Development of learning material to complement pain education of physiotherapists in Indian universities: A synthesis of an action research study

Article accepted

This article has been accepted for publication. Peer reviews and author responses are available at the end of the article.


Background and purpose: It is necessary to bring the current understanding of pain to undergraduate, postgraduate, and academic faculty of physiotherapy in all the universities and independent institutions in India. Approximately 15,000 students graduate every year from various physiotherapy institutions in India. More than 20,000 physiotherapists teach or practice in various institutions, hospitals, and universities. The current pain curriculum for physiotherapy education is outdated and scanty. Physiotherapists are first-line managers of pain and it is important to understand the current advances in pain management to effect competent practice. Methods: An action research methodological concept (three phases) has been adapted to identify the missing areas of pain science from the physiotherapy curricula of universities of India (n=30). Instructional Digital Versatile Discs (DVD) was developed in these areas by experts through consensus methods. The reach of the study was evaluated through Google forms and email responses received from the participating institutions. Results: Pain lectures (22 hours) were recorded and four DVDs were commercially produced and duplicated. The DVDs were sent to all the universities and individual institutions (n=469) by post and recommended that they incorporate the information into the undergraduate and postgraduate curricula. The lecture series was also made available online via the institutional library depository system. Conclusion: This project has created a snowball effect by imparting current understanding and knowledge in young therapists and teaching faculty as the lectures are available on the website of the participating institution. Cultural and other characteristics are similar across the countries of South Asia (India, Pakistan, Sri Lanka, Nepal, Bhutan, Bangladesh, Maldives, and Myanmar) and all of these countries use English as the medium of higher education. Hence a regional impact is also anticipated.


Thank you for the opportunity to review this paper.

There were some grammatical issues with the paper – I have commented on the article itself in this regard.

The paper needs some work in the following areas:
1. ‘Objectives: To assess the reach of pre-recorded learning material on the current understanding of pain.’
Issue: Looking at the methods and results the following seem to be objectives of the paper:
• Identified important pain concepts that were missing in the curriculum.
• Revised method of teaching – video-recorded lectures.
• Assessed effectiveness, acceptance of lecture series and attitude of towards new method of learning experience – Google form.
Suggestion: Relook the objective of this paper and what you would like to report on, ask yourself who is my take away message for?

2. Participants
Issue: It is not always clear who participated in the study. I share some examples.
a) In the introduction, the authors mention “According to the Indian Association of Physiotherapists (IAP), there are 223 recognized institutions that offer undergraduate (UG) and postgraduate (PG) in physiotherapy, under various private and government universities ( 2016)”
b) Then, in Phase 2 of the Methods section, 469 colleges are mentioned.
c) In phase 3 (Method section) two institutions of Southern India are mentioned
d) In the Results section the authors mention that five institutions responded.

Suggestion: Clearly state who participated and how many participated.

3. Results
a) It is not clear what questions were asked in the google form to determine/understand ‘effectiveness and acceptance of the lecture series’, I assume these were sent to the students?
b) The authors do not clearly report on ‘effectiveness and acceptance of the lecture series’. They only report on how many participants said ‘yes’ but there is no report on findings – whether the lecture series was effective/acceptance? It is also difficult to understand how the authors measured ‘effectiveness’.
a) Include some sort of understanding of the form used and what the responses were for the reader to understand the picture of the results.
b) Report on the findings of the Google form more vigorously to give the reader an understanding of the ‘acceptance and effectiveness of the lecture series’.

4. Analysis
a) The analysis is only reported for the decision of pain topics included.

a) Include an analysis of the Google survey as well.

5. Discussion
a) The discussion needs to demonstrate more interpretation of the findings in relation to what is already known about the topic. Currently, the authors do not relate their own findings to what has previously been done.

a) Clearly outline and describe your own findings.
b) Rework the discussion to include more integration of what is known about the results.

6. Practical Implications
a) The practical implications seem to be disconnected from the objectives highlighted in the study and the results.
b) Align the practical implications with the objectives and the results of the study.

7. Title
a) The title doesn’t align with what the authors set out to do or achieved?
a) Revise title once the authors have decided who they are aiming the article at and what they want to share?

Thank you for submitting this article, and apologies for the delay in completing the review process. I think that your study addresses a relevant issue in contemporary physiotherapy education, however, there are a number of areas in which I think the article would benefit from significant revision and clarification.

The fundamental issue to address from my perspective relates to the aims and methodology of the study as currently reported. Your concluding statement in the introduction gives the objective of the study as being to “…assess the reach of pre-recorded learning material on the current understanding of pain…”. However, the methods and results reported relate predominantly to the development of the resources, with reference also to a survey evaluating the effectiveness and acceptability of the resources. The discussion and conclusion then focus back on the reach or potential reach and therefore do not relate to the methods and results. My feeling is that overall the article would benefit from being rewritten with a clearer aim of articulating the process of development of the learning materials in line with your methods, with less emphasis on reach, which has not been established at this point. 

In relation to the methodology, my feeling is that the process described in your methods section suggests that the study might be better conceived of as a piece of action research. Your methods appear to describe a process of problem identification, action planning, data collection, analysis and planning of future action through at least two cycles, which is in keeping with an action research methodology. Rewriting the article as a report of an action research project would provide clearer alignment between your aims, methods and results. I also feel this would give more scope to add detail regarding the curriculum review phase of the project, which would increase the usefulness of the article for other physiotherapy educators. 

Bearing in mind this overall recommendation, please find below further comments relating to each section.



This provides a clear background to the project, although would benefit from being split up into paragraphs. There is a sound argument for the need to update the pain curricula of pre-registration physiotherapy programmes in India and some of the contextual barriers to this. Considering to what extent pain curricula in other countries share the issues identified may add relevance to a broader readership, for example, there are studies of pain curricula in the UK and Finland. I also wondered whether considering studies evaluating the relationship between pain education and students’ beliefs and practice (such as Springer et al 2018 and Domenench et al 2011 and would strengthen the rationale.



The methods provide some clear detail around the process of developing the teaching materials. As per my previous comments, I feel that reconceiving of this paper as a report of an action research paper would provide a clearer structure. This could incorporate the phases that you have identified as well as including more detail on the reflective process that led you from the initial intensive training programme that you developed to the current project. As a reader, I would have been interested to know more about the curriculum review and how the plan for the recorded materials was informed by this process and the input of the external expert review committee. It would also be good to have more information on the evaluation survey aims and content. 

Examples of published action research projects of teaching material development in healthcare education that might be helpful for restructuring your paper include; “A model teaching session for the hypothesis-driven physical examination” (Nishigori et al 2011) and “Learning to listen: Improving students’ communication with disabled people” (Anderson et al 2011).



In keeping with the restructure towards action research, your results would focus more on how each stage and each group of participants (initial project group and experience with the previous intense teaching model, external expert review committee, students and educators at participating institutions) informed the development of the teaching resources and the future direction. I would suggest that more detail around the content of the teaching package and how topics were structured and linked rather than on their duration would be of most interest to other healthcare educators. Greater clarity is needed around who was involved in the initial rollout of the materials and the evaluation survey, possibly in the form of a flow diagram, as I found this difficult to track through.


Discussion and future perspectives

The discussion should provide a more detailed explanation and analysis of the results presented. Expanding the scope of the discussion away from the current and potential reach of the resources to focus more on the development process and the content of the project output in the form of the teaching materials would fit with the proposed methodological change. It would also be good to see a critique of your methods in the form of strengths and limitations of the study, as this adds reflexivity and would potentially be useful for other educators undertaking a similar project.


Thank you again for submitting this article. I would be interested to see a future iteration of it and happy to continue the discourse.

Conflict of interest statement

The authors report no conflict of interest.

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