scores of individual items are totalled, yielding the HC-PAIRS score. Comparison of pre-intervention and post-intervention (immediate and 1 month follow up) HC-PAIRS scores (assessed on a 7-point Likert scale).

  Up to 1 month pre-intervention, immediate post-intervention (lecture) and 1 month follow up

• Change in Management Advice Vignette (MAV)

  4 MSK Management Advice Questions (Bishop et al. 2008). It is a quiz to assess the appropriateness of MSK pain management recommendations of the participants. A clinical case vignette is provided and the participant is required to answer short multiple choice questions regarding the appropriate management advice. It is an indirect measure of the clinical behaviour. Comparison of pre-intervention and post-intervention (immediate and 1 month follow up) MAV scores (assessed through number of correct answers).

  Up to 1 month pre-intervention, immediate post-intervention (lecture) and 1 month follow up

Study Arms (2)

Intervention group

EXPERIMENTAL

One-time 2.5-hour virtual lecture on musculoskeletal pain conducted following Transformative Learning principles

Other: Transformative Learning principles

Control group

ACTIVE COMPARATOR

One-time 2.5-hour virtual lecture on musculoskeletal pain conducted using conventional didactic approach

Other: Conventional didactic approach

Interventions

Transformative Learning principles OTHER

Transformative Learning principles are incorporated into the pain education workshop to stimulate critical reflection and critical discourse during the learning process.

Intervention group

Conventional didactic approach OTHER

The conventional didactic approach focuses on lecture-based instruction as the teaching center, emphasizing the delivery of syllabus and concept.

Control group

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Healthcare professionals working in SingHealth Polyclinics

You may not qualify if:

• Healthcare professionals working in institutions other than SingHealth Polyclinics

Sponsors & Collaborators

• SingHealth Polyclinics: lead

Study Sites (1)

SingHealth Polyclinics

Singapore, Singapore

Location

Related Publications (10)

• 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.

  PMID: 28797666 BACKGROUND

• Moseley L. Unraveling the barriers to reconceptualization of the problem in chronic pain: the actual and perceived ability of patients and health professionals to understand the neurophysiology. J Pain. 2003 May;4(4):184-9. doi: 10.1016/s1526-5900(03)00488-7.

  PMID: 14622702 BACKGROUND

• Catley MJ, O'Connell NE, Moseley GL. How good is the neurophysiology of pain questionnaire? A Rasch analysis of psychometric properties. J Pain. 2013 Aug;14(8):818-27. doi: 10.1016/j.jpain.2013.02.008. Epub 2013 May 4.

  PMID: 23651882 BACKGROUND

• Moroz A. Clinical Reasoning Workshop: Lumbosacral Spine and Hip Disorders. MedEdPORTAL. 2017 Sep 20;13:10632. doi: 10.15766/mep_2374-8265.10632.

  PMID: 30800833 BACKGROUND

• Riley JF, Ahern DK, Follick MJ. Chronic pain and functional impairment: assessing beliefs about their relationship. Arch Phys Med Rehabil. 1988 Aug;69(8):579-82.

  PMID: 3408327 BACKGROUND

• Rainville J, Bagnall D, Phalen L. Health care providers' attitudes and beliefs about functional impairments and chronic back pain. Clin J Pain. 1995 Dec;11(4):287-95. doi: 10.1097/00002508-199512000-00006.

  PMID: 8788576 BACKGROUND

• Houben RM, Vlaeyen JW, Peters M, Ostelo RW, Wolters PM, Stomp-van den Berg SG. Health care providers' attitudes and beliefs towards common low back pain: factor structure and psychometric properties of the HC-PAIRS. Clin J Pain. 2004 Jan-Feb;20(1):37-44. doi: 10.1097/00002508-200401000-00008.

  PMID: 14668655 BACKGROUND

• Bishop A, Foster NE, Thomas E, Hay EM. How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists. Pain. 2008 Mar;135(1-2):187-95. doi: 10.1016/j.pain.2007.11.010.

  PMID: 18206309 BACKGROUND

• Keyte D, Richardson C. Re-thinking pain educational strategies: Pain a new model using e-learning and PBL. Nurse Educ Today. 2011 Feb;31(2):117-21. doi: 10.1016/j.nedt.2010.05.001. Epub 2010 Jun 20.

  PMID: 20566232 BACKGROUND

• Ng KS, Tang ZY, Wong PNF, Chua JLJ, Goh LLL, Koh YLE, Koh KH. Integrating transformative learning theory in synchronous E-learning in musculoskeletal pain education among primary care nurses: a randomized study. BMC Nurs. 2025 Jul 7;24(1):858. doi: 10.1186/s12912-025-03540-9.

  PMID: 40624538 DERIVED

MeSH Terms

Conditions

Musculoskeletal Pain

Condition Hierarchy (Ancestors)

Muscular Diseases; Musculoskeletal Diseases; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Khim Siong Ng

  SingHealth Polyclinics

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Khim Siong Ng

CONTACT

+6592708819; ng.khim.siong@singhealth.com.sg

Zhi Yin Tang

CONTACT

+6581872378; tang.zhi.yin@singhealth.com.sg

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 18, 2022
• First Posted: October 21, 2022
• Study Start: December 1, 2022
• Primary Completion: December 1, 2023
• Study Completion: December 1, 2023
• Last Updated: October 21, 2022

Record last verified: 2022-10

Data Sharing

• IPD Sharing: Will not share

Locations

SG (1)