Background and purpose: Different levels of pain neurophysiology knowledge and beliefs about pain have been investigated in Physiotherapists and student physiotherapists. Improving levels of knowledge and beliefs about pain has been shown to improve patient care. However, such knowledge and beliefs has not been investigated in unregistered staff/support workers (URS) in the United Kingdom’s (UK) physiotherapy workforce. The aim of this study was to compare levels of pain neurophysiology knowledge and beliefs held by registered physiotherapists, URS and physiotherapy students in order to identify if there were any learning needs for each respective group.

Methods: This was a cross sectional observational study design, involving 65 participants from in the UK physiotherapy workforce (33 Physiotherapists, 20 physiotherapy students and 12 URS). Procedure: Participants were recruited via an online link shared on several social media platforms (Facebook, Twitter and LinkedIn). A post was also shared on a member’s page on the Chartered Society of Physiotherapy website, inviting participation. Participants followed the link to a questionnaire containing the Health Care Pain Attitudes and Impairment Relationship Scale (HC-PAIRS) and The Revised Neurophysiology of Pain Questionnaire (RNPQ). The total scores of the three sample sub-groups were compared. Demographic details were also collected for the participants to test for other cofounding variables as secondary aims. Data was collected on which URS had a previous undergraduate degree as well as if each of the participants had previous experience working or studying in a Musculoskeletal, Orthopaedic, Oncology setting. The outcome scores of those with a previous undergraduate degree in the URS and those with previous experience in any of the three named settings above were compared for differences in medians and interquartile ranges. Two Kruskal-Wallis tests were done to check for differences between the three workforce groups and then Wilcoxon rank sum tests were completed to test which groups were significantly different from each other. Bonferroni corrections were used to adjust the results of the Wilcoxon tests and effect sizes were calculated for each of the Wilcoxon tests. Twelve Kendall’s tau correlations were completed to test for associations between participants’ ages and years of experience and HC-PAIRS and RNPQ scores with the sample divided into the three workforce groups.

Results: The Kruskal-Wallis test for the HC-PAIRS revealed a significant difference between the 3 workforce groups (H(2) = 11.274, p = 0.004) and the Kruskal-Wallis test for the RNPQ revealed a significant difference between the 3 workforce groups (H(2) = 7.991, p = 0.018). On the HC-PAIRS, physiotherapists scored significantly better than the physiotherapy students (p = 0.004, Cohen’s d = 0.80) and URS (p = 0.013, Cohen’s d = 0.70). There was no significant difference between physiotherapy students and URS on the HC-PAIRS (p = 0.696, Cohen’s d = 0.18). On the RNPQ the difference between physiotherapists and physiotherapy students was not significant but close to being so (p = 0.027, Cohen’s d = 0.56). The difference between physiotherapists and URS was also close to being significant (p = 0.022, Cohen’s d = 0.63). The difference between physiotherapy students and URS was not significant (p = 0.404, Cohen’s d = 0.08). No significant correlations were found on any of the Kendall’s tau correlations between age and years of experience with either the HC-PAIRS or RNPQ.

Discussion: URS and physiotherapy students did not score as highly as their physiotherapist colleagues in this study. It would appear that there is a training need in the URS within the workforce which is not met as well as the training needs of physiotherapists and physiotherapy students. Future studies should be conducted to investigate URS pain neurophysiology knowledge and beliefs in larger studies and test whether PNE interventions can produce more optimal scores in URS. Such improved scores could have an impact on the management of patients in chronic pain considering URS are responsible for a large part of patient care.