What question did this study set out to answer?

This study aims to evaluate the impact of enhanced education on pain knowledge, attitudes, and clinical behaviors among physical therapist students.

February 14, 2026

Benefits of Enhanced Education on Biopsychosocial Pain Knowledge, Attitudes, and Clinical Behavior of Physical Therapist Students: A Cluster Randomized Trial

Key Points

This study aims to evaluate the impact of enhanced education on pain knowledge, attitudes, and clinical behaviors among physical therapist students.
Cluster-randomized controlled trial design
Participants: first- and second-year physical therapist students at Hanze University
Intervention duration: 8 weeks of enhanced education compared to standard education
Assessment of primary outcomes using 5 measures of biopsychosocial pain knowledge, attitudes, and behaviors
Data analysis using linear mixed models and responder description
Both groups improved on all outcomes, with greater improvements in the enhanced-education group
Significant differences in Video Vignette score (P < .001) and Written Vignette score (P = .03)
Enhanced-education group shows better outcomes in Knowledge and Attitude of Pain (P = .006)
48% of the enhanced-education group exceeded minimal clinically important change for KNAP compared to 23.1% of the standard-education group

Abstract

Introduction: Whether person-centered pain education approaches for Physical Therapist (PT) students elicit positive guideline-consistent changes in knowledge, attitudes, and clinical behavior is unknown. This study aims to evaluate the effects of enhanced-education compared to standard-education among entry-level PT students. Review of Literature: Many (future) PTs adhere poorly to evidence-based clinical guidelines and find it challenging to integrate biopsychosocial (BPS) elements in the management of persistent musculoskeletal pain. Subjects: The eligibility criteria included all first- and second-year students from the Dutch 4-year entry-level PT education program at Hanze University of Applied Sciences in Groningen, the Netherlands. Methods: A cluster-randomized controlled trial design was used. Primary outcomes—including BPS pain knowledge, attitudes, and self-reported clinical behaviors—were assessed by comparing enhanced-education with standard-education on 5 measures. Intervention duration was 8 weeks. Enhanced-education teachers were additionally trained. Students were blinded to group allocation. Data were analyzed using linear mixed models and responder description. Results: N = 187 students responded at baseline and n = 264 postintervention, 63% being paired measurements. Both groups improved significantly on all outcomes, with the enhanced-education group demonstrating greater improvement than the standard-education group in 4 out of 5 outcomes: Video Vignette score ( P = <.001), Written Vignette score ( P = .03), Knowledge and Attitude of Pain (KNAP) ( P = .006), Pain Attitudes and Beliefs Scale for Physiotherapists biopsychosocial subscale ( P = .064), and biomedical subscale ( P = .019). Responder analysis demonstrated greater improvement in enhanced-education than in standard-education in all outcomes, with 48% of the enhanced-education group and 23.1% in the standard-education group exceeding the minimal clinically important change for KNAP. Discussion and Conclusions: Implementation of enhanced-education lead to better guideline-consistent BPS pain knowledge, attitudes, and self-reported clinical behaviors in PT students. These findings could enhance professional PT programs by focusing on improving students' contemporary pain beliefs and clinical behaviors.

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