The Effect of a Psychologically-Informed Intervention to Treat Adolescents with Patellofemoral Pain: A Randomized Controlled Trial

Mitchell Selhorst, Alicia Fernandez-Fernandez, Laura Schmitt, Jessica Hoehn
Archives of Physical Medicine and Rehabilitation 2021 April 7

OBJECTIVE: To determine if the addition of a brief psychologically-informed video to traditional physical therapy influenced function (primary aim), pain, and psychological beliefs (secondary aims) among adolescents with patellofemoral pain (PFP).

DESIGN: Double-blind randomized controlled trial.

SETTING: Outpatient physical therapy clinics of a single pediatric hospital.

PARTICIPANTS: Sixty-six adolescents with PFP (14.8 ± 1.7 years old, 65% female).

INTERVENTION: Adolescents were randomly assigned to view a brief psychologically-informed video (n=34) or control video (n=32). The psychologically-informed video targeted pain-related fear and pain catastrophizing, and the control video related basic anatomy and factors involved in PFP.

MAIN OUTCOMES: The primary outcome was change in function (Anterior Knee Pain Scale). Secondary outcomes were change in psychological beliefs (fear-avoidance beliefs, kinesiophobia, and pain catastrophizing), and pain. Outcomes were assessed at baseline, immediately post-intervention, 2 weeks, 6 weeks, and 3 months.

RESULTS: Using a two-way mixed analysis of variance, change in function in the intervention group was greater than the control group with a moderate treatment effect noted (p = 0.001, partial η2  = 0.1). Post-hoc testing revealed that there was a significant interaction between the intervention and time from baseline to two weeks, but no interaction was noted between two weeks and three months. The psychologically-informed video significantly reduced maladaptive psychological beliefs (p = 0.01, η2  = 0.32). No significant between-group differences in pain were noted.

CONCLUSION: Incorporating a brief one-time psychologically-informed video into standard physical therapy care significantly reduced pain-related fear, pain catastrophizing and improved function among adolescents with PFP. The immediate effect noted on function did not continue throughout the course of care.

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