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

Abstract

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.