Two Weeks of Wearing a Knee Brace Compared With Minimal Intervention on Kinesiophobia at 2 and 6 Weeks in People With Patellofemoral Pain: A Randomized Controlled Trial

Published:December 09, 2019DOI:



      To investigate the effect of a knee brace compared with minimal intervention on self-reported kinesiophobia and function, objective function, and physical activity level in people with patellofemoral pain (PFP).


      Single-blind randomized controlled trial (1:1), parallel.


      Individuals with PFP (N=50).

      Main Outcome Measures

      Primary: kinesiophobia (Tampa Scale for Kinesiophobia). Secondary: self-reported function (Anterior Knee Pain Scale), physical activity level (International Physical Activity Questionnaire), and objective function (forward step-down test). Outcomes were assessed at baseline (T0), at the end of the intervention (2wk) (T1), and at 6 weeks after baseline (T2).


      Participants were randomly assigned to 1 of 2 interventions groups: (1) use of knee brace for 2 weeks during daily living, sports, or painful tasks (brace group) and (2) educational leaflet with information about PFP (leaflet group).


      The knee brace reduced kinesiophobia in people with PFP compared with minimal intervention with moderate effect size at T1=mean difference (95% CI) −5.56 (−9.18 to −1.93) and T2=−5.24 (−8.58 to −1.89). There was no significant difference in self-reported and objective function and physical activity level.


      The knee brace improved kinesiophobia immediately after intervention (at 2wk) and at 6-week follow-up in people with PFP compared with minimal intervention. A knee brace may be considered within clinically reasoned paradigms to facilitate exercise therapy interventions for people with PFP.


      List of abbreviations:

      AKPS (Anterior Knee Pain Scale), PFP (patellofemoral pain), RCT (randomized clinical trial)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Smith B.E.
        • Selfe J.
        • Rathleff M.S.
        Incidence and prevalence of patellofemoral pain: a systematic review and meta-analysis.
        PLoS One. 2018; 13e0190892
        • Dey P.
        • Callaghan M.
        • Cook N.
        • et al.
        A questionnaire to identify patellofemoral pain in the community: an exploration of measurement properties.
        BMC Musculoskelet Disord. 2016; 17: 237
        • Crossley K.M.
        • Stefanik J.J.
        • Selfe J.
        • et al.
        2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures.
        Br J Sports Med. 2016; 50: 839-843
        • Nimon G.
        • Murray D.
        • Sandow M.
        • Goodfellow J.
        Natural history of anterior knee pain: a 14- to 20-year follow-up of nonoperative management.
        J Pedriatric Orthop. 1998; 18: 118-122
        • Powers C.M.
        • Witvrouw E.
        • Davis I.S.
        • Crossley K.M.
        Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3.
        Br J Sports Med. 2017; 51: 1713-1723
        • Maclachlan L.R.
        • Collins N.J.
        • Matthews M.L.G.
        • Hodges P.W.
        • Vicenzino B.
        The psychological features of patellofemoral pain: a systematic review.
        Br J Sports Med. 2017; 51: 732-742
        • Domenech J.
        • Sanchis-Alfonso V.
        • López L.
        • Espejo B.
        Influence of kinesiophobia and catastrophizing on pain and disability in anterior knee pain patients.
        Knee Surg Sport Traumatol Arthrosc. 2013; 21: 1562-1568
        • Maclachlan L.R.
        • Matthews M.
        • Hodges P.W.
        • Collins N.J.
        • Vicenzino B.
        The psychological features of patellofemoral pain: a cross-sectional study.
        Scand J Pain. 2018; 18: 261-271
        • Priore L.B.
        • Azevedo F.M.
        • Pazzinatto M.F.
        • et al.
        Influence of kinesiophobia and pain catastrophism on objective function in women with patellofemoral pain.
        Phys Ther Sport. 2019; 35: 116-121
        • De Oliveira Silva D.
        • Pazzinatto M.F.
        • Priore L.B. Del
        • et al.
        Knee crepitus is prevalent in women with patellofemoral pain, but is not related with function, physical activity and pain.
        Phys Ther Sport. 2018; 33: 7-11
        • De Oliveira Silva D.
        • Barton C.J.
        • Briani R.V.
        • et al.
        Kinesiophobia, but not strength is associated with altered movement in women with patellofemoral pain.
        Gait Posture. 2019; 68: 1-5
        • Collins N.J.
        • Barton C.J.
        • van Middelkoop M.
        • et al.
        2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017.
        Br J Sports Med. 2018; 52: 1170-1178
        • Lankhorst N.E.
        • van Middelkoop M.
        • Crossley K.M.
        • et al.
        Factors that predict a poor outcome 5-8 years after the diagnosis of patellofemoral pain: a multicentre observational analysis.
        Br J Sports Med. 2016; 50: 881-886
        • Doménech J.
        • Sanchis-Alfonso V.
        • Espejo B.
        Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain.
        Knee Surg Sport Traumatol Arthrosc. 2014; 22: 2295-2300
        • Goldberg P.
        • Zeppieri G.
        • Bialosky J.
        • et al.
        Kinesiophobia and its association with health-related quality of life across injury locations.
        Arch Phys Med Rehabil. 2018; 99: 43-48
        • Hart H.F.
        • Crossley K.M.
        • Ackland D.C.
        • Cowan S.M.
        • Collins N.J.
        Effects of an unloader knee brace on knee-related symptoms and function in people with post-traumatic knee osteoarthritis after anterior cruciate ligament reconstruction.
        Knee. 2016; 23: 85-90
        • Cudejko T.
        • van der Esch M.
        • van der Leeden M.
        • et al.
        Effect of soft braces on pain and physical function in patients with knee osteoarthritis: systematic review with meta-analyses.
        Arch Phys Med Rehabil. 2018; 99: 153-163
        • Arazpour M.
        • Notarki T.T.
        • Salimi A.
        • Bani M.A.
        • Nabavi H.
        • Hutchins S.W.
        The effect of patellofemoral bracing on walking in individuals with patellofemoral pain syndrome.
        Prosthet Orthot Int. 2013; 37: 465-470
        • Collins N.
        • Crossley K.
        • Beller E.
        • Darnell R.
        • McPoil T.
        • Vicenzino B.
        Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial.
        BMJ. 2008; 337: a1735
        • Décary S.
        • Frémont P.
        • Pelletier B.
        • et al.
        Validity of combining history elements and physical examination tests to diagnose patellofemoral pain.
        Arch Phys Med Rehabil. 2018; 99: 607-614.e1
        • Crossley K.M.
        • Bennell K.L.
        • Cowan S.M.
        • Green S.
        Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid?.
        Arch Phys Med Rehabil. 2004; 85: 815-822
        • Cunha R.A.
        • Costa L.O.P.
        • Hespanhol Junior L.C.
        • Pires R.S.
        • Kujala U.M.
        • Lopes A.D.
        Translation, cross-cultural adaptation, and clinimetric testing of instruments used to assess patients with patellofemoral pain syndrome in the Brazilian population.
        J Orthop Sports Phys Ther. 2013; 43: 332-339
        • Kujala U.M.
        • Jaakkola L.H.
        • Koskinen S.K.
        • Taimela S.
        • Hurme M.
        • Nelimarkka O.
        Scoring of patellofemoral disorders.
        Arthroscopy. 1993; 9: 159-163
        • Karachalios T.
        • Hantes M.
        • Zibis A.
        • Zachos V.
        • Karantanas A.
        • Malizos K.
        Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears.
        J Bone Joint Surg Am. 2005; 87: 955-962
        • Kim J.
        • Shin W.
        How to do random allocation (randomization).
        Clin Orthop Surg. 2014; 6: 103-109
        • de Souza F.S.
        • Marinho C.D.S.
        • Siqueira F.B.
        • Maher C.G.
        • Costa L.O.P.
        Psychometric testing confirms that the Brazilian-Portuguese adaptations, the original versions of the Fear-Avoidance Beliefs Questionnaire, and the Tampa Scale of Kinesiophobia have similar measurement properties.
        Spine (Phila Pa 1976). 2008; 33: 1028-1033
        • French D.J.
        • France C.R.
        • Vigneau F.
        • French J.A.
        • Evans R.T.
        Fear of movement/(re)injury in chronic pain: a psychometric assessment of the original English version of the Tampa scale for kinesiophobia (TSK).
        Pain. 2007; 127: 42-51
        • Kori S.H.
        • Miller R.P.
        • Todd D.D.
        Kinesiophobia: a new view of chronic pain behavior.
        Pain Manag. 1990; 3: 35-43
        • Craig C.L.
        • Marshall A.L.
        • Sjöström M.
        • et al.
        International physical activity questionnaire: 12-country reliability and validity.
        Med Sci Sports Exerc. 2003; 35: 1381-1395
        • Briani R.V.
        • Pazzinatto M.F.
        • Silva D.O.
        • Azevedo F.M.
        Different pain responses to distinct levels of physical activity in women with patellofemoral pain.
        Brazilian J Phys Ther. 2017; 21: 138-143
        • Loudon J.K.
        • Wiesner D.
        • Goist-Foley H.L.
        • Asjes C.
        • Loudon K.L.
        Intrarater reliability of functional performance tests for subjects with patellofemoral pain syndrome.
        J Athl Train. 2002; 37: 256-261
        • Sullivan G.M.
        • Feinn R.
        Using effect size - or why the P value is not enough.
        J Grad Med Educ. 2012; 4: 279-282
        • Lack S.
        • Neal B.
        • De Oliveira Silva D.
        • Barton C.
        How to manage patellofemoral pain – understanding the multifactorial nature and treatment options.
        Phys Ther Sport. 2018; 32: 155-166
        • Petersen W.
        • Ellermann A.
        • Rembitzki I.V.
        • et al.
        Evaluating the potential synergistic benefit of a realignment brace on patients receiving exercise therapy for patellofemoral pain syndrome: a randomized clinical trial.
        Arch Orthop Trauma Surg. 2016; 136: 975-982
        • Foroughi F.
        • Sobhani S.
        • Yoosefinejad A.K.
        • Motealleh A.
        Added value of isolated core postural control training on knee pain and function in women with patellofemoral pain syndrome: a randomized controlled trial.
        Arch Phys Med Rehabil. 2019; 100: 220-229
        • Chughtai M.
        • Khlopas A.
        • Mont M.A.
        • et al.
        Clinical outcomes of a pneumatic unloader brace for Kellgren-Lawrence grades 3 to 4 osteoarthritis: a minimum 1-year follow-up study.
        J Knee Surg. 2016; 29: 634-638
        • Hsieh L.F.
        • Lin Y.T.
        • Wang C.P.
        • Liu Y.F.
        • Tsai C.T.
        Comparison of the effect of Western-made unloading knee brace with physical therapy in Asian patients with medial compartment knee osteoarthritis - a preliminary report.
        J Formos Med Assoc. 2020; 119: 319-326
        • Smith T.O.
        • Drew B.T.
        • Meek T.H.
        • Clark A.B.
        Knee orthoses for treating patellofemoral pain syndrome.
        Cochrane Database Syst Rev. 2015; 12: CD010513
        • Thoumie P.
        • Marty M.
        • Avouac B.
        • et al.
        Effect of unloading brace treatment on pain and function in patients with symptomatic knee osteoarthritis: the ROTOR randomized clinical trial.
        Sci Rep. 2018; 8: 1-9
        • Petersen W.
        • Ellermann A.
        • Henning J.
        • et al.
        Non-operative treatment of unicompartmental osteoarthritis of the knee: a prospective randomized trial with two different braces: ankle-foot orthosis versus knee unloader brace.
        Arch Orthop Trauma Surg. 2019; 139: 155-166