People's beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: A qualitative study

Robertson, Claire; Hurley, Michael; Jones, Fiona

doi:10.1016/j.msksp.2017.01.012

Cited by 25 publications

(33 citation statements)

References 22 publications

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“…Joint noises are a common feature of normal joint movement; 37 however, participants commonly reported distress and confusion at joint noises, often finding healthcare practitioners’ explanations inadequate.…”

Section: Resultsmentioning

confidence: 99%

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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: Resultsmentioning

confidence: 99%

“…This was in agreement with previous research, which identified negative emotions and inaccurate aetiological beliefs with joint noises in patients with PFP. 37 …”

Section: Resultsmentioning

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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“…Currently there exists limited evidence to indicate that some with PFP have higher levels of catastrophising and poorer patient-reported general mental health than controls [11]. Qualitative research has also found that catastrophic thinking and anxiety related to joint crepitus, a frequent symptom of PFP, may lead to avoidance or modification of activity [12]. These findings indicate that PFP may be more than just a mechanical problem.…”

Section: Introductionmentioning

confidence: 99%

The psychological features of patellofemoral pain: a cross-sectional study

Maclachlan

Matthews

Hodges

et al. 2018

Scandinavian Journal of Pain

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Abstract Background and aims: Patellofemoral pain (PFP) is a prevalent and debilitating musculoskeletal condition, considered to have a mechanical aetiology. As such, the physical impairments associated with PFP are well documented and have helped characterise different physical phenotypes. But little is known about the relationship between PFP and psychological well-being. In this study, we aimed to: (1) compare psychological profiles between groups with and without PFP; (2) compare psychological profiles and condition severity between PFP subgroups; and (3) explore relationships between psychological factors and their contribution to disability. We expected to find higher levels of psychological impairment, especially kinesiophobia and catastrophizing in the PFP group. We also expected to identify a sub-group for who worsening levels of disability correspond with worsening psychological well-being. Methods: One hundred participants with PFP (72 females, mean±SD age 27±5 years, BMI 25.3±4.8 kg/m2) completed measures of pain, disability, and psychological features (kinesiophobia, catastrophizing, anxiety and depression). Fifty controls, matched by sex, age and activity level (36 females, age 27±5 years, BMI 22.9±4.5 kg/m2) also completed psychological measures. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to cluster PFP participants (K-means cluster analysis) into more and less severe sub-groups. Differences between the control and PFP groups were analysed using t-tests, analysis of variance, Mann-Whitney U-tests or χ2 tests as appropriate (p<0.05). Pearson correlations were used to explore relationships between psychological measures. Backward stepwise regression (p out >0.05) evaluated how the psychological factors potentially relate to disability. Results: Psychological features did not differ between PFP and pain-free groups. But differences were apparent when the PFP cohort was subgrouped. Compared to controls, the more-severe group had significantly higher levels of depression (MD 1.8, 95% CI 0.8–2.8; p≤0.001) and catastrophizing (MD 5.7, 95% CI 2.4–9; p≤0.001). When compared to less-severe cases, the more-severe group also demonstrated significantly higher levels of kinesiophobia (MD 4.3, 95% CI 2.1–6.5; p≤0.001), depression (MD 1.5 95% CI 0.5–2.6; p=0.01) and catastrophizing (MD 4.9, 95% CI 1–8.8; p=0.01). The weakest relationship between psychological factors was found between kinesiophobia and anxiety (r=0.29; p=0.02). While the strongest relationship existed between depression and anxiety (r=0.52; p≤0.001). Both kinesiophobia (β −0.27, 95% CI −0.265 to −0.274) and depression (β −0.22, 95% CI −0.211 to −0.228) were associated with disability as defined by the KOOS in the regression model (R2=0.17, p≤0.001). Conclusions: Those with more-severe PFP-related disability have higher levels of psychological impairment than less-severe cases. Kinesiophobia seems to stand as an important factor in the experience of PFP, because it was elevated in the PFP group, significantly differed between the PFP sub-groups and contributed to explaining disability. Contrary to our hypothesis, levels of catastrophizing in the PFP group and severe sub-group were low and seemingly not important. Implications: These findings draw attention to psychological factors to which clinicians assessing PFP should show vigilance. They also highlight psychological impairments that might be worthwhile targets in optimising PFP management.

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“…We speculate that these findings might be explained by the negative beliefs individuals with knee pain have regarding knee crepitus. 22,24 Many individuals become fearful and insecure of the noise related to crepitus and might end with the belief that their condition is actually worse than it really is. 24 A common concern of patients in the clinical setting is about the meaning and importance of knee crepitus.…”

Section: Discussionmentioning

confidence: 99%

“…23 Despite being associated with the development of knee OA and structural damage, it is unknown whether knee crepitus is indicative of an overall poor clinical presentation, including lower function, strength, quality of life and higher pain. 1 As individuals with knee pain often report negative beliefs regarding crepitus, 22 it is important to investigate the importance of crepitus to the overall clinical presentation of individuals with knee OA. If crepitus is associated with poor function, this information would aid clinicians to potentially identify a clinical finding indicative of OA severity.…”

Section: Introductionmentioning

confidence: 99%

What are the clinical implications of knee crepitus to individuals with knee osteoarthritis? An observational study with data from the Osteoarthritis Initiative

Pazzinatto

Silva

Faria

et al. 2019

Brazilian Journal of Physical Therapy

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Background: Crepitus is a common clinical feature of knee osteoarthritis. However, the importance of crepitus in the overall clinical presentation of individuals with knee osteoarthritis is unknown. Objective(s): (A) To compare function, pain and quality of life between individuals with knee osteoarthritis with and without crepitus; (B) to compare whether individuals with knee osteoarthritis in both knees, but crepitus in just one, differ in terms of function pain, and knee strength. Methods:: Setting: Observational study. Participants: (A) A total of 584 participants with crepitus who had the same Kellgren-Lawrence grade on both knees were matched for gender, body mass index and Kellgren-Lawrence grade to participants without crepitus on both knees. (B) 361 participants with crepitus in only one knee and with the same Kellgren-Lawrence grade classification on both knees were included. Main outcome measure(s): A-Self-reported function, pain, quality of life, 20-m walk test and chair-stand test. B-Knee extensor and flexor strength, self-reported function and pain.

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People's beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: A qualitative study

Abstract: Background: A feature of patellofemoral pain is joint crepitus. Several

Cited by 25 publications

References 22 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

The psychological features of patellofemoral pain: a cross-sectional study

What are the clinical implications of knee crepitus to individuals with knee osteoarthritis? An observational study with data from the Osteoarthritis Initiative

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