Physical Therapist Perceptions and Use of Clinical Pain Mechanism Assessment in the Musculoskeletal Setting

Research Objectives To explore perceptions and use of clinical pain mechanism assessment by physical therapists managing musculoskeletal pain. Design This was a cross-sectional survey study. Setting The survey was completed electronically by physical therapists in the United States. Participants This was a convenience sample of physical therapists from a professional membership organization in the United States. Members were invited via email to participate if they evaluate and treat musculoskeletal pain. Interventions Not applicable. Main Outcome Measures Two primary outcomes were assessed: respondent beliefs/opinions related to and utilization of clinical pain mechanism assessments. Likert-type questions exploring degree of agreement were provided to capture relevant data. Results In total, 148 respondents completed all aspects of the survey. Respondent age ranged from 26 to 73 years, with a mean of 43.9 (12.0). Most respondents (70.8%) reported performing clinical pain mechanism assessments at least ‘sometimes’. A majority (80.4%) believed clinical pain mechanism assessments are useful in guiding management strategies while 79.8% reported specifically choosing interventions to alter aberrant pain mechanisms. The most commonly used pain severity, physical examination testing and questionnaires were the numeric pain rating scale, pressure pain thresholds and pain diagrams, respectively. However, the vast majority of instruments available to clinically assess pain mechanisms were performed by a small proportion of respondents (< 30%). There were no significant correlations between age, years of experience, highest earned degree, completion of advanced training or specialist certification and testing frequency. Conclusions The evaluation of pain mechanisms involved in the pain experience is becoming common in research. However, the clinical application of pain mechanism assessment is unclear. Based on the results of this survey, physical therapists in the orthopedic setting believe pain mechanism assessment is useful, but data suggests it is infrequently performed. Additional qualitative inquiry regarding motivations for or against using clinical pain mechanism assessment could be useful in the knowledge translation process. Author(s) Disclosures None to report.