Patellofemoral Pain (PFP) is a common knee problem, primarily affecting adolescents and young adults. PFP is characterised by significant retropatellar and/or peripatellar pain and impairment of function and quality of daily life. Exercise therapy is unequivocally recommended as a core component of the management of PFP. Different exercise types (e.g. quadriceps strengthening, hip strengthening and functional/neuromuscular exercises) have been investigated, with knee and hip strengthening exercises as the most common and recommended types. These exercises approaches produce similar small to moderate effects on pain and physical function. However, the PFP population is very heterogeneous and "one-size-fits-all"-approaches presumably are sub-optimal because the heterogeneity is ignored. The heterogeneity probably explains the overall limited beneficial effects of exercise, and the lack of differences in direct comparisons of different exercise types. In that sense, it is not unlikely that certain patient characteristics may predict outcome success of either a hip training program or a training program that focus on the quadriceps but this remains to be shown. This study has two aims: 1. To assess the comparative effectiveness of two different exercise programs (Quadricep Exercise \[QE\] vs. Hip Exercise \[HE\]) on self-reported pain and function in individuals with PFP. 2. To explore candidate patient characteristics that predict differential responses to the two exercise programs (QE vs HE) on self-reported pain and physical function in individuals with PFP. According to the study aims we pursue the following hypothesis: \- QE and HE have equivalent efficacy on self-reported pain after 12 weeks of treatment in patients with PFP. The second study aim is to explore possible candidate patient characteristics that may associate with differential outcomes. As this is exploratory, the pursuit of this aim is hypothesis-free.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
200
The exercise program is initiated at an individual clinical visit. An experienced physiotherapist introduces the participant to the exercise program and provides instructions to the individual exercises. An experienced physiotherapist provides the monthly supervision visits. The program details can be requested rom the responsible party. In brief the QE-program consists of: \- A short warm-up and 3 specific exercises for the quadriceps muscle Progression of the exercise intensity is done by adding (additional) external loads, such as elastic rubber bands, free weights, etc.
The exercise program is initiated at an individual clinical visit. An experienced physiotherapist introduces the participant to the exercise program and provides instructions to the individual exercises. An experienced physiotherapist provides the monthly supervision visits. The program details be requested rom the responsible party. In brief the HE-program consists of: \- A short warm-up and 3 specific exercises for the hip abductor and extensor muscles Progression of the exercise intensity is done by adding (additional) external loads, such as elastic rubber bands, body weight etc.
Bispebjerg Hospital, Department of Physical and Occupational Therapy
Copenhagen, Denmark
Change from baseline in the KUJALA scoring questionnaire
The Kujala Patellofemoral Scale - sometimes called the anterior knee pain scale - is disease specific validated disability scale ranging from 0 (complete disability) to 100 (fully functional). It is a 13-item self-report questionnaire that documents response to 6 activities (walking, running, jumping, climbing stairs, squatting, and sitting for prolonged periods with knees bent), as well as symptoms such as limp, inability to weight bear, swelling, abnormal patellar movement, muscle atrophy, and limitations in knee flexion.
Time frame: week 12 and 26
Change from baseline in the KOOS questionnaire
The Knee injury and Osteoarthritis Outcome Score (KOOS) is used to assess patient-reported knee-related symptoms. The KOOS is a patient-reported outcome measurement instrument developed to assess the patient's opinion about their knee and associated problems.KOOS comprises of 42 items in 5 separately scored subdomains: KOOS Pain (9 items), KOOS Symptoms (7 items), Function in daily living (KOOS Function; 17 items), Function in Sport and Recreation (5 items), and Knee-related Quality of Life (4 items). The previous week is the time period considered when answering the questions, and the questions relate to one knee (the target knee in this trial).
Time frame: Week 12 and 26
Change fom baseline in isometric muscle strength of hip abductors, hip external rotators, hip extensors, and quadriceps
Isometric muscle strength of hip abductors, hip external rotators, quadriceps, and hamstrings is performed by using a handheld dynamometer following a previously published testing protocol.
Time frame: Week 12
Change fom baseline in the Dynamic Assessment of Pain test
The Dynamic Assessment of Pain Test is a simple performance test with an integrated pain score, designed to provide useful information for monitoring treatment progress and evaluating treatment effects in clinical physiotherapy practice. The patient is asked to perform as many squatting movements (both legs) as possible within 30 seconds. The knees should reach approximately 90 degrees of flexion and full extension for each squat. This is supervised by the rater. There outcome of the test is the knee pain during the test on a 0-10 Numeric Rating Scale (NRS) rated immediately after the test.
Time frame: Week 12
Change fom baseline in the Pain Self-Efficacy Questionnaire
The pain self-efficacy questionnaire is a 10-item questionnaire developed to assess the confidence people with pain have in performing activities while in pain. It is applicable to all persisting pain presentations, and covers a range of functions. Confidence in performing activities are rated on a 7-point (0-6) Likert scale with 0 representing not at all confident and 6 representing completely confident. A total score is calculated by summing the answers producing a score between 0 and 60. Higher scores reflect stronger self-efficacy beliefs.
Time frame: Week 12 and 26
Change fom baseline in the EuroQoL Questionnaire
The EuroQoL questionnaire is a standardised patient-reported instrument for use as a measure of health related quality of life.
Time frame: Week 12 and 26
Transition Questionnaire of global perceived effect on overall health, pain, and function
The Transition Questionnaire of global perceived effect is an adaptive questionnaire in which the participants initially answer if their current state is "unchanged, worse" or "better" compared to the baseline visit. An "unchanged" equals a transition score of 0. If the participant answers "worse", he/she is asked to rate the degree of worsening on a 7 point Likert scale, and the corresponding scores range from -1 to -7. Correspondingly, if a participant answers "better", he/she is asked to rate the degree of improvement on a 7 point Likert scale, and the corresponding scores range from 1 to 7. Thus the Transition score range from -7 (worsening) to 7 (improvement), with the mid-point - 0 - representing no change. The transition scale is used to assess overall knee related health status.
Time frame: Week 12 and 26
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