The psychological features of patellofemoral pain: a systematic review

Abstract

background Patellofemoral pain (PFP) is prevalent in adolescence and adulthood and often persists. In contrast to other persistent musculoskeletal conditions, for which non-physical, psychological features are implicated, PFP remains largely conceptualised in mechanical terms. Aims To (1) identify whether the psychological characteristics of individuals with PFP differs from asymptomatic controls and (2) evaluate the correlations between psychological characteristics and PFP severity. study design Systematic review Methods A systematic review of the literature was conducted according to PRISMA guidelines. The Epidemiological Appraisal Instrument was used to evaluate quality. Studies measuring psychological constructs with patient-reported measures were included. Standardised mean differences were calculated and supported by narrative synthesis. results Twenty-five studies were eligible. Quality results ranged from 28.3% to 61.7%. Psychological constructs were reported under four groupings: mental health, cognitive factors, behavioural factors and other factors. There is limited evidence of mental health and cognitive differences in some individuals with PFP. Features demonstrating linear correlations with pain and physical function included anxiety/depression, catastrophising, praying and hoping and pain-related fear. conclusions Anxiety, depression, catastrophising and fear of movement may be elevated in individuals with PFP and correlate with pain and reduced physical function. These results derive from a limited number of studies. Future research should aim to evaluate if and how psychological factors contribute to PFP. clinical relevance Patients are likely to benefit from clinician vigilance to the presence of psychological factors.

Should we consider changing traditional physiotherapy treatment of patellofemoral pain based on recent insights from the literature?

“…Therefore, research and clinical practice is encouraged to consider psychological characteristics during assessment, along with the potential value of interventions to address them. We support the recommendations to use the short form Orebro Musculoskeletal Pain Questionnaire suggested by Maclachlan et al 5 as a starting point for physiotherapists to implement early in consultation to identify those who may require more detailed assessment and management of psychological factors.…”

“…Limited evidence synthesised in Maclachlan et al ’s5 systematic review highlights a number of psychological features which may be elevated in people with PFP, including anxiety, depression, catastrophising and fear of movement 5. Importantly, these psychological features may influence the development of widespread pain, healthcare usage and adherence to traditional physiotherapy treatments such as exercise therapy 5.…”

“…Importantly, these psychological features may influence the development of widespread pain, healthcare usage and adherence to traditional physiotherapy treatments such as exercise therapy 5. Therefore, research and clinical practice is encouraged to consider psychological characteristics during assessment, along with the potential value of interventions to address them.…”

Taking the pain out of the patellofemoral joint: articulating a bone of contention

“…Emerging evidence suggests that patellofemoral pain ought to be considered in a framework that encompasses the biological/somatic, psychological and social aspects of a person. For example, our systematic review found that individuals with patellofemoral pain exhibited higher levels of anxiety, depression, catastrophisation and fear of movement, which were correlated with the pain 7. While far from conclusive, these findings highlight that psychological factors may need consideration in some cases.…”

“…Indeed, numerous clinical trials report mean duration of patellofemoral pain to be anywhere from 6 to 76 months,3 with one reporting 87% of adolescents having pain for more than 12 months (median (IQR): 39 (21–60) 6. In a recent systematic review, we highlighted similarities between persistent patellofemoral pain and other persistent musculoskeletal conditions with insidious onset (eg, low back pain) 7. Managing these other musculoskeletal conditions requires an approach informed by pain science and that considers psychosocial factors.…”