Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients

Doménech, Julio; Sanchis-Alfonso, Vicente; Espejo, Begoña

doi:10.1007/978-0-85729-507-1_9

Cited by 2 publications

(2 citation statements)

References 127 publications

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“… 45 The majority of participants in this study had previous experience of healthcare management for PFP suggesting that variation in healthcare treatment may have a negative impact on the patients’ lived experience. Historically, the biomedical model of pain establishes a direct relationship between tissue structure and pain, 46 and participants characteristically attributed their pain to structure and/or anatomical problems. However, several studies have recently demonstrated that structural abnormalities of the patellofemoral joint on MRI are not associated with PFP.…”

Section: Discussionmentioning

confidence: 99%

The experience of living with patellofemoral pain—loss, confusion and fear-avoidance: a UK qualitative study

et al. 2018

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ObjectivesTo investigate the experience of living with patellofemoral pain (PFP).DesignQualitative study design using semistructured interviews and analysed thematically using the guidelines set out by Braun and Clarke.SettingA National Health Service physiotherapy clinic within a large UK teaching hospital.ParticipantsA convenience sample of 10 participants, aged between 18 and 40 years, with a diagnosis of PFP and on a physiotherapy waiting list, prior to starting physiotherapy.ResultsParticipants offered rich and detailed accounts of the impact and lived experience of PFP, including loss of physical and functional ability; loss of self-identity; pain-related confusion and difficulty making sense of their pain; pain-related fear, including fear-avoidance and ‘damage’ beliefs; inappropriate coping strategies and fear of the future. The five major themes that emerged from the data were: (1) impact on self; (2) uncertainty, confusion and sense making; (3) exercise and activity beliefs; (4) behavioural coping strategies and (5) expectations of the future.ConclusionsThese findings offer an insight into the lived experience of individuals with PFP. Previous literature has focused on pain and biomechanics, rather than the individual experience, attached meanings and any wider context within a sociocultural perspective. Our findings suggest that future research is warranted into biopsychosocial targeted interventions aimed at the beliefs and pain-related fear for people with PFP. The current consensus that best-evidence treatments consisting of hip and knee strengthening may not be adequate to address the fears and beliefs identified in the current study. Further qualitative research may be warranted on the impact and interpretation of medical terminology commonly used with this patient group, for example, ‘weakness’ and ‘patellar mal-tracking’ and its impact and interpretation by patients.Trial registration numberISRCTN35272486; Pre-results.

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Section: Discussionmentioning

confidence: 99%

The experience of living with patellofemoral pain—loss, confusion and fear-avoidance: a UK qualitative study

et al. 2018

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“…It is thought that these deviations from the ‘normal’ affect patellar alignment, kinematics or joint loading, resulting in greater stress between the patella and femur and the development of pain and dysfunction [ 14 , 16 – 18 ]. This biomedical model of pain establishes a direct relationship between tissue structure and pain [ 24 ], and traditionally, the focus of physiotherapy treatment has been aimed at reducing pain and improving function by addressing these biomedical tissue structures; treatments including taping, stretches, exercises, electrotherapy, joint mobilisations and foot orthoses have all been suggested [ 16 , 17 ]. However, systematic reviews consistently acknowledge the limitations of included studies when drawing their conclusions on the effectiveness of these interventions [ 14 , 15 , 17 , 25 – 27 ].…”

Section: Introductionmentioning

confidence: 99%

Study protocol: a mixed methods feasibility study for a loaded self-managed exercise programme for patellofemoral pain

Smith

Hendrick

Bateman³

et al. 2017

Pilot Feasibility Stud

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BackgroundPatellofemoral pain (PFP) is one of the most common forms of knee pain in adults under the age of 40, with a prevalence of 23% in the general population. The long-term prognosis is poor, with only one third of people pain-free 1 year after diagnosis.The biomedical model of pain in relation to persistent PFP has recently been called into question. It has been suggested that interventions for chronic musculoskeletal conditions should consider alternative mechanisms of action, beyond muscles and joints. Modern treatment therapies should consider desensitising strategies, with exercises that target movements and activities patients find fearful and painful.High-quality research on exercise prescription in relation to pain mechanisms, not directed at specific tissue pathology, and dose response clearly warrants further investigation.Our primary aim is to establish the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with patellofemoral pain.MethodThis is a single-centred, multiphase, sequential, mixed-methods trial that will evaluate the feasibility of running a definitive large-scale randomised controlled trial of a loaded self-managed exercise programme versus usual physiotherapy. Initially, 8–10 participants with a minimum 3-month history of PFP will be recruited from an NHS physiotherapy waiting list and interviewed. Participants will be invited to discuss perceived barriers and facilitators to exercise engagement, and the meaning and impact of PFP. Then, 60 participants will be recruited in the same manner for the main phase of the feasibility trial. A web-based service will randomise patients to a loaded self-managed exercise programme or usual physiotherapy. The loaded self-managed exercise programme is aimed at addressing lower limb knee and hip weakness and is positioned within a framework of reducing fear/avoidance with an emphasis on self-management. Baseline assessment will include demographic data, average pain within the last week (VAS), fear avoidance behaviours, catastrophising, self-efficacy, sport and leisure activity participation, and general quality of life. Follow-up will be 3 and 6 months. The analysis will focus on descriptive statistics and confidence intervals. The qualitative components will follow a thematic analysis approach.DiscussionThis study will evaluate the feasibility of running a definitive large-scale trial on patients with patellofemoral pain, within the NHS in the UK. We will identify strengths and weaknesses of the proposed protocol and the utility and characteristics of the outcome measures. The results from this study will inform the design of a multicentre trial.Trial registration ISRCTN35272486.

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Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients

Cited by 2 publications

References 127 publications

The experience of living with patellofemoral pain—loss, confusion and fear-avoidance: a UK qualitative study

The experience of living with patellofemoral pain—loss, confusion and fear-avoidance: a UK qualitative study

Study protocol: a mixed methods feasibility study for a loaded self-managed exercise programme for patellofemoral pain

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