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

doi:10.1016/j.apmr.2021.03.016

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

Arch Phys Med Rehabil. 2021 Jul;102(7):1267-1273. doi: 10.1016/j.apmr.2021.03.016. Epub 2021 Apr 7.

Authors

Mitchell Selhorst¹, Alicia Fernandez-Fernandez², Laura Schmitt³, Jessica Hoehn⁴

Affiliations

¹ Sports and Orthopedic Physical Therapy, Nationwide Children's Hospital, Columbus, OH. Electronic address: [email protected].
² Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL.
³ Jameson Crane Sports Medicine Research Institute, Ohio State University Wexner Medical Center, Columbus, OH; Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH.
⁴ Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, United States.

PMID: 33838141
DOI: 10.1016/j.apmr.2021.03.016

Abstract

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

Results: Using a 2-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=.001, partial η²=0.1). Post hoc testing revealed that there was a significant interaction between the intervention and time from baseline to 2 weeks, but no interaction was noted between 2 weeks and 3 months. The psychologically informed video significantly reduced maladaptive psychological beliefs (P=.01, η²=0.32). No significant between-group differences in pain were noted.

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

Trial registration: ClinicalTrials.gov NCT02332200.

Keywords: Adolescent; Patellofemoral pain syndrome; Psychology; Rehabilitation.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Catastrophization / psychology
Double-Blind Method
Female
Humans
Male
Pain Measurement
Patellofemoral Pain Syndrome / psychology*
Patellofemoral Pain Syndrome / rehabilitation*
Physical Therapy Modalities*

Associated data

ClinicalTrials.gov/NCT02332200