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Predictors of pain and function outcome after rehabilitation in patients with patellofemoral pain syndrome
Open accessAbstract
OBJECTIVE: To identify changes in impairments associated with functional and pain outcome in patients with patello-femoral pain syndrome following a standardized physiotherapy treatment. DESIGN: One group pre-post design. SUBJECTS: Seventy-four patients (median age 27 years, 52% female) diagnosed with patellofemoral pain syndrome and referred to physiotherapy treatment. METHODS: Baseline measures included self-reported function and pain, which were the dependent variables, and measures of independent variables: strength of quadriceps, hip abduction and hip external rotation; length of hamstrings, quadriceps, plantar flexors, iliotibial band/tensor fascia lata complex, and lateral retinaculum; quality of movement, and fear-avoidance beliefs. Following the baseline measurements, subjects participated in a standardized physiotherapy program. Measurements were repeated at 2-month follow-up. Data were analyzed using 2 forward regression models, the first using function outcome, and the second using pain outcome as the criterion. Age, gender, height and weight were controlled in the regression models. RESULTS: Change in fear-avoidance beliefs about physical activity and change in gastrocnemius length predicted function outcome. Change in fear-avoidance beliefs about physical activity and about work predicted outcome of pain. CONCLUSION: Change in fear-avoidance beliefs about physical activity was the strongest predictor of function and pain outcome. The fact that patients who decreased their fear-avoidance beliefs improved function and decreased pain indicates that perhaps fear-avoidance beliefs should be targeted during the treatment of patients with patellofemoral pain syndrome.
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“Evidence in some cases demonstrates that psychosocial variables are more predictive of long-term disability than physical measures (Edwards et al., 2016;Piva et al., 2009).”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Piva et al., 2009
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Clifford, A. M., Buckley, E., O’Farrell, D., Louw, Q. A., & Moloney, C. (2017) · Physiotherapy Practice and Research · doi:10.3233/ppr-170098 · Cited by 5
Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients
Doménech, J., Sanchis‐Alfonso, V., & Espejo, B. (2012) · Springer eBooks · doi:10.1007/978-1-4471-4495-3_9 · Cited by 1
Ambrus, M., Wolf, G., Molnár, D., Soussi, B., Horváth, T., Horváth, M., & Lacza, Z. (2026) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-026-09556-9 · Cited by 4
“Although it is less frequently examined in isolation, training of the hip and core in patients suffering from patellofemoral pain syndrome has also been linked to functional advancements in the aspects measured by the Lysholm scale [28].”
Martins, D., de Castro, M. D., Ruschel, C., Pierri, C. A. A., Fontana, H. D. B., & Santos, G. M. (2022) · International Journal of Sports Physical Therapy · doi:10.26603/001c.31044 · Cited by 4
Lowry, V., Bass, A., Vukobrat, T., Décary, S., Belisle, P., Sylvestre, M., & Desmeules, F. (2021) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-021-04534-9 · Cited by 4
Assessment, Reasoning and Management of Psychological Factors in Musculoskeletal Practice
Beneciuk, J. M., George, S. Z., & Jones, M. A. (2019) · Elsevier eBooks · doi:10.1016/b978-0-7020-5976-6.00009-7 · Cited by 3
Kong, W., Wang, Z.-R., Zhou, Q., Yan, X., Li, J.-Y., Zhao, Y., Wang, X., Wang, H.-N., & Ni, G.-X. (2025) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2025.06.003 · Cited by 3
Chen, P., Wang, L., Zhou, W., & Wang, L. (2024) · PLoS ONE · doi:10.1371/journal.pone.0299008 · Cited by 3
Maryam, E., Mahbobeh, S., Farzaneh, M., Fatemeh, K., & Zohreh, N. (2022) · Physiotherapy Quarterly · doi:10.5114/pq.2021.108670 · Cited by 3
“Furthermore, according to the fear avoidance model, fear of pain is associated with functional disability and muscle weakness [52, 53].”
BackgroundBalblanc, M., Lohse, A., Meyer, F., Rapp, C., Bourgoin, C., Balblanc, J., & Conrozier, T. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13185372 · Cited by 2
“Patellofemoral syndrome is a condition that is difficult to treat, in which fear-avoidance beliefs are the main predictor of rehabilitation outcome [43,44].”
BackgroundGolpayegani, M., Fayazi, Z., & Hoseini, Y. (2021) · مجله دانشگاه علوم پزشکی اراک · doi:10.32598/jams.24.5.6275.1 · Cited by 2
Ghordadekar, D. (2021) · Indian Journal of Forensic Medicine & Toxicology · doi:10.37506/ijfmt.v15i1.13373 · Cited by 2
“The fact that patients who decreased their fear-avoidance beliefs improved function and decreased pain indicates that perhaps fear-avoidance beliefs should be targeted during the treatment of patients with patellofemoral pain syndrome(21).”
BackgroundLeibbrandt, D. C., & Louw, Q. (2019) · South African Journal of Physiotherapy · doi:10.4102/sajp.v75i1.684 · Cited by 2
“Changes in fear-avoidance behaviour have been suggested as an important predictor of functional outcome in patients with PFP (Piva et al. 2009).”
BackgroundKarimzadehfini, A., Zolaktaf, V., & Vahdatpour, B. (2014) · Advanced Biomedical Research · doi:10.4103/2277-9175.139128 · Cited by 2
“Decreased flexibility in the hamstrings can increase the demand on the quadriceps during extension of the knee and increased joint forces at the patella-femoral joint.[24] Tight lateral structures contribute to a lateral patella pull and result in patella displacement.”
BackgroundMethodInfluentialPredictors for patients with knee complaints receiving physiotherapy
Karstens, S., Hermann, K., Froböse, I., & Weiler, S. W. (2014) · European Journal of Physiotherapy · doi:10.3109/21679169.2013.852241 · Cited by 2
Darjee, J. P., & Sahai, N. (2026) · Journal of Physics, Conference Series · doi:10.1088/1742-6596/3196/1/012065 · Cited by 1
“The study shows that the impact of the persisting pain is enough to affect the quality of life, including sports participation and career selection (19). assemble a multidisciplinary team including clinicians, software developers, and user experience designers.”
Canino, M., Arvin, N., Nachazel, Z., Irrgang, J. J., Popchak, A. J., Musahl, V., Sterczala, A. J., & Flanagan, S. D. (2025) · Experimental Brain Research · doi:10.1007/s00221-025-07003-0 · Cited by 1
“…et al. 1993 ), modifications were implemented to ensure knee specificity and has been previously used in patients with knee osteoarthritis (van Baar et al. 1998), patellofemoral pain syndrome (Piva et al. 2009), and ACL injuries (Geno-ese et al. 2020 ; Baez et al. 2021; Barchek et al. 2021).”
Metadata
- Authors
- Piva, Sr., Fitzgerald, G., Wisniewski, S., & Delitto, A.
- Venue
- Journal of Rehabilitation Medicine
- Published
- 2009
- Volume
- 41
- Issue
- 8
- Pages
- 604-612
- ISSN
- 1650-1977 (ISSN-L)
- OpenAlex
- W2017982646
- Cited by
- 133
- References
- 36
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 5 · 2023: 8 · 2022: 5 · 2021: 9 · 2020: 8 · 2019: 15 · 2018: 12 · 2017: 12 · 2016: 4 · 2015: 5 · 2014: 12 · 2013: 5 · 2012: 8
- FWCI
- 4.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Journal of Rehabilitation Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Physical Therapy Association
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Myofascial pain diagnosis and treatment
- Keywords
- patellofemoral pain, fear-avoidance beliefs, physiotherapy, pain outcomes, functional outcome, quadriceps strength, hip external rotation, hamstring length, iliotibial band, lateral retinaculum, movement quality, prognostic factors
- MeSH terms
- Adolescent, Adult, Child, Fear, Female, Humans, Male, Middle Aged, Pain Measurement, Prognosis, Exercise, Range of Motion, Articular, Treatment Outcome, Outcome Assessment, Health Care, Physical Therapy Modalities, Patellofemoral Pain Syndrome, Muscle Strength, Young Adult
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