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Updated: Jan 15, 2026
Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery
Published on: April 14, 2016
Competency-Based Education: Development of the Entry-Level Pain Entrustable Professional Activities for
Jeb Helms1, Kory Zimney2, Priscilla Weaver1
1Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ 86011, United States.
Importance:
The physical therapy profession is being called to adopt a competency-based education (CBE) model, following the lead of other health professions. A key element of CBE is workplace-based assessment, in which clinicians evaluate learners' readiness to perform essential clinical tasks through entrustable professional activities (EPAs). Although a common set of EPAs exist for the profession, none currently guide assessment and learning in specialty areas like pain.
Objective:
The objective of this study was to describe the development and initial validation of pain-specific entrustable professional activities (Pain EPAs) designed to assess physical therapist clinical competency in managing pain within a CBE framework.
Design:
This was a developmental study following published recommendations for EPA creation, including preparation, drafting, quality control, and curriculum alignment.
Setting:
The study was conducted across 4 American universities.
Participants:
Five American-based physical therapists collaborated on EPA development and gathered feedback from educators, clinicians, and an 8-person reactor panel.
Intervention:
The intervention involved developing Pain EPAs through expert consensus and external review for alignment with competency frameworks.
Main Outcome:
The main outcome was a set of Pain EPAs reviewed for clarity, observability, and assessability using the EQual rubric, with external feedback guiding their categorization.
Results:
Twenty-one Pain EPAs were developed and aligned with pain competency frameworks, with feedback organizing them into 4 levels of increasing complexity and autonomy: generalist, pain-specific entry-level, specialty clinic entry-level, and advanced practice.
Conclusions:
This study outlines a structured, replicable approach for developing EPAs aligned with CBE principles. The Pain EPAs provide an initial framework to assess readiness for autonomous pain management tasks. Further research is needed to establish their validity and support implementation in entry-level and post-professional training.
Relevance:
The Pain EPAs support CBE workplace-based assessment in physical therapist education. This approach can be adapted for other specialty areas within physical therapist practice.
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