Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Medical Campus Jette, Building F-Kine, Laarbeeklaan 103, BE-1090 Brussels, Belgium; Pain in Motion International Research Group; Research Foundation Flanders (FWO), Brussels, Belgium; and Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.
Pain in Motion International Research Group and Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Phys Ther. 2018 May 1;98(5):357-368. doi: 10.1093/ptj/pzx092.
Available evidence favors the use of pain neuroscience education (PNE) in patients with chronic pain. However, PNE trials are often limited to small sample sizes and, despite the current digital era, the effects of blended-learning PNE (ie, the combination of online digital media with traditional educational methods) have not yet been investigated.
The study objective was to examine whether blended-learning PNE is able to improve disability, catastrophizing, kinesiophobia, and illness perceptions.
This study was a 2-center, triple-blind randomized controlled trial (participants, statistician, and outcome assessor were masked).
The study took place at university hospitals in Ghent and Brussels, Belgium.
Participants were 120 people with nonspecific chronic spinal pain (ie, chronic neck pain and low back pain).
The intervention was 3 sessions of PNE or biomedically focused back/neck school education (addressing spinal anatomy and physiology).
Measurements were self-report questionnaires (Pain Disability Index, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Illness Perception Questionnaire, and Pain Vigilance and Awareness Questionnaire).
None of the treatment groups showed a significant change in the perceived disability (Pain Disability Index) due to pain (mean group difference posteducation: 1.84; 95% CI = -2.80 to 6.47). Significant interaction effects were seen for kinesiophobia and several subscales of the Illness Perception Questionnaire, including negative consequences, cyclical time line, and acute/chronic time line. In-depth analysis revealed that only in the PNE group were these outcomes significantly improved (9% to 17% improvement; 0.37 ≤ Cohen d ≥ 0.86).
Effect sizes are small to moderate, which might raise the concern of limited clinical utility; however, changes in kinesiophobia exceed the minimal detectable difference. PNE should not be used as the sole treatment modality but should be combined with other treatment strategies.
Blended-learning PNE was able to improve kinesiophobia and illness perceptions in participants with chronic spinal pain. As effect sizes remained small to medium, PNE should not be used as a sole treatment but rather should be used as a key element within a comprehensive active rehabilitation program. Future studies should compare the effects of blended-learning PNE with offline PNE and should consider cost-effectiveness.
现有证据支持在慢性疼痛患者中使用疼痛神经科学教育（PNE）。然而，PNE 试验通常仅限于小样本量，并且尽管当前处于数字时代，混合学习 PNE 的效果（即在线数字媒体与传统教育方法的结合）尚未得到研究。
本研究旨在探讨混合学习 PNE 是否能够改善残疾、灾难化、运动恐惧症和疾病认知。
这是一项 2 中心、三盲随机对照试验（参与者、统计人员和结果评估者均被蒙蔽）。
该研究在比利时根特和布鲁塞尔的大学医院进行。
参与者为 120 名非特异性慢性脊柱疼痛患者（即慢性颈痛和腰痛）。
干预措施为 3 次 PNE 或生物医学聚焦背部/颈部学校教育（涉及脊柱解剖学和生理学）。
测量使用自我报告问卷（疼痛残疾指数、疼痛灾难化量表、坦帕运动恐惧症量表、疾病认知问卷和疼痛警觉与意识问卷）。
由于疼痛，任何治疗组的残疾感知（疼痛残疾指数）均未发生显著变化（教育后平均组间差异：1.84；95%置信区间：-2.80 至 6.47）。对于运动恐惧症和疾病认知问卷的几个亚量表，包括负面后果、周期性时间线和急性/慢性时间线，观察到显著的交互效应。深入分析表明，只有在 PNE 组中，这些结果才得到显著改善（9%至 17%的改善；0.37≤Cohen d≥0.86）。
效应大小为小至中等，这可能引起临床实用性有限的关注；然而，运动恐惧症的变化超过了最小可检测差异。PNE 不应作为单一治疗方式，而应与其他治疗策略相结合。
混合学习 PNE 能够改善慢性脊柱疼痛患者的运动恐惧症和疾病认知。由于效应大小仍然较小，PNE 不应作为单一治疗方法，而应作为综合主动康复计划中的关键要素。未来的研究应比较混合学习 PNE 与离线 PNE 的效果，并应考虑成本效益。
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