Cognitive and emotional features associated with pain related fear of movement in patellofemoral pain

<p dir="ltr">This thesis examines the relationship between cognitive and emotional features of people with patellofemoral pain (PFP) and pain-related fear of movement. A protocol was registered with the OSF (DOI https://doi.org/10.17605/OSF.IO/M9F3J) and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) 2020 statement.</p><p dir="ltr">Patellofemoral pain (PFP) is a common musculoskeletal condition characterised by pain around the kneecap during activities that load the patellofemoral joint such as negotiating stairs, squatting, and running. It is estimated that over 50% of people with PFP will experience persistent pain. One possible driver for the persistence of pain is the fear-avoidance model. Hallmark features of the fear-avoidance model are catastrophizing, depression, anxiety and ultimately pain-related fear of movement, all of which have been reported in people with PFP.</p><p dir="ltr">The main chapter of this thesis is a systematic review. A search of electronic databases was conducted. Studies were required to have at least one measure or exploration of pain-related fear of movement, and at least one measure or exploration of cognitive or emotional function. Seventeen articles were included in this systematic review.</p><p dir="ltr">The association between pain-related fear of movement and cognitive-emotional function, measured by patient-reported outcome measures, was extractable from a single study, which combined 100 people with PFP and 50 pain-free controls. Data from three studies were provided on request. Data from these three studies reporting on correlations obtained solely from people with PFP found significant, large associations between the Tampa Scale for Kinesiophobia (TSK) and Pain Catastrophising Scale (PCS) (ρ=0.50, 95% CI 0.37 to 0.62, p<0.001) and the TSK-11 and PCS-child (study 1 ρ= 0.54, 95% CI 0.34 to 0.67, p<0.001; study 2 ρ= 0.62, 95% CI 0.45 to 0.75, p<0.001). The study which combined pain-free controls with people who had PFP found moderate correlations (ρ= 0.45). Moderate correlations were found between the TSK and Hospital Anxiety and Depression Scale (HADS) depression subscale, as well as between the TSK and Pain self-efficacy questionnaire (PSEQ). A small correlation was found between TSK and the HADS anxiety subscale. A large correlation was found between the Fear Avoidance Beliefs Questionnaire (FABQ) and PCS-child.</p><p dir="ltr">Current evidence indicates there is an association between pain-related fear of movement and cognitive and emotional features in people with PFP. Further exploration of this relationship in future research is warranted to develop this concept and inform targeted management strategies for this population.</p>