The Effect of a Brief Psychologically-Informed Education Intervention for Improving Function in Adolescents With Atraumatic Leg Pain: A Randomized Controlled Trial

OBJECTIVE: To assess whether adding psychologically-informed education (PIE) videos to usual care physical therapy (PT) improved function (primary outcome) and pain-related beliefs, pain, and physical activity (secondary outcomes) in adolescents with atraumatic leg pain. DESIGN: Double-blinded randomized controlled trial. METHODS: Eighty-three adolescents (mean age 14.7 ± 1.6 years; 62% female) with atraumatic leg pain (including patellofemoral pain, apophyseal injuries, tendinopathy) were randomized to view three PIE videos or control videos. All participants completed six weeks of PT. The PIE videos targeted kinesiophobia, fear-avoidance, and catastrophizing; control videos addressed anatomy and biomechanics. Outcomes were assessed at baseline, one month, and 12 months. The primary outcome was change in function (Lower Extremity Functional Scale). Secondary outcomes were pain-related beliefs, pain intensity, and physical activity. RESULTS: There was no between-group difference in function over time (p = 0.40), with similar changes at 1 month [PIE 12.5 (95% CI 7.4, 17.5); control 8.9 (95% CI 5.1, 12.8)] and 12 months [PIE 17.1 (95% CI 11.8, 22.5); control 14.9 (95% CI 10.3, 19.5)]. Adolescents in the PIE group had a greater reduction in pain-related beliefs after 1 month (fear avoidance: PIE 50% vs control 23%; kinesiophobia: PIE 50% vs control 8%; catastrophizing: PIE 27% vs control 19%; p = 0.01). There were no between-group differences in pain (p = 0.82) or physical activity (p = 0.50). At 12 months, 34%(n = 26) reported persistent pain. CONCLUSION: Brief PIE did not improve function, pain, or physical activity when added to usual PT care for adolescents with atraumatic leg pain. Adolescents who received the PIE videos reduced pain-related beliefs.