Influence of unilateral versus bilateral patellofemoral pain on physical activity, pain self-efficacy, and disability.

BACKGROUND: Patellofemoral pain (PFP) affects physical and psychosocial health; however, it is unclear if unilateral and bilateral PFP induce similar levels of impairments. OBJECTIVES: We aimed to compare physical activity (PA), pain self-efficacy, and disability between individuals with unilateral and bilateral PFP, and to compare these groups against pain-free controls. DESIGN: Cross-sectional case-control. METHOD: Sixty-two individuals with PFP (25 unilateral and 37 bilateral) and 20 pain-free controls completed the PA assessment using an accelerometer by daily steps, light PA, and moderate-to-vigorous PA (MVPA). We also calculated variability in each PA variable. Pain self-efficacy and disability were measured using the Pain Self-Efficacy Questionnaire and Anterior Knee Pain Scale, respectively. RESULTS: Individuals with bilateral PFP took fewer daily steps compared to pain-free controls (9568.1 ± 3827.0 vs. 12,285.8 ± 2821.2 steps/day; P = 0.018, Cohen d = 0.79), whereas individuals with unilateral PFP did not (11,099.2 ± 3547.1 steps/day; P = 0.503, Cohen d = 0.37). Individuals with bilateral PFP showed greater variability in MVPA compared to individuals with unilateral PFP (42.9 ± 23.1 vs. 29.0 ± 15.9; P = 0.011, Cohen d = 0.91) and pain-free controls (42.9 ± 23.1 vs. 17.6 ± 6.1; P < 0.001, Cohen d = 1.21). Individuals with unilateral and bilateral PFP similarly exhibited less time spent in MVPA, greater variability in daily steps, lower pain self-efficacy, and greater disability compared to pain-free controls (P < 0.001, Cohen d = 1.14-3.89). CONCLUSIONS: Versus pain-free controls, individuals with bilateral PFP displayed greater variability in MVPA than individuals with unilateral PFP. However, it is important to note that unilateral PFP influenced time spent in MVPA, variability in daily steps, pain self-efficacy, and disability at similar levels to bilateral PFP.

The Influence of Psychological Factors on Physical Activity in Individuals With Patellofemoral Pain.

CONTEXT: Patellofemoral pain (PFP) is a prevalent chronic condition characterized by retropatellar or peripatellar pain exacerbated by various knee flexion-based activities. Previous research has highlighted the impact of psychological constructs on pain and function in chronic musculoskeletal pain conditions, yet their influence on physical activity in PFP cohorts remains unexplored. We aimed to evaluate whether pain self-efficacy and pain catastrophizing predict variations in steps per day and moderate to vigorous physical activity (MVPA) among individuals with PFP. DESIGN: Cross-sectional observational study. METHODS: Thirty-nine participants (11 males) with PFP were included. Dependent variables were steps per day and minutes of MVPA. Independent variables were pain self-efficacy and pain catastrophizing, measured by the pain self-efficacy questionnaire and the pain catastrophizing scale. Participants were given an ActiGraph wGT3X-BT for 7 days to assess physical activity. Correlations were assessed between psychological measures and physical activity, and a simple linear regression was performed on psychological variables that correlated with physical activity. Alpha was set a priori at P < .05. RESULTS: Pain self-efficacy scores displayed a moderate association with steps per day (rho = .45, P = .004) and a weak association with MVPA (rho = .38, P = .014). Pain catastrophizing scores exhibited no significant associations with physical activity (P < .05). Regression models affirmed pain self-efficacy scores as significant predictors of both steps per day (F1,37 = 10.30, P = .002) and MVPA (F1,37 = 8.98, P = .004). CONCLUSIONS: Psychological measures continue to demonstrate value to clinicians treating PFP. Pain self-efficacy scores were moderately associated with steps per day and weakly associated with MVPA, explaining nearly a fifth of the variation in physical activity. Clinicians should prioritize the assessment of pain self-efficacy when treating individuals with PFP, potentially employing psychological interventions to improve physical activity in the PFP population.

Knee Confidence, Fear of Movement, and Psychological Readiness for Sport in Individuals With Knee Conditions: A Systematic Review and Meta-analysis.

OBJECTIVES: To (1) compare activity-related psychological factors between individuals with and without knee conditions, and (2) assess associations between these factors and objective measures of function in individuals with knee conditions. DESIGN: A priori registered systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE-Ovid, Embase-Ovid, Scopus-Elsevier, CINAHL-EBSCO, SPORTDiscus-EBSCO, and Cochrane Library were searched to May 27, 2022. STUDY SELECTION CRITERIA: We included peer-reviewed primary data studies (observational and experimental) of human participants with and without knee conditions reporting knee confidence, fear of movement/avoidance beliefs, and/or psychological readiness to return to sport (RTS) or reporting correlations between these factors and objective measures of function in knee conditions. DATA SYNTHESIS: Where possible, data were pooled by knee conditions, otherwise performed narrative syntheses. The Downs and Black checklist assessed the methodological quality of the included studies. RESULTS: Forty studies (3546 participants with knee conditions; 616 participants without knee conditions) were included. There was very low-certainty evidence of higher fear of movement in individuals with knee osteoarthritis (standardized mean difference [SMD], 0.46; 95% confidence interval [CI]: 0.41, 0.52), but not in individuals with patellofemoral pain (SMD, 0.66; 95% CI: -7.98, 9.29) when compared with those without knee conditions. There was very low-certainty evidence of no differences in psychological readiness to RTS after anterior cruciate ligament reconstruction (SMD, -1.14; 95% CI: -2.97, 0.70) compared to no knee condition, and negligible to weak positive correlations between psychological readiness to RTS and objective measures of function. CONCLUSION: There was very low-certainty evidence of higher fear of movement in individuals with knee osteoarthritis compared to those without, and very low-certainty evidence of no correlations between these factors and objective measures of function following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2024;54(4):1-14. Epub 29 January 2024. doi:10.2519/jospt.2024.12070.

The relationship of behavioral and psychological traits with pain sensitivity in females with patellofemoral pain: A cross-sectional study.

OBJECTIVE: The purpose of this study was to describe the relationship between behavioral and psychological traits with indicators of central sensitization in female runners with patellofemoral pain (PFP), and to determine if behavioral and psychological traits improve with strength training. DESIGN: Cross-sectional study. SETTING: University laboratory. PARTICIPANTS: Twenty-eight active females (mean age 32 ± 8.1 years) with PFP completed testing at baseline, 8 weeks (post intervention), and 12 weeks. MAIN OUTCOME MEASURES: Behavioral and psychological questionnaires included the General Anxiety Disorder-7, Patient Health Questionairre-9, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia-11, and Central Sensitization Inventory. Quantitative sensory testing (QST) measures were also collected. After baseline testing, subjects were instructed in a hip and knee strengthening intervention to be completed twice daily over 8 weeks. RESULTS: A statistically significant improvement was found at 12 weeks for anxiety (p = .015; ηp (Boling et al., 2010) = 0.099) and kinesiophobia (p = .041; ηp (Boling et al., 2010) = 0.076). There was no significant improvement for depression, catastrophizing, or subjective central sensitization. No significant correlations were found between any of the behavioral and psychological questionnaires with baseline QST variables. CONCLUSIONS: No relationship was found for behavioral and psychological characteristics with QST measures in female runners with persistent PFP.

The association between kinesiophobia and dynamic balance in patients with patellofemoral pain syndrome.

OBJECTIVE: The aim of the study was to examine the relationship between Kinesiophobia and dynamic balance in patients with patellofemoral pain syndrome (PFPS). PATIENTS AND METHODS: Forty subjects with PFPS [20 Low Kinesiophobia (LK), 20 High Kinesiophobia (HK)], and 20 pain-free subjects (control group) were enrolled in the study. All subjects performed a Y-balance test to measure the dynamic balance. Normalized reach distance and balance parameters were recorded. RESULTS: Our findings indicated that patients with PFPS who have a greater Kinesiophobia showed a poorer dynamic balance. In addition, the HK group showed a significantly lower mean reach distance score in the anterior, posterolateral, and posteromedial directions compared to LK and healthy groups. CONCLUSIONS: Addressing the psychological factors such as Kinesiophobia during examination and treatment of people with PFPS may be important to improve the dynamic balance.

Clinicians' experience of the diagnosis and management of patellofemoral pain: A qualitative exploration.

BACKGROUND: Patellofemoral pain (PFP) is common and has a poor long-term prognosis. There is a lack of clarity about the clinical reasoning of recognised inter-disciplinary experts in the published literature. OBJECTIVES: To help identify best practice by exploring the clinical reasoning of a range of inter-disciplinary experts that regularly diagnose and treat PFP. DESIGN: Qualitative study with semi-structured interviews. METHOD: Recruitment resulted in a convenience sample for semi-structured interview, which were recorded and transcribed verbatim. Data were analysed until theoretical saturation, as determined by multiple investigators. FINDINGS: Interviews with 19 clinical experts (15 men, 4 women; mean experience 18.6 years ± 8.6) from four broad professions yielded four themes. Firstly, the assessment and diagnosis process should include a thorough history and examination to rule in PFP. Secondly, information provision should aim to increase patients' understanding, aid in controlling symptoms, and facilitate behaviour change. Thirdly, active rehabilitation, which was a salient theme and included advocacy of combined hip and knee exercise that is adapted to the individual. Finally, treatment adjuncts, which can be used selectively to modify symptoms, may include running retraining, taping, or foot orthoses. CONCLUSIONS: PFP should be diagnosed clinically, and tailored treatment programmes should be prescribed for people with PFP. Exercise was considered the most effective treatment and underlying psychological factors should be addressed to improve prognosis.

Does central nervous system dysfunction underlie patellofemoral pain in young females? Examining brain functional connectivity in association with patient-reported outcomes.

Patellofemoral pain (PFP) is defined as retro- or peri-patellar knee pain without a clear structural abnormality. Unfortunately, many current treatment approaches fail to provide long-term pain relief, potentially due to an incomplete understanding of pain-disrupted sensorimotor dysfunction within the central nervous system. The purposes of this study were to evaluate brain functional connectivity in participants with and without PFP, and to determine the relationship between altered brain functional connectivity in association with patient-reported outcomes. Young female patients with PFP (n = 15; 14.3 ± 3.2 years) completed resting-state functional magnetic resonance imaging (rs-fMRI) and patient-reported outcome measures. Each patient with PFP was matched with two controls (n = 30, 15.5 ± 1.4 years) who also completed identical rs-fMRI testing. Six bilateral seeds important for pain and sensorimotor control were created, and seed-to-voxel analyses were conducted to compare functional connectivity between the two groups, as well as to determine the relationship between connectivity alterations and patient-reported outcomes. Relative to controls, patients with PFP exhibited altered functional connectivity between regions important for pain, psychological functioning, and sensorimotor control, and the connectivity alterations were related to perceived disability, dysfunction, and kinesiophobia. The present results support emergent evidence that PFP is not localized to structural knee dysfunction, but may actually be resultant to altered central neural processes. Clinical significance: These data provide potential neuro-therapeutic targets for novel therapies aimed to reorganize neural processes, improve neuromuscular function, and restore an active pain-free lifestyle in young females with PFP.

Fear of movement and (re)injury is associated with condition specific outcomes and health-related quality of life in women with patellofemoral pain.

OBJECTIVES: Investigate the association of fear of movement and (re)injury with clinical outcomes in women with patellofemoral pain (PFP). METHODS: This cross-sectional study included 92 women with PFP who completed the TAMPA scale for kinesiophobia. The TAMPA score and its two subscales - activity avoidance and somatic focus were correlated with BMI, physical activity level, pain catastrophizing scale, health-related quality of life, pain sensitivity via pressure pain threshold, self-reported disability, and worst knee pain in last month. RESULTS: Greater fear of movement and (re)injury, activity avoidance, and somatic focus were correlated with lower local pain sensitivity (rho = -0.29 to -0.55), lower health-related quality of life (rho = -0.38 to -0.42), greater pain catastrophizing (rho = 0.41 to 0.47), and greater self-reported disability (rho = -0.31 to -0.52). Greater fear of movement and (re)injury and activity avoidance were correlated with adjacent and remote pain sensitivity (rho = -0.24 to -0.39). Greater fear of movement and (re)injury and somatic focus were correlated with greater worst knee pain in last month (rho = 0.21 to 0.32). Fear of movement and (re)injury predicted pain measures, disability, and health-related quality of life (p ≤ 0.010). CONCLUSION: The relationship of greater fear of movement and (re)injury with greater disability, pain catastrophizing, pain sensitization, and poorer health-related quality of life highlights the potential importance of considering this psychological feature of PFP during assessment and management.

Effect of a Psychologically Informed Intervention to Treat Adolescents With Patellofemoral Pain: A Randomized Controlled Trial.

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=.001, partial η2=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=.01, η2=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.

A Contemporary Approach to Patellofemoral Pain in Runners.

Patellofemoral pain (PFP) is among the most common injuries in recreational runners. Current evidence does not identify alignment, muscle weakness, and patellar maltracking or a combination of these as causes of PFP. Rather than solely investigating biomechanics, we suggest a holistic approach to address the causes of PFP. Both external loads, such as changes in training parameters and biomechanics, and internal loads, such as sleep and psychological stress, should be considered. As for the management of runners with PFP, recent research suggested that various interventions can be considered to help symptoms, even if these interventions target biomechanical factors that may not have caused the injury in the first place. In this Current Concepts article, we describe how the latest evidence on education about training modifications, strengthening exercises, gait and footwear modifications, and psychosocial factors can be applied when treating runners with PFP. The importance of maintaining relative homeostasis between load and capacity will be emphasized. Recommendations for temporary or longer-term interventions will be discussed. A holistic, evidence-based approach should consist of a graded exposure to load, including movement, exercise, and running, while considering the capacity of the individual, including sleep and psychosocial factors. Cost, accessibility, and the personal preferences of patients should also be considered.

Adolescent psychological beliefs, but not parent beliefs, associated with pain and function in adolescents with patellofemoral pain.

OBJECTIVES: The purpose of this study was to assess the association of adolescent and parent psychological beliefs with 1) self-reported functional ability, 2) pain and 3) objective measures of function. STUDY DESIGN: Cross-sectional study. SETTING: Pediatric Outpatient Hospital. PARTICIPANTS: Eighty-six adolescents with patellofemoral pain (PFP) (14.6 ± 1.7 years old, 62% female) and 72 parents. MAIN OUTCOME MEASURES: Patient questionnaires were used to describe pain, knee function, fear avoidance (Fear Avoidance Beliefs Questionnaire-Physical Activity; FABQ-PA), kinesiophobia (Tampa Scale for Kinesiophobia-11; TSK-11), and pain catastrophizing (Pain Catastrophizing Scale; PCS) in adolescents with PFP. Parents (n = 72) completed FABQ-PA, TSK-11, and PCS questionnaires. Hip and knee strength, quadriceps and dorsiflexion motion, the single-leg hop for distance and lateral-step down test measured physical performance. RESULTS: Adolescent psychological beliefs were significantly associated with pain (FABQ-PA r = 0.33, and PCS r = 0.34), function (FABQ-PA r = -0.59,TSK-11 r = -0.33), hip strength (FABQ-PA r = -0.41, TSK-11 r = -0.32), and single leg hop for distance (FABQ-PA r = -0.38). Parent psychological beliefs were not associated with the adolescent's beliefs, pain or function. CONCLUSIONS: Adolescent, but not parent, psychological beliefs were associated with pain, self-reported function and objective measures of function.

Pain and disability in women with patellofemoral pain relate to kinesiophobia, but not to patellofemoral joint loading variables.

BACKGROUND: Altered patellofemoral joint (PFJ) loading and elevated kinesiophobia are commonly reported in people with patellofemoral pain (PFP). However, the relative relationship of these physical-psychological variables with pain and disability in people with PFP is unknown. AIM: To explore the relationship of PFJ loading during stair ascent and kinesiophobia, with self-reported pain and disability in women with PFP. METHODS: Fifty-seven women with PFP completed the Tampa Scale for Kinesiophobia, a Visual Analog Scale (0-100 mm) for pain during stair ascent, and the Anterior Knee Pain Scale (disability). Stair ascent mechanics were assessed via three-dimensional motion analysis while participants ascended an instrumented seven-step staircase. Peak PFJ contact force and stress, and PFJ contact force and stress loading rates were estimated using a musculoskeletal model. The relationships of PFJ kinetics during stair ascent and kinesiophobia, with the Anterior Knee Pain Scale (disability) and pain during stair ascent, were evaluated with Spearman rank correlation. Variables (kinetics and kinesiophobia) significantly correlating with the dependent variables (pain and disability) were inserted in linear regression models. RESULTS: Kinesiophobia was moderately associated with self-reported pain (rho = 0.37) and disability (rho = -0.58) in women with PFP. No PFJ loading variables were found to be associated with self-reported pain or disability (P > .05). Kinesiophobia explained 14% of the variance of participants' pain while ascending stairs and 33% of the variance of participant's self-reported disability. CONCLUSION: Addressing kinesiophobia during treatment of women with PFP may be important to reduce self-reported pain and disability.

Two Weeks of Wearing a Knee Brace Compared With Minimal Intervention on Kinesiophobia at 2 and 6 Weeks in People With Patellofemoral Pain: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effect of a knee brace compared with minimal intervention on self-reported kinesiophobia and function, objective function, and physical activity level in people with patellofemoral pain (PFP). DESIGN: Single-blind randomized controlled trial (1:1), parallel. PARTICIPANTS: Individuals with PFP (N=50). MAIN OUTCOME MEASURES: Primary: kinesiophobia (Tampa Scale for Kinesiophobia). Secondary: self-reported function (Anterior Knee Pain Scale), physical activity level (International Physical Activity Questionnaire), and objective function (forward step-down test). Outcomes were assessed at baseline (T0), at the end of the intervention (2wk) (T1), and at 6 weeks after baseline (T2). INTERVENTION: Participants were randomly assigned to 1 of 2 interventions groups: (1) use of knee brace for 2 weeks during daily living, sports, or painful tasks (brace group) and (2) educational leaflet with information about PFP (leaflet group). RESULTS: The knee brace reduced kinesiophobia in people with PFP compared with minimal intervention with moderate effect size at T1=mean difference (95% CI) -5.56 (-9.18 to -1.93) and T2=-5.24 (-8.58 to -1.89). There was no significant difference in self-reported and objective function and physical activity level. CONCLUSIONS: The knee brace improved kinesiophobia immediately after intervention (at 2wk) and at 6-week follow-up in people with PFP compared with minimal intervention. A knee brace may be considered within clinically reasoned paradigms to facilitate exercise therapy interventions for people with PFP.

Predictors of Pain, Function, and Change in Patellofemoral Pain.

BACKGROUND: Identification of factors predictive of outcome and change is important to improve treatment for patellofemoral pain (PFP). Few studies have examined the predictive value of psychological factors in PFP, although they have been reported to be important predictors in other musculoskeletal pain conditions. PURPOSE: To evaluate predictors of pain, function, and change 1 year after an exercise-based intervention in PFP. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: In sum, 112 patients were recruited to a randomized controlled trial; 98 attended 1-year follow-up. There were no between-group differences in the trial; thus, the material was analyzed as 1 cohort. Nine baseline factors-sex, bilateral pain, worst pain, pain duration, Anterior Knee Pain Scale (AKPS), kinesiophobia, anxiety and depression, self-efficacy, and number of pain sites throughout the body-were investigated for their predictive ability on outcome at 1 year (AKPS, worst pain) and for change at 1 year (global change score, change in AKPS, and change in worst pain). Multivariable linear regression models with stepwise backward removal method were used to find predictors of poor outcome. RESULTS: Number of pain sites at baseline was a significant predictor of worse outcome for AKPS (B = -2.7; 95% CI, -4.0 to -1.3; P < .01), worst pain (B = 0.5; 95% CI, 0.2-0.8; P < .01), global change (B = -0.8; 95% CI, -1.2 to -0.5; P < .01), change in AKPS (B = -2.7; 95% CI, -4.0 to -1.3; P < .01), and change in worst pain (B = 0.5, 95% CI, 0.2-0.8; P < .01) at 1 year. Baseline scores for AKPS and worst pain predicted respective 1-year levels and change scores (P < .01). Lower self-efficacy and male sex predicted less global change (P < .01). Longer pain duration predicted final score and change score for worst pain (P < .01). The predictive models had reasonable fit with adjusted R2 from 0.22 to 0.35. CONCLUSION: Higher number of pain sites throughout the body was a consistent predictor of poor outcome and less change at 1 year. Baseline levels for AKPS and worst pain predicted respective final scores and change scores. REGISTRATION: NCT02114294 ( ClinicalTrials.gov identifier).

Investigating the prevalence of anxiety and depression in people living with patellofemoral pain in the UK: the Dep-Pf Study.

Background and aims Patellofemoral pain (PFP) is a common knee condition causing pain around or behind the kneecap which is exacerbated by certain activities. Traditionally it has been viewed as a self-limiting condition. Recent research proves this is not the case and the evidence for poor long-term outcomes is growing. Whilst the evidence base for PFP treatment and the understanding of its aetiology is improving, it remains a complex and difficult to treat condition. In many physical conditions, it has been shown that anxiety and depression negatively affect both their management and duration. It is unclear how prevalent anxiety and depression are in PFP. This study aimed to identify the prevalence of anxiety and depression in people living with PFP in the UK. Methods In order to investigate this, a cross-sectional online survey was undertaken. Four hundred participants with self-reported symptoms of PFP were recruited through a tailored social media campaign, using modified snowball sampling. Eligibility criteria were (i) aged between 18 and 44, (ii) self-reported symptoms of PFP (using accepted criteria) (iii) resident in the UK. Exclusion criteria were previous history of patella dislocation or previous surgery to affected knee. The survey recorded demographic information, previous treatment for both PFP and anxiety and depression, the Hospital Anxiety and Depression Scale and the Anterior Knee Pain Scale. Ethical approval was gained from a University of Plymouth Ethics Committee. Results Half (49.5%; n=198) of respondents were classified as experiencing anxiety and 20.8% (n=83) as experiencing depression. The levels of anxiety and depression identified in this study are higher than those found in the general population (5.9-7.8% and 3.3-7.8%, respectively). This mirrors results which have been reported in other studies into PFP in different settings and with other musculoskeletal conditions, such as osteoarthritis and contracted shoulder. Conclusions Anxiety and depression are more common in people living with PFP than in the general population. These findings support the need for greater research into the effects of psychological factors, such as anxiety and depression, in PFP. A key area of future research will be to determine whether these psychological factors affect treatment outcomes in people living with PFP. Implications This is the first study to investigate the prevalence of anxiety and depression in people living with patellofemoral pain in the UK. This study shows that anxiety and depression are very common in people living with patellofemoral pain. The need for further work into the effects of psychological factors in patellofemoral pain is indicated.

Influence of kinesiophobia and pain catastrophism on objective function in women with patellofemoral pain.

OBJECTIVES: (i) To compare kinesiophobia, pain catastrophism and objective function between women with patellofemoral pain (PFP) and pain-free; (ii) to investigate the association of kinesiophobia and pain catastrophism with objetive function in women with PFP. DESIGN: Case-control. SETTING: Laboratory-based. PARTICIPANTS: Fifty-five women with PFP and forty pain-free women. MAIN OUTCOME MEASURES: Kinesiophobia and pain catastrophism were assessed using the Tampa Scale of Kinesiophobia and Pain Catastrophizing Scale, respectively. Forward step-down, single leg hop, and modified star balance tests were used to assess objective function. Independent t-tests were used for between-groups comparisons and Pearson correlation coefficients were used to investigate the association between the outcomes. RESULTS: Women with PFP had significantly worse kinesiophobia (p < 0.001; Effect size (ES) = 1.16), pain catastrophism (p < 0.001; ES = 1.57), and poorer objective function (step-down, (p < 0.001; ES = 0.99); single-leg hop (p = 0.002; ES = 0.74); modified star balance (p < 0.001; ES = 0.66) than pain-free controls. Kinesiophobia and pain catastrophism were not correlated with objective function. CONCLUSION: Greater kinesiophobia, pain catastrophism and poorer objective function is evident in women with PFP, compared to pain-free controls. Kinesiophobia and pain catastrophism were not associated with objective function in women with PFP. Future research is necessary to understand how other physical and psychological factors might affect objective function.

Kinesiophobia, but not strength is associated with altered movement in women with patellofemoral pain.

BACKGROUND: Evidence indicates the presence of both kinesiophobia and knee extension strength deficits in women with patellofemoral pain (PFP). Both impairments may contribute to apparent compensatory gait patterns including reduced cadence and peak knee flexion during stair negotiation. RESEARCH QUESTION: Is kinesiophobia or knee extension strength associated with movement pattern in women with patellofemoral pain? METHODS: Forty women with PFP were assessed with three-dimensional kinematic analyses during stair descent; isokinetic dynamometry of the knee extensors (isometric, concentric and eccentric); and the Tampa scale for kinesiophobia. Pearson coefficients were calculated to determine relationship among variables. RESULTS: Kinesiophobia correlated significantly with cadence (r = -0.62, p < 0.001), and peak knee flexion (r = -0.76, p < 0.001). No significant correlations were found between any knee extensor strength variables and kinematics (cadence or peak knee flexion); or kinesiophobia (p > 0.05). SIGNIFICANCE: Findings of this study could suggest addressing strength impairments alone may not adequately address kinesiophobia and movement pattern impairments in women with PFP. However, high-quality randomised controlled trials are needed to test this assumption. Further value may be added if currently evidence-based knee strengthening exercise is combined with education and/or graded exposure to address kinesiophobia, and consideration to gait retraining to address altered movement patterns at the knee.

Association of altered frontal plane kinematics and physical activity levels in females with patellofemoral pain.

BACKGROUND: Females with patellofemoral pain (PFP) present with altered frontal plane kinematics, decreased physical activity, and elevated psychological features. However, the relationship between these factors has not been evaluated. RESEARCH QUESTION: Does a relationship exist between frontal plane kinematics, physical activity levels, and fear avoidance beliefs in females with PFP. METHODS: 16 females with PFP (Age = 23.2 ±â€¯4.9years; Height = 166.1 ±â€¯5.9 cm; Mass = 66.3 ±â€¯13.5 kg) completed a 3-D biomechanical assessment during a single leg squat, step-down, and jogging task. Physical activity was collected with an activity monitor over 2-weeks and the Fear Avoidance Belief Questionnaire physical activity subscale was used to assess fear avoidance beliefs. Frontal plane kinematics were correlated with physical activity and fear avoidance, with significant variables included in a multiple regression. RESULTS: Significant correlations were identified between physical activity and single leg squat hip adduction (r=-0.626, p = 0.01), step-down knee abduction (r=-0.783, p < 0.001) and jogging hip adduction (r=-0.639, p = 0.008). Step-down knee abduction predicted activity level and accounted for 61% of the total variance. Correlations between fear avoidance belief and single leg squat hip adduction (r = 0.477, p = 0.049), step-down knee abduction (r = 0.644, p = 0.007), jogging knee abduction (r = 0.558, p = 0.025), and jogging hip adduction (r = 0.557, p = 0.025) were also identified. Knee abduction during the step-down and single leg squat hip adduction accounted for 37.5% of the variance in the Fear Avoidance Belief Questionnaire. SIGNIFICANCE: Altered frontal plane kinematics during step-down and jogging provide insight for clinicians to identify females with patellofemoral pain that may be less physically active, while step-down and squatting kinematics related to fear avoidance beliefs. While these relationships were found, it is essential to identify the underlying mechanism for this activity modification so clinicians and researchers can evaluate successful interventions.

Cross-cultural adaptation and validation of the Italian versions of the Kujala, Larsen, Lysholm and Fulkerson scores in patients with patellofemoral disorders.

BACKGROUND: The Kujala, Fulkerson, Larsen and Lysholm questionnaires have been demonstrated to be reliable and sensitive in assessing patients with patellofemoral pathology. The purpose of this study is to translate and cross-culturally adapt into Italian the English versions of the Kujala, Fulkerson, Larsen and Lysholm questionnaires, and undertake reliability and validity evaluations of the Italian versions of these scores in patients with patellofemoral pathology. MATERIALS AND METHODS: The cross-cultural adaptation process was carried out following the simplified Guillemin criteria. The questionnaires were administered to 63 patients with either patellar instability or painful patella syndrome. To assess the validity of the questionnaires, they were compared with the Oxford knee score. The questionnaires were administered to a subsample of 33 patients 5 days later to assess test-retest reliability. RESULTS: The interclass coefficient correlation was 0.96 for the Kujala score, 0.92 for the Larsen score, 0.96 for the Lysholm score, 0.94 for the Fulkerson score (P < 0.01), and 0.83 for the Oxford score. Pearson's correlation was0.96 between the Kujala and Oxford scores, 0.90 between the Larsen and Oxford scores, 0.94 between the Lysholm and Oxford score, and 0.93 between the Fulkerson and Oxford scores. Responsiveness, calculated by standardized response mean, was 1.2, and effect size was 1.4. CONCLUSIONS: The Italian versions of the Kujala, Larsen, Lysholm and Fulkerson scoring systems were shown to be equivalent to their English versions and demonstrated good validity, reliability and responsiveness to surgical treatment of patellofemoral pathology. To the best of the authors' knowledge, this is the first attempt to adapt four of the most common patellofemoral-specific scoring scales to the Italian language. LEVEL OF EVIDENCE: Level II.