Orthopedics · Medical Literature
The Effect of a Brief Psychologically Informed Education Intervention for Improving Function in Adolescents With Atraumatic Leg Pain: A Randomized Controlled Trial.
Abstract
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 intensity, 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 3 PIE or control videos. All participants completed 6 weeks of PT. The PIE videos targeted kinesiophobia, fear avoidance, and catastrophizing; the control videos addressed anatomy and biomechanics. Outcomes were assessed at baseline, 1 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 = .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 = .01). There were no between-group differences in pain (P = .82) or physical activity (P = .50). At 12 months, 34% (n = 26) reported persistent pain. CONCLUSION: Brief PIE did not improve function, pain intensity, 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. J Orthop Sports Phys Ther 2026;56(8):555-562. Epub 26 May 2026. doi:10.2519/jospt.2026.14057.
Clinical relevance
Maladaptive pain-related beliefs such as kinesiophobia, fear avoidance, and catastrophizing are increasingly recognized contributors to persistent musculoskeletal pain in adolescents, yet evidence-based psychological adjuncts to standard physical therapy remain underexplored in this population. This RCT addresses that gap by evaluating a pragmatic, scalable psychologically informed education (PIE) video intervention in adolescents with common atraumatic leg conditions including patellofemoral pain, apophyseal injuries, and tendinopathy. Clinicians managing adolescent musculoskeletal pain should be aware of these findings given the notable 34% rate of persistent pain at 12 months in this cohort, underscoring the need for effective early intervention strategies.
Key findings
1. No significant between-group difference in the primary outcome of lower extremity function (Lower Extremity Functional Scale) was observed over time (P = .40), with comparable gains at 1 month (PIE: +12.5 [95% CI: 7.4–17.5] vs. control: +8.9 [95% CI: 5.1–12.8]) and 12 months (PIE: +17.1 [95% CI: 11.8–22.5] vs. control: +14.9 [95% CI: 10.3–19.5]). 2. The PIE group demonstrated significantly greater reductions in pain-related beliefs at 1 month compared to controls (overall P = .01), representing a clinically meaningful psychological effect. 3. Fear avoidance decreased by 50% in the PIE group versus 23% in the control group at 1 month. 4. Kinesiophobia decreased by 50% in the PIE group versus only 8% in the control group at 1 month, representing the largest between-group differential observed. 5. Catastrophizing decreased by 27% in the PIE group versus 19% in the control group at 1 month, though this difference was less pronounced relative to the other belief domains. 6. No significant between-group differences were found for pain intensity (P = .82) or physical activity (P = .50) at any time point; 34% of the total sample (n = 26) reported persistent pain at 12-month follow-up.
Practice implications
Brief PIE delivered via video format as an adjunct to a 6-week physical therapy program should not be expected to improve functional outcomes, pain intensity, or physical activity levels in adolescents with atraumatic leg pain, and therefore cannot replace or meaningfully augment usual PT care for these endpoints. However, the significant short-term reductions in kinesiophobia and fear avoidance beliefs observed in the PIE group (with NNTs not reported) suggest that video-based psychoeducation may be a low-cost, scalable tool to address maladaptive cognitions early in the treatment course, particularly in adolescents who screen positive for elevated pain catastrophizing or fear-avoidance behaviors. Clinicians should remain vigilant for persistent pain, given the 34% prevalence at 12 months, and consider whether more intensive or individualized psychological interventions—beyond brief video-based education—are warranted for adolescents who fail to achieve functional recovery with standard PT.