A Brief Report on the PPA North Workshop on Assessment of Painat Queen Margaret University College, Edinburgh 23 April 2001.
Facilitator Dr. Denis Martin
The 2 hour workshop was attended by 19 Physiotherapists working in pain management, palliative care, outpatients and mental health.
The overall aim was to gain an initial overview of practice in assessing pain and its effects. There were three main objectives.
- To collect reports of what is done in practice.
- To gather opinion as to why practice is so.
- To generate ideas for small and large changes to improve practice.
Activity 1: Stakeholders.
Participants were asked to make a list of the people who they most wanted to benefit from their assessment practice. A rating system was used to sort the lists into priorities. Participants were also asked to indicate the benefits of assessment to the stakeholders.
| Priority | Stakeholder | Perceived Benefits |
| Patients | identification of their needs and goals feedback on their progress improved understanding of their condition | |
| 52 | Physiotherapist | clinical decision making providing evidence of effectiveness increasing knowledge and understanding of pain building rapport with patient increasing personal satisfaction and confidence |
| 22 | Physiotherapy colleagues | improved communication and referral processes |
| 20 | Patients' friends/families | highlighting areas of need |
| 13 | Other professionals | communication and referral |
| 06 | Management | evidence base provision of figures for audit |
| 04 | Physiotherapy Profession | increasing the evidence base helping research promoting professional development |
| 02 (low) | Patients' employers | determination of fitness to work |
Activity 2 Domains of pain
Participants were asked to list at least 7 domains of pain and explain what they meant by their selection. The suggestions were then compared with the 7 domains of pain described by Morley et al (1999 Pain 80:1-13) - pain experience, psychological coping, social, mood, communication/behaviour, physical fitness and physiological function, and health-care usage.
Everyone reported at least 4 domains and 12/19 listed at least 7. Fitted on the template of the 7 domains suggested by Morley et al, the responses looked like this.
Mood IIIIIIIIIIIIIIIIIIIII 21
Physical fitness/biological function IIIIIIIIIIIIIIII 16
Pain experience IIIIIIIIIIII 12
Communication/behaviour IIIIIIIIIII 11
Social IIIIIIII 08
Psychological coping IIIIII 06
Health-care use I 01
Other domains which did not fit neatly into the template, were the meaning of the pain to the person, economic costs such as being out of work, spiritual effects and general quality of life.
Activity 3 Suggestions for change
Participants were asked to list what they thought were positive and negative aspects of their pain assessment practices.
Positive points were that the participants saw themselves as skilled in verbally questioning their patients. They valued the process as a way of gaining better insight into the patients' pain and its effects. The use of verbal questions was praised as being flexible and efficient in time, aiding communication and gaining the trust of the patient. Those who spoke favourably about the use of measurement tools praised ones that were quick to administer and score, such as visual analogue scales.
Negative comments referred to a lack of objectivity both in the information and in the documentation of the information obtained by verbal questioning. Participants were uncomfortable with the ability of measurement tools to capture the patients' experience of pain and also in their own abilities to analyse and interpret the results of measurement tools. In particular there were comments that participants did not know how to translate results into treatment/management action. Common comments were that there was not enough time for an in-depth assessment and also that there was insufficient privacy within a typical clinical environment to discuss aspects of a very personal nature.
Participants were then asked what they could do now and in the future to improve their own practice. Suggestions were classified as small changes, i.e. those which could be implemented immediately with limited resources; and larger changes i.e. those which would require more resources.
Small changes:
- more use of validated scales
- more accurate documentation especially of subjective observations
- measurement of more domains of pain and its effects
Larger changes:
- training in skills of analysis and interpretation
- more time for assessment
- more multidisciplinary team assessments
- matching patient literacy and the content of questionnaires
Conclusion
The workshop gave an insight into the issues involved in assessing pain and its effects in practice. Within the group there was certainly evidence of a fertile environment for introducing more systematic methods. It must be remembered, of course, that the group was self-selected and that they had a clear interest in assessing pain and its effects. This it would be wrong to make too many conclusions about physiotherapy practice in general.
It does appear, however, that the system in which many of the participants work is a barrier to adequate assessment; and that there is a clear need for training and education in the use of measurement tools and in the analysis and interpretation of the information.
The information will be used to develop further similar activities within PPA North and it will inform research at Queen Margaret University College in Edinburgh investigating the assessment practices of health professions working with people with pain.