Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial

Abstract

Objective To assess the effectiveness of supervised exercise therapy compared with usual care with respect to recovery, pain, and function in patients with patellofemoral pain syndrome.Design Open label randomised controlled trial.Setting General practice and sport physician practice.Participants Patients with a new episode of patellofemoral pain syndrome recruited by their general practitioner or sport physician.Interventions The intervention group received a standardised exercise programme for 6 weeks tailored to individual performance and supervised by a physical therapist, and were instructed to practise the tailored exercises at home for 3 months. The control group were assigned usual care, which comprised a “wait and see” approach of rest during periods of pain and refraining from pain provoking activities. Both the intervention group and the control group received written information about patellofemoral pain syndrome and general instructions for home exercises.Main outcome measures The primary outcomes were self reported recovery (7 point Likert scale), pain at rest and pain on activity (0-10 point numerical rating scale), and function (0-100 point Kujala patellofemoral score) at 3 months and 12 months follow-up.Results A total of 131 participants were included in the study: 65 in the intervention group and 66 in the control group. After 3 months, the intervention group showed better outcomes than the control group with regard to pain at rest (adjusted difference −1.07, 95% confidence interval −1.92 to −0.22; effect size 0.47), pain on activity (−1.00, −1.91 to −0.08; 0.45), and function (4.92, 0.14 to 9.72; 0.34). At 12 months, the intervention group continued to show better outcomes than the control group with regard to pain (adjusted difference in pain at rest −1.29, −2.16 to −0.42; effect size 0.56; pain on activity −1.19, −2.22 to −0.16; effect size 0.54), but not function (4.52, −0.73 to 9.76). A higher proportion of patients in the exercise group than in the control group reported recovery (41.9% v 35.0% at 3 months and 62.1% v 50.8% at 12 months), although the differences in self reported recovery between the two groups were not statistically significant. Predefined subgroup analyses revealed that patients recruited by sport physicians (n=30) did not benefit from the intervention, whereas those recruited by general practitioners (n=101) showed significant and clinically relevant differences in pain and function in favour of the intervention group.Conclusion Supervised exercise therapy resulted in less pain and better function at short term and long term follow-up compared with usual care in patients with patellofemoral pain syndrome in general practice. Exercise therapy did not produce a significant difference in the rate of self reported recovery.Trial registration ISRCTN83938749.

Efficacy of Nonsurgical Interventions for Anterior Knee Pain

“…[11,45,46] However, it appears that the addition of hip components, supervision, or other adjunct interventions to quadriceps-based programs does not change AKP outcomes. It is important to highlight that these studies tended to lack specific vasti retraining, instead aiming for general quadriceps strengthening.…”

“…[11,45,46] Herrington Two studies evaluated hip exercises as an addition to standard exercise programs ( Figure 3). …”

“…[1][2][3][4][5][6][7][8] It affects an individual's ability to perform routine daily activities such as stair ambulation, walking and running, and thus impacts on work-related activities and participation in physical activity. Findings from prospective studies in active populations [9][10][11] reflect the chronicity of AKP, with a randomised controlled trial (RCT) reporting no recovery in half of the no-treatment control group at 12 months. [11] Furthermore, it is plausible that AKP in adults may precede the development of osteoarthritis in later years.…”

“…Findings from prospective studies in active populations [9][10][11] reflect the chronicity of AKP, with a randomised controlled trial (RCT) reporting no recovery in half of the no-treatment control group at 12 months. [11] Furthermore, it is plausible that AKP in adults may precede the development of osteoarthritis in later years. [12] Despite its prevalence, chronicity and impact, AKP remains one of the most challenging musculoskeletal conditions managed by practitioners.…”

Effects of strength training on the treatment of patellofemoral pain syndrome - a meta-analysis of randomized controlled trials

“…PFPS affects around 7% of active young adults and about 25% of people at some stage in their lives, but is most common among the former (5). Incidence rates are even more pronounced among sports enthusiasts, accounting for up to 40% of injuries in sports medicine (6).…”