Dr Rachel Nelligan APAM is a clinical physiotherapist and research fellow at the University of Melbourne with an interest in chronic pain. 

‘I was working mainly with people with chronic pain, such as fibromyalgia and osteoarthritis [OA], which developed into a clinical interest.'

'I then went back to the University of Adelaide and did some studies in psychology to gain insights into the complexity of chronic pain. 

'I applied for a research assistant role within the Centre for Health, Exercise and Sports Medicine, which is predominantly a musculoskeletal research institute that focuses on OA, and I guess the rest is history.’ 

In 2022, Rachel received a Seeding Grant for her research project, titled ‘Effects of a patient-focused e-Learning course about osteoarthritis and its management on knowledge and pain self-efficacy: a randomised controlled trial’ (supported by Physiotherapy Research Foundation corporate partner WorkSafe Victoria). 

The results of the randomised controlled trial (RCT) were recently published in the journal Patient Education and Counseling. 

The RCT involved 124 community volunteers with knee and/or hip OA who were randomised into either a four-week self-directed e-learning course or a control group using an electronic OA pamphlet. 

The primary outcomes included change in knowledge (assessed using the Osteoarthritis Knowledge Scale) and change in pain self-efficacy (using the pain subscale of the Arthritis Self-Efficacy Scale) over five weeks. 

The secondary outcomes included exercise self-efficacy, OA illness perceptions, fear of movement and use of weight loss to manage joint symptoms. 

Data was subsequently collected at five and 13 weeks. 

For the primary outcomes, there was evidence of improvements in OA knowledge at five and 13 weeks, in favour of the e-learning group, while no significant between-group differences were found for pain self-efficacy. 

In the secondary outcomes, the e-learning group experienced greater improvements in exercise self-efficacy and OA illness perceptions at five weeks than the control group and, at 13 weeks, greater reduction in fear of movement and weight loss efforts to manage OA than the control group. 

‘At the outset, I was optimistic that the e-learning course could improve knowledge and pain self-efficacy because it was rigorously designed according to behaviour change techniques and learning science principles. 

'On reflection, however, it was possibly too optimistic to think that a standalone intervention could affect pain self-efficacy. 

'The research is quite mixed and pain self-efficacy is complex. 

'From the evidence, there is some indication that a multi-component intervention would be more effective.’ 

A nested qualitative study is currently under peer review and a follow-up clinical trial is almost complete. 

‘We are conducting another RCT, this one looking at physiotherapists delivering the course with some additional education and exercises, employing minor tweaks and updating information following the previous RCT. 

'We’ve finished recruiting 136 people across Australia for that study and we should have the final data collected around November, so by the end of the year we will have the results analysed and prepared for publication. 

'We will be interested to see the effect on clinical outcomes of coupling the course with a physiotherapy intervention.’ 

The resources are now available free online for patients to use independently and with the guidance of physiotherapists.

Download the resources here.

Read about the trial here.