Hand therapists' knowledge and practice-related beliefs about pain science: A survey study

Introduction: Identifying hand therapists' knowledge and beliefs about pain can illuminate familiarity with modern pain science within hand therapy. Purpose of the Study: The primary aim was to identify hand therapists' knowledge of pain neurophysiology. Secondary purposes were to explore demographic variation in knowledge, describe practice-related beliefs about pain science, and explore associations between knowledge and beliefs. Study Design: Cross-sectional descriptive survey study. Methods: An electronic survey, including the Revised Neurophysiology of Pain Questionnaire (R-NPQ) and Likert-type questions about practice-related beliefs, was distributed to American Society of Hand Therapists members. Results: Data from 305 survey responses were analyzed. R-NPQ accuracy ranged from 42% to 100%, with a mean of 75% (9/12 ± 1.5). Certified hand therapists scored, on average, 0.8 points lower than their noncertified peers. Participants with a doctoral degree scored 0.7 or 0.6 points higher, respectively, than those with a bachelor's or master's degree. Objective knowledge of pain neurophysiology was positively associated with perceived knowledge of pain science (ρ =.31, P <.001). Associations between R-NPQ and perceived importance of knowing pain science; confidence in pain-related evaluation, treatment, and education; and frequency of incorporating pain science principles into practice were small but statistically significant (ρ =.12-.25, P = <.001-.04). Conclusions: Although hand therapists recognized the importance of knowing pain science, they had objective and subjective limitations in that knowledge. Specific errors in their R-NPQ responses suggest misconceptions related to the modern differentiation between nociception and pain. Blurring of these constructs may relate to participants' self-reported practice emphasis on acute versus chronic conditions. Future studies should explore knowledge, attitudes, and beliefs about pain beyond R-NPQ scores to understand variation in practice and training needs.