Investigating the prevalence of anxiety and depression in people living with patellofemoral pain in the UK
James Wride, Specialist Musculoskeletal Physiotherapist, Royal Devon and Exeter NHS Foundation Trust
BACKGROUND: Patellofemoral pain is a common knee condition causing pain around or behind the kneecap which is exacerbated by certain activities. It is commonly found in younger and more active people. Traditionally it has been viewed as a self-limiting condition. Recent research proves this is not the case. In many other conditions, it has been shown that anxiety and depression negatively affect both the treatability, and duration of, conditions. It is unclear how prevalent anxiety and depression are in patellofemoral pain.
AIM: To identify the prevalence of anxiety and depression in people experiencing patellofemoral pain in the UK.
DESIGN AND METHODS: A cross-sectional online survey design was utilised. Four hundred participants with self-reported symptoms of patellofemoral pain, based on accepted criteria, were recruited from a wide variety of online sources. The survey recorded demographic information, the Hospital Anxiety and Depression Scale and the Anterior Knee Pain Scale.
RESULTS: Half (49.5%; n=198) of respondents were classified as experiencing anxiety and 20.8% (n=83) as experiencing depression. A small statistically significant negative correlation was found between increased severity of patellofemoral symptoms and increased levels of anxiety and depression.
CONCLUSIONS: Anxiety and depression are more common in people living with patellofemoral pain than the general population. The study suggests a link between increased symptoms and more severe psychological symptoms, but no causal link can be drawn. This is the first study to investigate this in the UK and highlights the need for further investigation to determine if anxiety and depression affects treatment outcomes in patellofemoral pain.
BIOGRAPHY: James is a Specialist Musculoskeletal Physiotherapist working for the Royal Devon and Exeter NHS Foundation Trust. He has a special interest in lower limb injuries and rehabilitation, with an interest in patellofemoral pain. He is a NIHR trainee having recently completed a funded Masters in Clinical Research at the University of Plymouth. James’ research focuses around the psychological aspects of musculoskeletal conditions and how these can affect treatment outcomes and quality of life.
INSTEP - Insoles to Ease Pressure
Richard Collings, NIHR Clinical Doctoral Researcher,
University of Plymouth
BACKGROUND: As a common long-term complication, diabetic foot disease is associated with impaired quality of life, high direct and indirect treatment costs and high rates of mortality. Reducing plantar foot pressures is one crucial aspect of optimising healing potential and preventing foot ulceration, particularly in neuropathic feet absent of protective sensation, where plantar loads and tissue stress are increased. Therapeutic footwear and insoles are utilised to reduce plantar pressures. However, their effectiveness is variable and often evaluated by the high risk strategy of observing foot health and tissue integrity over time with frequent service provision and manufacturing delays.
RESEARCH DESIGN AND METHODS: A mixed methods feasibility double-blinded multicentre randomised controlled trial with subjects randomised to wear either an insole designed by in-shoe plantar pressure measurement technology (n=38) or a standard cushioned insole (n=38) over 3 sites (Torbay, Exeter, Solent).
BENEFITS: The results of this study will inform the design of a large scale multi-centred RCT to examine the clinical and cost effectiveness of the in-shoe pressure analysis designed insole. It will aim to provide an innovative service to the diabetic population in an attempt reduce the incidence of ulcer occurrence/re-occurrence making significant savings, both financial and in quality of life for patients and the NHS. It will provide a reliable model that can be utilised by other foot protection services within the national arena.
BIOGRAPHY: Graduating from the University of Plymouth in 2007 with a BSc (Hons) Podiatry, Richard undertook an MSc in Clinical Podiatric Biomechanics in 2013 at Stafford University. Richard started his PhD in April 2016 with a prestigious NIHR Clinical Doctoral Fellowship. His research is looking at incorporating an instant insole solution into NHS practice for ulcer prevention in people with diabetes. He currently works part time on his PhD and part time in the NHS in his role as a Team Lead Podiatrist, specialising in Musculoskeletal disorders. Richard has been a member of the Balance Enhancement and Ulcer Prevention (BEUP) collaborative for the last four years and as part of the Rehabilitation team for the School for Health Professions.