Original article
Associates of Physical Function and Pain in Patients with Patellofemoral Pain Syndrome

https://doi.org/10.1016/j.apmr.2008.08.214Get rights and content

Abstract

Piva SR, Fitzgerald GK, Irrgang JJ, Fritz JM, Wisniewski S, McGinty GT, Childs JD, Domenech MA, Jones S, Delitto A. Associates of physical function and pain in patients with patellofemoral pain syndrome.

Objectives

To explore whether impairment of muscle strength, soft tissue length, movement control, postural and biomechanic alterations, and psychologic factors are associated with physical function and pain in patients with patellofemoral pain syndrome (PFPS).

Design

Cross-sectional study.

Setting

Rehabilitation outpatient.

Participants

Seventy-four patients diagnosed with PFPS.

Interventions

Not applicable.

Main Outcome Measures

Measurements were self-reported function and pain; strength of quadriceps, hip abduction, and hip external rotation; length of hamstrings, quadriceps, plantar flexors, iliotibial band/tensor fasciae latae complex, and lateral retinaculum; foot pronation; Q-angle; tibial torsion; visual observation of quality of movement during a lateral step-down task; anxiety; and fear-avoidance beliefs.

Results

After controlling for age and sex, anxiety and fear-avoidance beliefs about work and physical activity were associated with function, while only fear-avoidance beliefs about work and physical activity were associated with pain.

Conclusions

Psychologic factors were the only associates of function and pain in patients with PFPS. Factors related to physical impairments did not associate to function or pain. Our results should be validated in other samples of patients with PFPS. Further studies should determine the role of other psychologic factors, and how they relate to anxiety and fear-avoidance beliefs in these patients.

Section snippets

Subjects

Subjects were recruited from rehabilitation clinics. Patients diagnosed by a physician with PFPS were invited to participate in this study. Patients were eligible to participate if they were between 12 and 50 years of age, had pain in 1 or both knees, had duration of signs and symptoms greater than 4 weeks, had a history of insidious onset not related to trauma, and had pain in the patellar region with at least 3 of the following: manual compression of the patella against the femur at rest or

Results

Seventy-four patients were recruited from 4 clinical sites. Twenty-five were from Minot Air Force Base, Minot, ND; 23 from Lackland Air Force Base, San Antonio, TX; 17 from Travis Air Force Base, Fairfield, CA; and 9 from University of Pittsburgh's Centers for Rehabilitation Services, Pittsburgh, PA. Participants across the 4 clinical sites were not significantly different on age, sex, height, weight, activity at work, use of pain medication, chronicity of pain, activity level, KOS-ADLS score,

Discussion

Although most physical impairment factors explored during this study have been theoretically or experimentally related to the presence of PFPS, the associates of function and pain in this cohort of patients with PFPS were all psychologic factors. Anxiety was the stronger associate of function, followed by FABQ-W and FABQ-PA. FABQ-W and FABQ-PA were the only associates of pain intensity in this sample. These findings may indicate that psychologic factors are overlooked in patients with PFPS.

Conclusions

Our study indicates that psychologic factors were the only associates of function and pain in this sample of patients with PFPS. Patients with more limitations in physical function reported higher levels of anxiety and fear-avoidance beliefs about work and physical activity. Patients with more pain reported higher levels of fear-avoidance beliefs about work and physical activity. Factors related to physical impairments did not associate with function or pain in this sample. Our preliminary

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  • Cited by (0)

    Supported by the Clinical Research Grant Program of the Orthopaedic Section of the American Physical Therapy Association, and the Pennsylvania Physical Therapy Association Research Fund.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    Reprints are not available from the author.

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