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Effect of a psychologically informed intervention to treat adolescents with patellofemoral pain: a randomized controlled trial
Selhorst M, Fernandez-Fernandez A, Schmitt L, Hoehn J
Archives of Physical Medicine and Rehabilitation 2021 Jul;102(7):1267-1273
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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 = 0.001, partial-eta2 = 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 = 0.01, partial-eta2 = 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.

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