Smith Benjamin E, Moffatt Fiona, Hendrick Paul, Bateman Marcus, Rathleff Michael Skovdal, Selfe James, Smith Toby O, Logan Pip
Physiotherapy Department, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK.
Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK.
BMJ Open. 2018 Jan 23;8(1):e018624. doi: 10.1136/bmjopen-2017-018624.
To investigate the experience of living with patellofemoral pain (PFP).
Qualitative study design using semistructured interviews and analysed thematically using the guidelines set out by Braun and Clarke.
A National Health Service physiotherapy clinic within a large UK teaching hospital.
A convenience sample of 10 participants, aged between 18 and 40 years, with a diagnosis of PFP and on a physiotherapy waiting list, prior to starting physiotherapy.
Participants offered rich and detailed accounts of the impact and lived experience of PFP, including loss of physical and functional ability; loss of self-identity; pain-related confusion and difficulty making sense of their pain; pain-related fear, including fear-avoidance and 'damage' beliefs; inappropriate coping strategies and fear of the future. The five major themes that emerged from the data were: (1) impact on self; (2) uncertainty, confusion and sense making; (3) exercise and activity beliefs; (4) behavioural coping strategies and (5) expectations of the future.
These findings offer an insight into the lived experience of individuals with PFP. Previous literature has focused on pain and biomechanics, rather than the individual experience, attached meanings and any wider context within a sociocultural perspective. Our findings suggest that future research is warranted into biopsychosocial targeted interventions aimed at the beliefs and pain-related fear for people with PFP. The current consensus that best-evidence treatments consisting of hip and knee strengthening may not be adequate to address the fears and beliefs identified in the current study. Further qualitative research may be warranted on the impact and interpretation of medical terminology commonly used with this patient group, for example, 'weakness' and 'patellar mal-tracking' and its impact and interpretation by patients.
ISRCTN35272486; Pre-results.
探讨髌股疼痛（PFP）患者的生活体验。
采用半结构式访谈的定性研究设计，并根据布劳恩和克拉克提出的指导方针进行主题分析。
英国一家大型教学医院内的国民保健服务物理治疗诊所。
一个便利样本，由10名年龄在18至40岁之间、被诊断为PFP且在开始物理治疗前在物理治疗等候名单上的参与者组成。
参与者详细阐述了PFP的影响和生活体验，包括身体和功能能力的丧失；自我认同的丧失；与疼痛相关的困惑以及难以理解自身疼痛；与疼痛相关的恐惧，包括恐惧回避和“损伤”信念；不适当的应对策略以及对未来的恐惧。从数据中得出的五个主要主题是：（1）对自我的影响；（2）不确定性、困惑与意义建构；（3）运动和活动信念；（4）行为应对策略；（5）对未来的期望。
这些发现深入了解了PFP患者的生活体验。以往文献关注的是疼痛和生物力学，而非个体体验、附加意义以及社会文化视角下的更广泛背景。我们的研究结果表明，未来有必要针对PFP患者的信念和与疼痛相关的恐惧进行生物心理社会靶向干预的研究。目前认为由髋部和膝部强化组成的最佳证据治疗可能不足以解决本研究中确定的恐惧和信念。可能有必要对该患者群体常用的医学术语（如“虚弱”和“髌骨轨迹不良”）的影响和解释及其对患者的影响和解释进行进一步的定性研究。
ISRCTN35272486；预结果。
