Effects of Biopsychosocial Education on the Clinical Judgments of Medical Students and GP Trainees Regarding Future Risk of Disability in Chronic Lower Back Pain: A Randomized Control Trial

Citation

Dwyer CP, MacNeela P, Durand H, O’Connor LL, Main CJ, McKenna-Plumley PE, Hamm RM, Reynolds B, Conneely S, Slattery BW, Taheny D, NicGabhainn S, Murphy AW, Kropmans T & McGuire BE (2020) Effects of Biopsychosocial Education on the Clinical Judgments of Medical Students and GP Trainees Regarding Future Risk of Disability in Chronic Lower Back Pain: A Randomized Control Trial. Pain Medicine, 21 (5), pp. 939-950. https://doi.org/10.1093/pm/pnz284

Abstract
Background Chronic lower back pain (CLBP) is a major health care burden and often results in workplace absenteeism. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions informed by the flags approach, which integrates cognitive and behavioral approaches via identification of biopsychosocial barriers to recovery, have resulted in reduced pain-related work absences and increased return to work for individuals with CLBP. However, research indicates that physicians’ adherence to biopsychosocial guidelines is low. Objective The current study examined the effects of a flags approach–based educational intervention on clinical judgments of medical students and general practitioner (GP) trainees regarding the risk of future disability of CLBP patients. Design Randomized controlled trial (trial registration number: ISRCTN53670726). Setting University classroom. Subjects Medical students and GP trainees. Methods Using 40 fictional CLBP cases, differences in clinical judgment accuracy, weighting, and speed (experimental N = 32) were examined pre- and postintervention, as were flags approach knowledge, pain attitudes and beliefs, and empathy, in comparison with a no-intervention control group (control N = 31). Results Results revealed positive effects of the educational intervention on flags approach knowledge, pain-related attitudes and beliefs, and judgment weighting of psychologically based cues; results are discussed in light of existing theory and research. Conclusions Short flags approach–based educational video interventions on clinical judgment-making regarding the risk of future disability of CLBP patients may provide opportunities to gain biopsychosocial knowledge, overcome associated attitude barriers, and facilitate development of clinical judgment-making more aligned with psychological cues.

Keywords
Chronic Lower Back Pain; Biopsychosocial; Flags Approach; Judgment-Making; Judgment Analysis

Journal
Pain Medicine: Volume 21, Issue 5