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Study protocol: a randomised controlled trial comparing the long term effects of isolated hip strengthening, quadriceps-based training and free physical activity for patellofemoral pain syndrome (anterior knee pain).

Abstract

BACKGROUND

Patellofemoral pain syndrome (PFPS), also known as Anterior Knee Pain, is a common cause of recurrent or chronic knee pain. The etiology is considered to be multifactorial but is not completely understood. At the current time the leading theory is that pathomechanics in the patellofemoral joint leads to PFPS. Traditionally, conservative treatment has focused on improving strength and timing in the quadriceps muscles. In recent years, evidence has been accumulating to support the importance of hip control and strengthening in PFPS. Two recent studies have shown promising results for hip strengthening as an isolated treatment for PFPS. The aim of this randomised controlled trial (RCT) is to compare isolated hip strengthening to traditional quadriceps-based training and a control group with free physical activity.

METHODS/DESIGN

An observer-blinded RCT will be performed. We intend to include 150 patients aged 16-40 years, referred from primary care practitioners to the department of Physical Medicine and Rehabilitation in Kristiansand, Norway for PFPS with more than three months duration. Patients meeting the inclusion criteria will be randomised using opaque sequentially numbered sealed envelopes to one of three groups: isolated hip strengthening, quadriceps based training, or a control group (free physical activity). All groups will receive standardized information about PFPS formulated with the intention to minimize fear avoidance and encourage self-mastery of symptoms. Standardized exercises will be performed under supervision of a study physiotherapist once per week in addition to home training two times per week for a total of six weeks. The primary outcome measure will be the Anterior Knee Pain Score (AKPS) at three and 12 months. Secondary outcome measures will include Visual analogue scale (VAS) for pain, hip abductor and quadriceps strength, the generic EuroQol (EQ-5D), Hopkins Symptom Checklist (HSCL), Knee self-efficacy score and Tampa score for Kinesiophobia.

DISCUSSION

This trial will help to elucidate the role of hip and quadriceps strengthening in the treatment of PFPS. Information as to the role of anxiety and depression, kinesiophobia and self-efficacy will be collected, also as regards prognosis and response to exercise therapy.

TRIAL REGISTRATION

ClinicalTrials.gov reference: NCT02114294.

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  • Authors+Show Affiliations

    ,

    Department of Physical Medicine and Rehabilitation, Sorlandet Hospital Kristiansand, PO box 416, 4604, Kristiansand, Norway. alexandra.hott@sshf.no.

    ,

    Department of Orthopedic Surgery, Sorlandet Hospital Arendal, PO box 783 Stoa, 4809, Arendal, Norway. sigurd.liavaag@sshf.no.

    ,

    Department of Physical Medicine and Rehabilitation, Oslo University Hospital-Ullevål, PO box 4956, Nydalen, 0424, Oslo, Norway. UXNGJU@ous-hf.no.

    Department of Physical Medicine and Rehabilitation, Oslo University Hospital-Ullevål, PO box 4956, Nydalen, 0424, Oslo, Norway. j.i.brox@medisin.uio.no.

    Source

    BMC musculoskeletal disorders 16: 2015 Feb 25 pg 40

    MeSH

    Adolescent
    Adult
    Biomechanical Phenomena
    Clinical Protocols
    Female
    Hip Joint
    Humans
    Male
    Motor Activity
    Muscle Strength
    Norway
    Patellofemoral Pain Syndrome
    Quadriceps Muscle
    Research Design
    Resistance Training
    Time Factors
    Treatment Outcome
    Young Adult

    Pub Type(s)

    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    25879452

    Citation

    Hott, Alexandra, et al. "Study Protocol: a Randomised Controlled Trial Comparing the Long Term Effects of Isolated Hip Strengthening, Quadriceps-based Training and Free Physical Activity for Patellofemoral Pain Syndrome (anterior Knee Pain)." BMC Musculoskeletal Disorders, vol. 16, 2015, p. 40.
    Hott A, Liavaag S, Juel NG, et al. Study protocol: a randomised controlled trial comparing the long term effects of isolated hip strengthening, quadriceps-based training and free physical activity for patellofemoral pain syndrome (anterior knee pain). BMC Musculoskelet Disord. 2015;16:40.
    Hott, A., Liavaag, S., Juel, N. G., & Brox, J. I. (2015). Study protocol: a randomised controlled trial comparing the long term effects of isolated hip strengthening, quadriceps-based training and free physical activity for patellofemoral pain syndrome (anterior knee pain). BMC Musculoskeletal Disorders, 16, p. 40. doi:10.1186/s12891-015-0493-6.
    Hott A, et al. Study Protocol: a Randomised Controlled Trial Comparing the Long Term Effects of Isolated Hip Strengthening, Quadriceps-based Training and Free Physical Activity for Patellofemoral Pain Syndrome (anterior Knee Pain). BMC Musculoskelet Disord. 2015 Feb 25;16:40. PubMed PMID: 25879452.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Study protocol: a randomised controlled trial comparing the long term effects of isolated hip strengthening, quadriceps-based training and free physical activity for patellofemoral pain syndrome (anterior knee pain). AU - Hott,Alexandra, AU - Liavaag,Sigurd, AU - Juel,Niels Gunnar, AU - Brox,Jens Ivar, Y1 - 2015/02/25/ PY - 2014/06/03/received PY - 2015/02/03/accepted PY - 2015/4/17/entrez PY - 2015/4/17/pubmed PY - 2015/12/17/medline SP - 40 EP - 40 JF - BMC musculoskeletal disorders JO - BMC Musculoskelet Disord VL - 16 N2 - BACKGROUND: Patellofemoral pain syndrome (PFPS), also known as Anterior Knee Pain, is a common cause of recurrent or chronic knee pain. The etiology is considered to be multifactorial but is not completely understood. At the current time the leading theory is that pathomechanics in the patellofemoral joint leads to PFPS. Traditionally, conservative treatment has focused on improving strength and timing in the quadriceps muscles. In recent years, evidence has been accumulating to support the importance of hip control and strengthening in PFPS. Two recent studies have shown promising results for hip strengthening as an isolated treatment for PFPS. The aim of this randomised controlled trial (RCT) is to compare isolated hip strengthening to traditional quadriceps-based training and a control group with free physical activity. METHODS/DESIGN: An observer-blinded RCT will be performed. We intend to include 150 patients aged 16-40 years, referred from primary care practitioners to the department of Physical Medicine and Rehabilitation in Kristiansand, Norway for PFPS with more than three months duration. Patients meeting the inclusion criteria will be randomised using opaque sequentially numbered sealed envelopes to one of three groups: isolated hip strengthening, quadriceps based training, or a control group (free physical activity). All groups will receive standardized information about PFPS formulated with the intention to minimize fear avoidance and encourage self-mastery of symptoms. Standardized exercises will be performed under supervision of a study physiotherapist once per week in addition to home training two times per week for a total of six weeks. The primary outcome measure will be the Anterior Knee Pain Score (AKPS) at three and 12 months. Secondary outcome measures will include Visual analogue scale (VAS) for pain, hip abductor and quadriceps strength, the generic EuroQol (EQ-5D), Hopkins Symptom Checklist (HSCL), Knee self-efficacy score and Tampa score for Kinesiophobia. DISCUSSION: This trial will help to elucidate the role of hip and quadriceps strengthening in the treatment of PFPS. Information as to the role of anxiety and depression, kinesiophobia and self-efficacy will be collected, also as regards prognosis and response to exercise therapy. TRIAL REGISTRATION: ClinicalTrials.gov reference: NCT02114294. SN - 1471-2474 UR - https://www.unboundmedicine.com/medline/citation/25879452/Study_protocol:_a_randomised_controlled_trial_comparing_the_long_term_effects_of_isolated_hip_strengthening_quadriceps_based_training_and_free_physical_activity_for_patellofemoral_pain_syndrome__anterior_knee_pain__ L2 - https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0493-6 DB - PRIME DP - Unbound Medicine ER -