Implementing pain competencies in Canadian physiotherapy education: Challenges, barriers, and opportunities

The Pain Education in Physiotherapy (PEP) competency profile provides a structured framework for integrating pain management competencies into Canadian physiotherapy (PT) curricula. Despite widespread endorsement, the integration of pain management competencies into PT curricula remains inconsistent. Identifying the barriers and enablers to implementation is essential for developing strategies that support students in achieving these competencies. This study explored factors influencing the implementation of the PEP competency profile in Canadian PT programs and identified key challenges and opportunities for improving integration. A qualitative description study was conducted using five focus groups with 23 participants, including pain educators and program directors from 13 entry-level PT programs in Canada. Data were analyzed using the Consolidated Framework for Implementation Research to identify multilevel barriers and facilitators. Participants recognized the value of the PEP competency profile in enhancing pain education but highlighted three key challenges: (1) a lack of structured guidance for teaching and assessment, (2) an overreliance on faculty champions rather than systemic institutional support, and (3) the absence of rigorous assessment approaches. Participants expressed uncertainty about integrating competencies within existing curricula, emphasizing the need for national collaboration, faculty development, and shared resources. The iterative, decentralized nature of curriculum change further complicated efforts to achieve consistent integration. Sustainable implementation of the PEP competencies requires structured guidance, institutional commitment, and adapted assessment strategies. Addressing these barriers through national-level collaboration, accreditation alignment, and faculty support is critical to ensure that PT graduates develop the necessary competencies for high-quality pain management.

物理治疗疼痛教育能力框架（Pain Education in Physiotherapy, PEP）为将疼痛管理能力融入加拿大物理治疗（Physiotherapy, 简称PT）课程体系提供了结构化框架。尽管该框架已获得广泛认可，但将疼痛管理能力融入PT课程的实践仍存在不一致性。明确该框架实施的阻碍因素与促进因素，对于制定助力学生掌握相关能力的策略至关重要。本研究探讨了影响加拿大PT项目中PEP能力框架实施的相关因素，并明确了提升其融入效果的核心挑战与机遇。本研究采用质性描述研究设计，针对加拿大13个入门级PT项目的23名参与者（含疼痛教育者与项目负责人）开展了5组焦点小组访谈。采用整合实施研究框架（Consolidated Framework for Implementation Research）对数据进行分析，以识别多层面的阻碍因素与促进因素。参与者认可PEP能力框架在提升疼痛教育质量方面的价值，但同时指出了三大核心挑战：其一，缺乏针对教学与评估的结构化指导；其二，过度依赖教师带头人而非系统性的机构支持；其三，缺乏严谨的评估方法。参与者对于在现有课程体系中融入相关能力存在顾虑，并强调需开展全国性协作、推进教师发展以及共享相关资源。课程变革的迭代性与去中心化特征，进一步加大了实现统一融入的难度。要实现PEP能力框架的可持续实施，需提供结构化指导、获得机构支持承诺，并采用适配性的评估策略。通过全国性协作、契合认证标准以及教师支持来破解上述阻碍因素，对于确保PT毕业生掌握高质量疼痛管理所需的相关能力至关重要。