Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Health Care Sciences - Physical Therapy Department

First Advisor

Alicia Fernandez-Fernandez

Second Advisor

Jessica Hoehn

Third Advisor

Laura Schmitt

Publication Date / Copyright Date

2020

Publisher

Nova Southeastern University

Abstract

Problem and purpose: Psychological factors impact self-report measures of pain and function among adults with anteriorknee pain (AKP), but we do not know (1) if psychological factors also impact pain, self-reported function, and objective measures of function among adolescents with AKP and (2) if a psychological intervention would affect function. The purpose of this dissertation is to determine the impact of psychological factors on pain, self-reported function, and objective measures of function in adolescents with AKP.

Methods: This dissertation was prospective, with three separate studies. Two were cross-sectional observational studies, and the third was a randomized-controlled trial. Patient questionnaires were used to describe psychological beliefs, including fear avoidance (fear avoidance beliefs questionnaire-physical activity), kinesiophobia (Tampa scale for kinesiophobia-11), and paincatastrophizing (pain catastrophizing scale-child) in adolescents with AKP aged 12-17 years. In research study #1, self-reported function, pain, and clinical measures of function were assessed. In research study #2, three-dimensional motion analysis was used to assess movement patterns during a single leg hop for distance in a subset of the participants (n=30). In research study #3, participants were randomly assigned to a psychologically-informed education group or a control group. Change in self-reported function was assessed over six weeks.

Results: Adolescents with AKP (n=87, 62% female, age 14.6 ±1.7 years) and healthy controls (research study #2 only, n=10, 60% female, age 15.5 ±1.8 years) were recruited for participation. Research study #1 identified a significant mild-moderate adverse association between psychological beliefs, self-reported function (r = -0.59), pain (r = 0.34), hip abductor strength (r = -0.41), and single leg hop distance (r = -0.38). Research study #2 found no significant between-group differences in movement patterns in adolescents with elevated or low maladaptive psychological beliefs. Research study #3 found that adolescents who received a brief psychologically-informed educational intervention had significantly greater short-term improvements in function compared to controls (mean difference of 8.0 points, 95% CI 2.4, 13.5; p = 0.01).

Conclusion: Maladaptive psychological beliefs were adversely associated with self-reported function, pain, and certain aspects of objective function. Providing a brief psychologically-informed intervention significantly improved maladaptive beliefs and self-reported function among adolescents with AKP.

Disciplines

Physical Therapy

Keywords

Adolescent, Anterior knee pain, Fear, Patellofemoral, Psychological

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