title: Effectiveness of a biopsychosocial e-learning intervention on the clinical judgements of medical students and GP trainees regarding future risk of disability in patients with chronic lower back pain: study protocol for a randomised controlled trial.
abstract: Chronic lower back pain (CLBP) is a major healthcare problem with wide ranging effects. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions that identify biopsychosocial barriers to recovery have been observed to lead to successfully reduced pain-related work absences and increased return to work for individuals with CLBP. Modern conceptualisations of pain adopt a biopsychosocial approach, such as the flags approach. Biopsychosocial perspectives have been applied to judgements about future adjustment, recovery from pain and risk of long-term disability; and provide a helpful model for understanding the importance of contextual interactions between psychosocial and biological variables in the experience of pain. Medical students and general practitioner (GP) trainees are important groups to target with education about biopsychosocial conceptualisations of pain and related clinical implications.
  
  
  
  The current study will compare the effects of an e-learning intervention that focuses on a biopsychosocial model of pain, on the clinical judgements of medical students and trainees.
  
  
  
  Medical student and GP trainee participants will be randomised to 1 of 2 study conditions: (1) a 20 min e-learning intervention focused on the fundamentals of the flags approach to clinical judgement-making regarding risk of future pain-related disability; compared with a (2) wait-list control group on judgement accuracy and weighting (ie, primary outcomes); flags approach knowledge, attitudes and beliefs towards pain, judgement speed and empathy (ie, secondary outcomes). Participants will be assessed at preintervention and postintervention.
  
  
  
  The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee. The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals.
  
  
  
  ISRCTN53670726; Pre-results.
authors.affiliation: Centre for Pain Research, National University of Ireland, Galway, Ireland School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Dwyer
authors.affiliation: Centre for Pain Research, National University of Ireland, Galway, Ireland School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Hannah
authors.identifier: 0000-0002-8761-0519
authors.initials: H
authors.lastname: Durand
authors.affiliation: School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Pádraig
authors.initials: P
authors.lastname: MacNeela
authors.affiliation: Centre for Pain Research, National University of Ireland, Galway, Ireland.
authors.forename: Bronagh
authors.initials: B
authors.lastname: Reynolds
authors.affiliation: Department of Family & Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hamm
authors.affiliation: Department of Behavioural Medicine, Keele University, Staffordshire, England.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Main
authors.affiliation: Centre for Pain Research, National University of Ireland, Galway, Ireland.
authors.forename: Laura L
authors.initials: LL
authors.lastname: O'Connor
authors.affiliation: School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Sinéad
authors.initials: S
authors.lastname: Conneely
authors.affiliation: Centre for Pain Research, National University of Ireland, Galway, Ireland.
authors.forename: Darragh
authors.initials: D
authors.lastname: Taheny
authors.affiliation: Centre for Pain Research, National University of Ireland, Galway, Ireland School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Slattery
authors.affiliation: Discipline of Economics, National University of Ireland, Galway, Ireland.
authors.forename: Ciaran
authors.initials: C
authors.lastname: O'Neill
authors.affiliation: Discipline of Health Promotion, National University of Ireland, Galway, Ireland.
authors.forename: Saoirse
authors.initials: S
authors.lastname: NicGabhainn
authors.affiliation: Discipline of General Practice, National University of Ireland, Galway, Ireland.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Murphy
authors.affiliation: Discipline of Medical Informatics and Education, National University of Ireland, Galway, Ireland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kropmans
authors.affiliation: Centre for Pain Research, National University of Ireland, Galway, Ireland School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Brian E
authors.initials: BE
authors.lastname: McGuire
mesh_terms: D059350:Chronic Pain / Q000150:complications*; D000066491:Clinical Decision-Making; D003194:Computer-Assisted Instruction; D004185:Disability Evaluation; D004504:Education, Medical, Undergraduate / Q000379:methods*; D058006:General Practice / Q000193:education*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007600:Judgment; D017116:Low Back Pain / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012107:Research Design; D016037:Single-Blind Method; D013337:Students, Medical / Q000523:psychology*
keywords: Biopsychosocial Model; Chronic Lower Back Pain; Clinical Judgement Making