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The effectiveness of online pain resources for health professionals: a systematic review with subset meta-analysis of educational intervention studies

Liossi, Christinaa,b,*; Failo, Alessandroc; Schoth, Daniel, E.a; Williams, Glynb; Howard, Richard, F.b

doi: 10.1097/j.pain.0000000000001146
Systematic Review and Meta-Analysis
Global Year 2018

Online educational interventions are increasingly developed for health professionals and students, although graduate and undergraduate medical curricula often contain limited information about how to assess and manage pain. This study reviews the literature on the effectiveness of pain-related online educational resources. Studies were identified through a search of Medline, PsychINFO, Web of Science, CINAHL, PubMed, Scopus, Cochrane Library, Google Scholar, and OpenGrey databases. Search terms included 3 concept blocks: (1) type of intervention—online education, computer-based, e-learning, web-based, and internet-based; (2) population—pediatrician, physician, nurse, psychologist, and medical; and (3) outcome—pain*. Thirty-two studies (13 randomised controlled trials, 5 nonrandomised controlled trials, and 14 single-group pre–post studies) were included. Ten provided data for inclusion in a series of between-groups meta-analyses. After intervention, participants receiving online instruction had significantly greater knowledge compared with those receiving training as usual/alternative training (Hedges' g = 0.80, 95% confidence interval [CI]: 0.12-1.49), and students had significantly greater skills compared with students receiving training as usual (g = 1.34, CI: 0.38-2.30). No significant differences were found for confidence/competence (g = 0.02, CI: −0.79 to 0.84) or attitudes/beliefs (g = 0.16, CI: −0.48 to 0.79). Although online educational resources show promise in improving learner knowledge, considerable heterogeneity exists between studies in quality, design, educational content, and outcomes. Furthermore, methodologically robust RCTs are required to establish the effectiveness of online educational interventions and a greater understanding of the key features of successful online resources, including cognitive interactivity. Few studies assessed health outcomes for patients, remaining a major priority for future investigations.

aUniversity of Southampton, Department of Psychology, Southampton, Hampshire, United Kingdom

bGreat Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom

cUniversity of Trento, Department of Psychology and Cognitive Sciences, Trento, Italy.

Corresponding author. Address: Department of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom. Tel.: 0044 02380594645. E-mail address: (C. Liossi).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received August 08, 2017

Received in revised form December 19, 2017

Accepted December 22, 2017

© 2018 International Association for the Study of Pain
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