Psychologically informed videos did not improve function in adolescents with leg pain
A double-blinded RCT of 83 adolescents with atraumatic leg pain found that adding videos targeting fear of movement and catastrophizing to usual physical therapy did not improve overall function or pain intensity over 12 months, though the intervention did reduce pain-related psychological beliefs at 1 month.
Researchers tested whether brief psychologically informed education (PIE)—videos designed to target kinesiophobia, fear avoidance, and catastrophizing—could boost the effect of standard physical therapy in 83 adolescents (mean age 14.7 years, 62% female) with atraumatic leg pain, including patellofemoral pain, tendinopathy, and apophyseal injuries. All participants completed 6 weeks of physical therapy; the PIE group viewed 3 targeted educational videos while the control group viewed anatomy and biomechanics videos.
Function, measured by the Lower Extremity Functional Scale, improved similarly in both groups at 1 month (PIE +12.5 points vs control +8.9 points) and 12 months (PIE +17.1 vs control +14.9), with no significant between-group difference (P=.40). The PIE group did show greater reductions in pain-related beliefs at 1 month: 50% reduced fear avoidance (vs 23% in control), 50% reduced kinesiophobia (vs 8%), and 27% reduced catastrophizing (vs 19%, P=.01). However, there were no between-group differences in pain intensity (P=.82) or physical activity (P=.50) at any timepoint. At 12 months, 34% of adolescents reported persistent pain, suggesting substantial room for improvement in current approaches. The negative primary outcome and lack of secondary pain reduction suggest that brief psychological education, even when added to structured therapy, may not be sufficient alone for functional gains in this population.
Notably, the effect size for function was modest in both groups—improvements ranged from 8.9 to 17.1 points on the Lower Extremity Functional Scale, a measure with unclear clinical significance thresholds in adolescents. The discrepancy between reduced pain-related beliefs (a psychological outcome) and unchanged function and pain suggests that addressing thoughts about injury risk may be necessary but insufficient; structural, biomechanical, or social factors may play a larger role. The persistent pain rate of 34% at 12 months underscores that even with combined PT and psychological intervention, one-third of adolescents continued to struggle. A key limitation is that the control videos still delivered education (on anatomy and biomechanics), so the true comparison was enhanced psychological education versus standard educational PT, not psychological intervention versus no education. Additionally, adherence to the videos was not explicitly reported, and the videos were brief—cumulative exposure and depth of psychological content may have been insufficient to move the needle on function or pain in this age group.
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Open in Cadence →References
- The Effect of a Brief Psychologically Informed Education Intervention for Improving Function in Adolescents With Atraumatic Leg Pain: A Randomized Controlled Trial. — The Journal of orthopaedic and sports physical therapy (Read the original)