Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type


Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

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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



Nova Southeastern University


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.


Physical Therapy


Adolescent, Anterior knee pain, Fear, Patellofemoral, Psychological