Dr James Milligan

Background Accelerated university courses were developed in response to consumer demand and educational advances, yet a lack of research exists related to the impact of accelerated health care courses in the United Kingdom. Objectives This study explored clinicians' perceptions of accelerated pre-registration courses in physiotherapy. Method Senior clinicians were recruited by purposive sampling from several National Health Service hospitals across northeast England. Data from face-to-face semi-structured interviews were recorded, transcribed verbatim and analysed using Interpretive Phenomenological Analysis. Findings Findings from fourteen participants indicated their admiration of accelerated students’ attributes to complete what they considered to be an intense and in-depth course. Such graduates were described as ‘superhuman.’ Participants noted that accelerated graduates were likely to ‘hit the ground running’ in clinical settings. However, concerns were raised that some accelerated graduates' over-confidence affected team dynamics and/or affected some aspects of clinical reasoning. Conclusions Participants valued the varied routes to graduation while recognising their strengths and limitations. Findings from the study suggested the need for different types of clinical supervision to support each route.

Background: Accelerated university courses were developed in response to consumer demand and educational advances, yet a lack of research exists related to the impact of accelerated health care courses in the United Kingdom. Objectives: This study explored clinicians' perceptions of accelerated pre-registration courses in physiotherapy. Method: Senior clinicians were recruited by purposive sampling from several National Health Service hospitals across northeast England. Data from face-to-face semi-structured interviews were recorded, transcribed verbatim and analysed using Interpretive Phenomenological Analysis. Findings: Findings from fourteen participants indicated their admiration of accelerated students’ attributes to complete what they considered to be an intense and in-depth course. Such graduates were described as ‘superhuman.’ Participants noted that accelerated graduates were likely to ‘hit the ground running’ in clinical settings. However, concerns were raised that some accelerated graduates' over-confidence affected team dynamics and/or affected some aspects of clinical reasoning. Conclusions: Participants valued the varied routes to graduation while recognising their strengths and limitations. Findings from the study suggested the need for different types of clinical supervision to support each route.

BACKGROUND: The importance of measuring ankle muscle strength (AMS) has been demonstrated in a variety of clinical areas. Much data has been accumulated using the Cybex Norm isokinetic dynamometer but a uniform framework does not exist. OBJECTIVE: To identify pertinent studies which have used the Cybex Norm to measure AMS in order to establish reference values. METHODS: A narrative review of the literature was used to identify papers that have used the Cybex Norm to measure isokinetic concentric and eccentric AMS. RESULTS: Fifty five research papers were identified but each study used a different isokinetic protocol. CONCLUSIONS: It is not possible to produce AMS reference values due to the wide variation in data collection methods. This is therefore an area of research that needs further exploration.

This qualitative study investigates how orthopaedic specialist registrars perceive the role of the physiotherapist working as an extended scope practitioner. The study uses in-depth interviews in a ‘grounded theory’ approach to generate data and analysis. Respondents provided viewpoints relating to impressions of ability, supervision and risk of litigation. Results indicate that staff promote the role.

Relevance: Within the United Kingdom (UK) physiotherapy pre-registration training is provided at both undergraduate and postgraduate level at seventeen universities. Whilst upholding the standards of proficiency the manner in which the curriculum is delivered varies from institute to institute. Two UK based universities have studied the impact of delivering elements of the pre-registration curriculum to both undergraduates and postgraduate students simultaneously. Termed ‘parallel teaching’ it is defined as’…any form of teaching that involves undergraduate and postgraduate students being located in the same class’. This is possible when the content-related learning outcomes are similar for the two different groups. Subsequent assessment for the differing cohorts follows the specific academic standard requirements as per Quality Assurance Agency guidance. Parallel teaching is under-researched. It is not known how students perceive this mode of learning. Purpose: The aim was to explore the perceived benefits and challenges to parallel teaching of mixed undergraduate and postgraduate pre-registration physiotherapy students in the same learning environments. Methods/analysis: Being exploratory a qualitative research design was used. To aid transferability of findings two different UK based universities participated in the study that trained students via both undergraduate and postgraduate routes. Data collection was by four different focus groups: Year 2 BSc (Hons) physiotherapy students and Year 1 of the MSc physiotherapy students from each university. To ensure participant anonymity recruitment was via a third party and the focus groups’ facilitator was independent to either teaching team. Pseudonyms were used during digital recording of the focus groups which were transcribed verbatim. Data were analysed using thematic analysis techniques. Investigator triangulation was used to validate coding and findings. Results: Several principal themes arose. ‘Lack of suitable induction’ led to misunderstandings of the rationale for the parallel teaching. Many student participants viewed the concept with scepticism. This led to a sense of ‘segregation’ and group dynamics were altered. The undergraduates felt more ‘intimidated’ initially in open classroom discussions as they put the Masters students on a ‘pedestal’ assuming that the latter had significantly greater knowledge. However, with time both cohorts felt that their counterparts brought something new to the classroom, that they learnt from each other and adopted a ‘sense of healthy competition’. Discussion and conclusions: This study offered useful insights into parallel teaching. It is clear from findings that students require clear indications and explanations from the outset to avoid perceptions that parallel teaching is merely a cost saving exercise. Ultimately, students from both sets of academic cohorts viewed the process positively and agreed that they had benefitted from each others’ involvement in their learning. However, resources need to be in place to ensure appropriate physical learning spaces and that suitable student: staff ratios remain. Impact and implications: To the authors’ knowledge this study is the first of its kind within physiotherapy. Findings indicate that there may be pedagogical benefits from parallel teaching as well as providing elements of efficiency when delivering specific similar curriculum content to mixed groups. Funding acknowledgement: This work was unfunded

Background/Aim: Within the United Kingdom (UK), physiotherapy preregistration training is provided at both undergraduate and postgraduate level at 17 higher education institutions (HEIs). Some course teams approach this by teaching preregistration BSc and MSc students simultaneously to meet the same learning outcomes. This is often termed “parallel learning” and it is not known how students perceive this mode of learning. The aim of the study was to explore the perceived benefits and challenges to parallel learning of preregistration BSc and MSc physiotherapy students. Methods: Students from two different UK-based HEIs participated in an exploratory qualitative research design, with data collected in focus groups of each cohort and HEI. Data were analyzed using thematic analysis. Results: Several themes arose from student perceptions of parallel learning that were sceptical: “starting over again,” “misunderstanding each other’s motivations,” “establishing knowledge hierarchies,” and “competing for space”. However, some themes emerged from students reflections on the perceived benefits of parallel learning including “healthy competition” and “learning from difference.” Conclusions: It is clear from findings that students perceive the benefits of parallel learning of mixed groups. However, to avoid perceptions that it is merely cost cutting, learning resources need to be maintained and from the outset clear explanations of the purposes should be given to students.

Forty-four Sustainability and Transformation Plans (STPs) were introduced in NHS planning guidance in December 2015. Draft STPs were published in late 2016. The plans bring together providers, commissioners, local government, and third-sector organisations to develop and deliver new models of care.1 These models aim to improve the quality, efficiency, and sustainability of healthcare services, across England over the next 5 years.2 Concerns have been raised about the impact of STPs on GP provision,3 on patient groups,4 and on the number of hospital beds.5 The purpose of this study was to identify the detail relating to rehabilitation, occupational therapy, and physiotherapy in STPs. Occupational therapy and physiotherapy are two of 12 professional groups that make up allied health professionals (AHPs). AHPs are the third largest workforce in health and care in England. A recent AHP strategy from NHS England6 has provided a blueprint by and for AHPs to contribute to future services, including STPs. The Chartered Society of Physiotherapy7 has promoted STPs to move towards a model of health prevention and a rehabilitation system that supports collaboration and integration across local systems; for example, NHS trusts and local authorities. The Royal College of Occupational Therapists8 agreed that STPs can provide a vehicle for occupational therapists to deliver early action, prevent admission to hospital, and implement a reabling approach that improves patient outcomes and saves money...

The identification of psychosocial determinants of injury in sport has become synonymous with the multi-component theoretical stress and injury model proposed by Williams and Anderson (1998). Williams and Andersen (1998) suggest that predisposing and environmental factors contribute to an adverse stress reaction that detrimentally impacts on neuromuscular functioning and increases the likelihood of injury. Climbing is considered to be a high-risk sport which requires individuals to routinely manage increased levels of stress and anxiety. A synthesis of the findings from the critical review suggests self-efficacy may have a duplicitous role in the antecedents of climbing related injury. Firstly, high levels of self-efficacy developed through repeated mastery experience create a robust confidence frame capable of ‘buffering’ the adverse effects of stress and therefore reduce the likelihood of acute injury in climbing. Contrastingly the reciprocal relationship of successful performance and repeated exposure may result in the manifestation of chronic overuse injuries when training loads are not adequately managed. Key Words: self-efficacy; stress, injury, antecedents

Objectives: The purpose of this study was to engage with physiotherapy clinicians, academics, physiotherapy students and patients to explore the acceptability, feasibility, and practical considerations of implementing person-focused evidence-based pain education concepts, identified from our previous research, in pre-registration physiotherapy training. Design: This qualitative study took a person-focused approach to ground pain education in the perspectives and experiences of people who deliver and use it. Data was collected via focus groups and in-depth semi-structured interviews. Data was analysed using the seven stage Framework approach. Setting: Focus groups and interviews were conducted either face to face, via video conferencing or via telephone. This depended on geographical location, participant preference, and towards the end of data collection the limitations on in-person contact due to the Covid-19 pandemic. Participants: UK based physiotherapy clinicians, physiotherapy students, academics and patients living with pain were purposively sampled and invited to take part. Results: Five focus groups and six semi-structured interviews were conducted with twenty-nine participants. Four key dimensions evolved from the dataset that encapsulate concepts underpinning the acceptability and feasibility of implementing pain education in pre-registration physiotherapy training. These are (1) make pain education authentic to reflect diverse, real patient scenarios, (2) demonstrate the value that pain education adds, (3) be creative by engaging students with content that requires active participation, (4) openly discuss the challenges and embrace scope of practice. Conclusions: These key dimensions shift the focus of pain education towards practically engaging content that reflects people experiencing pain from diverse sociocultural backgrounds. This study highlights the need for creativity in curriculum design and the importance of preparing graduates for the challenges that they will face in clinical practice.

Background Pain is a complex, global and multidimensional phenomena that impacts the lives of millions of people. Chronic pain (lasting more than 3 months) is particularly burdensome for individuals, health and social care systems. Physiotherapists have a fundamental role in supporting people who are experiencing pain. However, the appropriateness of pain education in pre-registration physiotherapy training programmes has been questioned. Recent research reports identify the need to integrate the voice of patients to inform the development of the pre-registration curriculum. The aim of this meta-ethnography was to develop new conceptual understanding of patients' needs when accessing physiotherapy for pain management. The concepts were viewed through an educational lens to create a patient needs-based model to inform physiotherapy training. Methods Noblit and Hare’s seven-stage meta-ethnography was used to conduct this qualitative systematic review. Five databases (MEDLINE, CINAHL Complete, ERIC, PsycINFO and AMED) were searched with eligibility criteria: qualitative methodology, reports patient experience of physiotherapy, adult participants with musculoskeletal pain, reported in English. Databases were searched to January 2018. Emerge reporting guidelines guided the preparation of this manuscript. Results A total of 366 citations were screened, 43 full texts retrieved and 18 studies included in the final synthesis. Interpretive qualitative synthesis resulted in six distinct categories that represent patients’ needs when in pain. Analysing categories through an education lens resulted in three overall lines of argument to inform physiotherapy training. The categories and lines of argument are represented in a ‘needs-based’ model to inform pre-registration physiotherapy training. Discussion The findings provide new and novel interpretations of qualitative data in an area of research that lacks patient input. This is a valuable addition to pain education research. Findings support the work of others relative to patient centredness in physiotherapy.

Objectives: High risk sports participants have typically been viewed as a homogenous group despite variability in performance characteristics and the level of risk undertaken. Prolonged engagement high risk sports such as winter climbing are relatively underserved within current literature. Elite winter climbers attempt climbs that are outside the scope of the current ‘known’ i.e. unclimbed routes. The majority of the current understanding of motivation in high risk sports is based on quantitative research and the methodologies and instruments used. The purpose of this study was to explore the experiences of elite winter climbers and gain a richer understanding of their motivational orientation and risk taking behaviour. Design: Qualitative – inductive. Method: Four elite male winter climbers (aged 42-49 years old) took part in semi-structured interviews and explore their motivational orientation and risk taking behaviour. A thematic analysis was used. Results: Two super-ordinate themes of enactive mastery and engendered disinhibition emerged from the data. Enactive mastery was interpreted as a composite of two higher order themes; task mastery and self-mastery. Engendered disinhibition was interpreted as a composite of two higher order themes; social cognitive appraisal and self-perception. Conclusion: Enactive mastery and engendered disinhibition emerged as key behavioural and psychological determinants that influenced individuals to attempt more difficult and riskier forms of winter climbing. Goal achievement was their primary motive which was set within a confidence frame encapsulated within these super-ordinate themes.

Background Pain education in professional health courses is key to producing healthcare professionals of the future that are competent to manage the needs of patients experiencing pain (IASP, 2015). In the UK, there is a lack of guidance from professional regulatory bodies, with only medicine and midwifery training specifically including standards for pain. Subject specific guidance is provided by specialist organisations such as the International Association for the Study of Pain (IASP), yet the uptake of this guidance in professional health courses is thought to be poor (Briggs et al., 2011). Recent surveys revealed that physiotherapy is one of the leading undergraduate health courses in regards to the average number of taught hours of pain education, however statistically it also has the most variance (Leegaard et al., 2014, Hoeger Bement and Sluka, 2015, Briggs et al., 2011).In addition to the number of taught pain hours, further information is needed regarding the structure of pain education. This scoping review will collate current available evidence that informs the provision of pain education across professional health courses. Aims Locate, map and report what evidence currently exists that has observed or investigated the structure of pain education in pre-registration professional health courses. Methods A systematic scoping review methodology was used (Levac et al., 2010). PRISMA guidelines were adopted where possible to ensure as robust a methodology as possible (PRISMA, 2015). The following search strategy was employed in Medline, Cinahl, ERIC, AMED, HMIC and EBM reviews; [Pain] AND [Education OR Curriculum] AND [Physiotherapy OR Allied health occupations OR Nursing OR Medicine]. MeSH or Thesaurus search terms were used within databases where possible. Two authors [KT & JM] independently screened titles and abstracts of all papers (2396) etrieved in the search strategy. Papers were included for data extraction if they had available abstracts written in English that referred to (1) pain AND (2) pre-registration education or curriculum AND (3) professional health education e.g. nursing, medical or other allied health professions such as Physiotherapy. Authors met to pilot the selection criteria at the beginning and midway through the screening process. A third reviewer [MB] was consulted where agreement could not be reached. The full text of all articles that met the inclusion criteria from the screening process were retrieved (68) and further assessed using eligibility criteria. Twenty nine papers were found eligible for this initial scoping review analysis. Results Twenty nine papers were found to be accessible and in a format that data could be extracted for initial analysis of results. Professional pain education provision has been investigated throughout more than 15 countries, with the majority of studies conducted in the USA (38%) and the UK (34%). 93% (27/29) of studies conducted primary research of which 67% (18/27) used a survey questionnaire methodology. No systematic reviews or RCTs were found. Professional pain education provision was investigated in the following pre-registration health courses; Nursing 62% (18/29), Medicine 31% (9/29), Physiotherapy 17% (5/29), Occupational therapy 17% (5/29), Dentistry 10% (3/29), Pharmacy 10% (3/29), Veterinary Science 7% (2/29), and Psychology 3% (1/29). Most studies surveyed student knowledge and skills based on current education provision 76% (22/29), whereas only 7 studies evaluated a ‘new’ educational strategy e.g. a dedicated pain course (24%). 89% of studies were conducted in the last 15 years Conclusion There is a body of literature that has examined pain education across professional health courses. The majority has been conducted in Nursing and Medicine, with a significant lack of research across the allied and other health professions. Much of the work describes a lack of pain knowledge and skills resulting from existing curriculum designs where pain teaching is embedded throughout modules. Studies that investigated dedicated pain teaching that was additional to the ‘usual’ curriculum generally reported more positive findings. Further in-depth analysis and synthesis of results is warranted. Where appropriate titles for systematic review and further empirical research will be proposed. Reference list BRIGGS, E. V., CARR, E. C. & WHITTAKER, M. S. 2011. Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. European Journal of Pain, 15, 789-795. HOEGER BEMENT, M. K. & SLUKA, K. A. 2015. The current state of physical therapy pain curricula in the United States: a faculty survey. Journal of Pain, 16, 144-152 9p. IASP, 2015 [Online] Available from http://www.iasp-pain.org/Education/CurriculaList.aspx?navItemNumber=647 [Accessed 13th December 2015] LEEGAARD, M., VALEBERG, B. T., HAUGSTAD, G. K. & UTNE, I. 2014. Survey of pain curricula for healthcare professionals in Norway. Nordic Journal of Nursing Research & Clinical Studies / Vård i Norden, 34, 42-45 4p. LEVAC, D., COLQUHOUN, H. & O'BRIEN, K. K. 2010. Scoping studies: advancing the methodology. Implement Sci, 5, 69. PRISMA, 2015 [Online] Available from http://www.prisma-statement.org/ [Accessed 13th December 2015]

The International Association for the Study of Pain (IASP) have designated 2018 as the global year for excellence in pain education. Despite advances in pain research, there remains an inadequate understanding and implementation of pain education that health professionals obtain in training prior to professional registration, licensure or certification. This paper reports on a synthesis of pain education research that has been conducted in this period of health professionals training. A scoping review framework by Arksey and O’Malley was used to guide a search of medical and education databases for records that have examined or evaluated pain education. Fifty-six reports were identified representing sixteen professions across twenty nine countries, published between 1992-2017. A descriptive account of the reports is provided which includes a timeline, geography, methods of evaluating and main purpose of the research. A narrative synthesis was undertaken to summarise and explain the results and main findings from reports of studies included in this review. Further to this a concept analysis was conducted to identify and map key concepts that can be used by stakeholders to develop or evaluate future pain education. Future directions for research are proposed which includes factors that are repeatedly reported to be important in advancing pain education and should underpin the campaign for environments that promote excellence in pain practice as the norm in healthcare.

INTRODUCTION: Pain is a global health concern causing significant health and social problems with evidence that patients experiencing pain are receiving inadequate care. The content of pain education in pre-registration professional health courses is thought to be lacking both in the UK and internationally which is unacceptable considering the prevalence of pain. Evaluating the effect of education is complex in that the outcome (improved healthcare) is some distance from the educational approach. Best evidence medical education has been proposed as a continuum between 'opinion-based teaching' and 'evidence-based teaching'. Searching for evidence to inform best practice in health education is complex. A scoping review provides a practical and comprehensive strategy to locate and synthesise literature of varied methodology including reports from a variety of sources. The aim of this article is to describe a protocol for a scoping review that will locate, map and report research, guidelines and policies for pain education in pre-registration professional health courses. The extent, range and nature of reports will be examined, and where possible titles for potential systematic review will be identified. METHODS AND ANALYSIS: Reports will be included for review that are directly relevant to the development of the pain curriculum in pre-registration professional health courses, eg nursing, medicine, physiotherapy. The search strategy will identify reports that include [pain] AND [pre-registration education or curriculum] AND [health professionals] in the title or abstract. Two authors will independently screen retrieved studies against eligibility criteria. A numerical analysis regarding the extent, nature and distribution of reports will be given along with a narrative synthesis to describe characteristics of relevant reports. ETHICS AND DISSEMINATION: Formal ethical approval was not required to undertake this scoping review. Findings will be published in scientific peer-reviewed journals and via conference presentations.

Relevance Pain education across professional health courses is known to be varied in method of delivery and number of taught hours, with the consensus that current pain education is inadequate. Physiotherapy is leading other health professions in the number of taught pain hours in pre-registration curricula, having the potential to promote and influence pain education policy. To understand how pain education should be structured, we firstly conducted part one of this scoping review to identify empirical evidence that informs pain education across professional health courses. In general, pain was embedded within modules on broader topics. There was tentative evidence that pain education additional to the ‘usual’ curriculum, rather than embedded, was more effective. In addition to research findings, health courses are guided by membership and subject specialist organisations, and must adhere to standards set by professional regulatory bodies. This second part of the scoping review will aim to identify this important information relevant to pain education that is additional to empirical evidence located in databases. Purpose To locate, map and report standards, protocols or frameworks that inform pain education in pre-registration professional health courses from non-research sources such as professional regulatory bodies and subject specialist organisations. Methods/Analysis A scoping review methodology was used to identify any professional standards relevant to pain education (health regulators), protocols or frameworks (membership organisations and special interest organisations). The following health regulator websites were searched; General Medical Council (GMC), Nursing and Midwifery Council (NMC), Health and Care Professions Council (HCPC), General Dental Council (GDC), General Chiropractic Council (GCC) , General Osteopathic Council, and General Pharmaceutical Council. This totalled 29 health professions. Seven membership organisations were searched; Chartered Society of Physiotherapy, Physiotherapy Pain Association (PPA), Royal College of Nursing (RCN), British Medical Association, British Psychological Society, British Dental Association, and Royal Pharmaceutical Society. Subject specialist pain organisations; British Pain Society and IASP were searched for any key documents relevant to pain education. Results Only five of the 29 health professions had a regulatory standard of education and training or proficiency that made some reference to the keyword ‘pain’; the GMC, NMC, the HCPC standard of proficiency for Operating Department Practitioners, and the GCC (1 reference each). The GDC outcomes for registration referred to pain on 7 occasions. Two membership organisations provided profession specific pain frameworks describing values, behaviours, knowledge and skills (PPA and RCN). IASP provide subject specific pain curricula for Pharmacy, Psychology, Physiotherapy, OT, Nursing, Medicine, Dentistry and Social Work. Discussion and Conclusions Physiotherapy and nursing membership organisations provide good examples of frameworks that can influence pain curriculum design within and across professional health courses. There is no professional regulatory standard for physiotherapy specifically for pain education. Dentistry is leading in terms of standards of training for pain, and should be considered as an example of good practice. Impact and Implications Physiotherapy has the potential to influence pain education policy, resulting in graduates that are better equipped to manage patients experiencing pain. Further research is needed to investigate how pain education is structured within current physiotherapy courses, identifying examples of good practice that can be shared.

The purpose of this dissertation was to explore the relevance of dysfunctional breathing (DB) in musculoskeletal (MSK) practice. As exposure to breathing practices become increasingly more prevalent across healthcare professionals and the public, and progressively more treatment modalities related to breathing mechanics are emerging, it is important to explore whether breathing mechanics are a relevant consideration within MSK practice. Initially, a critical review was conducted to explore the term ‘dysfunctional breathing’, its definition and the current evidence around DB in MSK health. One suggested formal definition of DB was identified, by Barker and Everard (2015), but there remains no consensus on what DB is within the reviewed literature. One model of DB was also identified (Barker and Everard, 2015), but it needs further modification and adaptation to meet the requirements of the most recent research published on DB. In addition, a literature review of the potential effects that DB can have on the MSK system was conducted. Anatomical, biomechanical, physiological and neurological effects of DB on the MSK system were identified, some grounded in research and others more narrative in nature and needing further exploration. Finally, an explorative focus group interview and one individual interview were conducted to acquire the beliefs and opinions of current MSK practitioners on the relevance of DB, their assessment methods, interventions and their beliefs on what effects DB can have on the MSK system. Thematic analysis was used to develop themes and classifications. This study revealed that DB assessment methods can be classified into three categories: observational assessment, manual assessment, and subjective assessment. Three types of breathing intervention were identified: breathing re-education, breathing exercises, and manual therapy. In total, fourteen potential effects of DB on the MSK system were identified by the participants. Unlike previous research exploring DB this dissertation has only focused on the implications within MSK health as opposed to exploring DB within respiratory and cardiovascular medicine. It adds to the debate of the need for a formal definition of DB and has identified areas for further research that are needed around the perceived effects of DB on the MSK system. In the absence of an overarching and accurate definition a new model of DB has been produced as a result of this dissertation to provide a suggested framework of what DB could potentially look like, when divided into three subcategories. These subcategories are biomechanical DB, biochemical DB and psychophysiological DB It is proposed by this author that the work produced in this study enables a future consensus to be reached on the formal definition, model and signs and symptoms of DB.

Dysfunctional breathing (DB) refers to various abnormalities breathing patterns. Whilst a formal definition exists, subsequent research has inconsistently applied or omitted it. As interest in breathing techniques grows among both healthcare professionals and the public, it is important to reach a consensus on DB's definition to ensure effective assessment and treatment. This critical review explores how DB is currently defined and applied within respiratory and musculoskeletal health. A lack of consistency in the literature identified the need for a more comprehensive framework of DB. To address this, a new model of DB is proposed that includes three subcategories: biomechanical, biochemical and psychophysiological DB. This revised model offers a foundation for future research and clinical application.

‘Unmasking Pain’ is an innovative artist-led project to explore creative approaches for telling stories of life with persistent pain. The purpose of this qualitative study was to explore and describe the lived experience of taking part in ‘Unmasking Pain’ from the perspectives of people living with pain (workshop attendees), artists (workshop facilitators) and pain rehabilitation specialists. Informed by descriptive phenomenology, data was collected via semi-structured interviews with three artists (workshop facilitators), five workshop attendees (all living with persistent pain) and one pain rehabilitation specialist. Data was analysed using thematic analysis for descriptive phenomenology. Three themes emerged from the analysis: Theme 1 Space to Breathe, reflects the context of ‘Unmasking Pain’ such as the conditions, environment and setting that people experienced; Theme 2 Flexibility to Participate, reflects the experience of the process of ‘Unmasking Pain’ such as the actions or internal workings/behaviours of the experience; and Theme 3 Possibility for Change, reflects the cognitive or emotional experience of ‘Unmasking Pain’. There were nine sub-themes: 1(a) Dissolved hierarchy, 1(b) Human connection, and 1(c) Personally meaningful; 2(a) Go with the flow, 2(b) Enjoyable experience, and 2(c) Curiosity to step into the unknown; and 3(a) Reforming pain, 3(b) Liberating in the moment (now), and 3(c) Gives you a boost (future). In conclusion, the uniqueness of ‘Unmasking Pain’ was to creatively facilitate curiosity and exploration of pain in a non-clinical, sociocultural, humanised context, to enable the possibility of a different pain experience. The findings from this qualitative study exploring the lived experience of taking part in ‘Unmasking Pain’ demonstrates the power and opportunity of the Arts sector and artist-led activities to support people with chronic pain to have a better pain experience.

Raw list of in vivo codes, patterns, sub-themes and overarching themes demonstrating data analysis process.