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

Abstract

<b>OBJECTIVE:</b> 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. <b>DESIGN:</b> Double-blinded randomized controlled trial. <b>METHODS:</b> 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. <b>RESULTS:</b> There was no between-group difference in function over time (<i>P</i> = .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%; <i>P</i> = .01). There were no between-group differences in pain (<i>P</i> = .82) or physical activity (<i>P</i> = .50). At 12 months, 34% (n = 26) reported persistent pain. <b>CONCLUSION:</b> 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. <i>J Orthop Sports Phys Ther 2026;56(8):555-562. Epub 26 May 2026. doi:10.2519/jospt.2026.14057</i>.