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The psychological features of patellofemoral pain: a systematic review
  1. Liam R. Maclachlan,
  2. Natalie J. Collins,
  3. Mark L.G. Matthews,
  4. Paul W. Hodges,
  5. Bill Vicenzino
  1. The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
  1. Correspondence to Bill Vicenzino, The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Brisbane, QLD 4072, Australia; b.vicenzino{at}


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.

  • Patellofemoral pain
  • non-physical features
  • Psychological features
  • Non-mechanical features

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  • Contributors LM and MM were responsible for the systematic search and data extraction. LM and NC were responsible for the methodological quality appraisals. All authors were involved in the study design, drafting and manuscript editing.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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