Wride James, Bannigan Katrina
Royal Devon and Exeter NHS Foundation Trust, MSK Physiotherapy Department, Exeter Community Hospital, Hospital Lane, Exeter, EX1 3RB, UK.
School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland, UK.
Scand J Pain. 2019 Apr 24;19(2):375-382. doi: 10.1515/sjpain-2018-0347.
Background and aims Patellofemoral pain (PFP) is a common knee condition causing pain around or behind the kneecap which is exacerbated by certain activities. Traditionally it has been viewed as a self-limiting condition. Recent research proves this is not the case and the evidence for poor long-term outcomes is growing. Whilst the evidence base for PFP treatment and the understanding of its aetiology is improving, it remains a complex and difficult to treat condition. In many physical conditions, it has been shown that anxiety and depression negatively affect both their management and duration. It is unclear how prevalent anxiety and depression are in PFP. This study aimed to identify the prevalence of anxiety and depression in people living with PFP in the UK. Methods In order to investigate this, a cross-sectional online survey was undertaken. Four hundred participants with self-reported symptoms of PFP were recruited through a tailored social media campaign, using modified snowball sampling. Eligibility criteria were (i) aged between 18 and 44, (ii) self-reported symptoms of PFP (using accepted criteria) (iii) resident in the UK. Exclusion criteria were previous history of patella dislocation or previous surgery to affected knee. The survey recorded demographic information, previous treatment for both PFP and anxiety and depression, the Hospital Anxiety and Depression Scale and the Anterior Knee Pain Scale. Ethical approval was gained from a University of Plymouth Ethics Committee. Results Half (49.5%; n=198) of respondents were classified as experiencing anxiety and 20.8% (n=83) as experiencing depression. The levels of anxiety and depression identified in this study are higher than those found in the general population (5.9-7.8% and 3.3-7.8%, respectively). This mirrors results which have been reported in other studies into PFP in different settings and with other musculoskeletal conditions, such as osteoarthritis and contracted shoulder. Conclusions Anxiety and depression are more common in people living with PFP than in the general population. These findings support the need for greater research into the effects of psychological factors, such as anxiety and depression, in PFP. A key area of future research will be to determine whether these psychological factors affect treatment outcomes in people living with PFP. Implications This is the first study to investigate the prevalence of anxiety and depression in people living with patellofemoral pain in the UK. This study shows that anxiety and depression are very common in people living with patellofemoral pain. The need for further work into the effects of psychological factors in patellofemoral pain is indicated.
背景与目的
髌股关节疼痛（PFP）是一种常见的膝关节疾病，会导致膝盖骨周围或后方疼痛，某些活动会使其加剧。传统上，它被视为一种自限性疾病。最近的研究证明并非如此，长期预后不佳的证据越来越多。虽然PFP治疗的证据基础及其病因学的认识正在改善，但它仍然是一种复杂且难以治疗的疾病。在许多身体疾病中，已经表明焦虑和抑郁会对其治疗和病程产生负面影响。目前尚不清楚PFP患者中焦虑和抑郁的普遍程度如何。本研究旨在确定英国PFP患者中焦虑和抑郁的患病率。
方法
为了对此进行调查，开展了一项横断面在线调查。通过量身定制的社交媒体活动，采用改良的雪球抽样方法，招募了400名自我报告有PFP症状的参与者。纳入标准为：（i）年龄在18至44岁之间；（ii）自我报告有PFP症状（采用公认标准）；（iii）居住在英国。排除标准为既往有髌骨脱位史或患侧膝关节既往手术史。该调查记录了人口统计学信息、既往PFP以及焦虑和抑郁的治疗情况、医院焦虑抑郁量表和膝前疼痛量表。获得了普利茅斯大学伦理委员会的伦理批准。
结果
一半（49.5%；n = 198）的受访者被归类为有焦虑症状，20.8%（n = 83）有抑郁症状。本研究中确定的焦虑和抑郁水平高于一般人群（分别为5.9 - 7.8%和3.3 - 7.8%）。这与其他针对不同环境下的PFP以及其他肌肉骨骼疾病（如骨关节炎和肩周炎）的研究结果相符。
结论
PFP患者中焦虑和抑郁比一般人群更常见。这些发现支持对焦虑和抑郁等心理因素在PFP中的影响进行更多研究的必要性。未来研究的一个关键领域将是确定这些心理因素是否会影响PFP患者的治疗结果。
意义
这是第一项调查英国髌股关节疼痛患者中焦虑和抑郁患病率的研究。该研究表明，焦虑和抑郁在髌股关节疼痛患者中非常常见。这表明需要进一步研究心理因素在髌股关节疼痛中的作用。
