Psychologically informed videos may reduce patellofemoral pain-related fear
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Use of a psychologically informed video during standard physical therapy may reduce pain-related fear and pain catastrophizing as well as improve function among adolescents with patellofemoral pain, according to published results.
Mitchell C. Selhorst, DPT, PhD, of the sports and orthopedic physical therapy department at Nationwide Children’s Hospital, and colleagues randomly assigned 66 adolescents with patellofemoral pain to view either a brief psychologically informed video that targeted pain-related fear and pain catastrophizing (n=34) or a control video that related basic anatomy and factors involved in patellofemoral pain (n=32). Researchers considered change in function as the primary outcome measure, while change in psychological beliefs and pain were considered secondary outcomes. Researchers assessed outcomes at baseline, immediately post-intervention, at 2 and 6 weeks and at 3 months.
A two-way mixed analysis of variance showed patients in the intervention group had a greater change in function compared with patients in the control group, with a moderate treatment effect noted. Although researchers found a significant interaction between the intervention and time from baseline to 2 weeks, post hoc testing showed no interaction between 2 weeks and 3 months. Results showed maladaptive psychological beliefs were significantly reduced among patients who viewed the psychologically informed video. Researchers found no significant between-group differences in pain.
“Psychologically informed physical therapy represents a multimodal rehabilitation approach that incorporates behavioral strategies from the mental health realm into physical therapist practice,” the authors wrote. “The psychologically informed intervention in this study was purely educational, and education is only one aspect of psychologically informed physical therapy. Providing a series of brief psychologically informed videos or having the physical therapist reinforce the education during exercise may increase the effect observed from the intervention in this study.”
Perspective
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Vicente Sanchis-Alfonso, MD, PhD
The objective of the authors is 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 anterior knee pain. They concluded that 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 anterior knee pain. However, the immediate effect noted on function did not continue throughout the course of care.
In another paper, Mitchell Selhorst, DPT, PhD, and colleagues have shown that better functional results and better reduction of pain compared with a traditional approach in the short-term follow-up will occur if we address psychosocial and physical impairments in the treatment algorithm of patients with anterior knee pain. However, at 6 months follow-up, the majority of patients in both groups (sequential cognitive and physical approach group vs. non-sequential physical impairment-based approach group) reported high levels of function, but 43% of patients still reported pain.
People with severe anterior knee pain and psychological impairment may benefit from therapeutic strategies that target both the physical and non-physical aspects of this pathological condition. Future research should try to determine whether interventions targeting reductions in psychologic factors can effectively optimize rehabilitation and reduce the high rate of people with anterior knee pain reporting unfavorable outcomes in the long term.
Reference:
Selhorst M, et al. Clin Rehabil. 2018;doi:10.1177/0269215518787002.
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