Effects of rehabilitation approaches for runners with patellofemoral pain: protocol of a randomised clinical trial addressing specific underlying mechanisms

DesignSingle-blind randomised clinical trial.ObjectiveTo compare the effects of three 8-week rehabilitation programmes on symptoms and functional limitations of runners with patellofemoral pain (PFP).MethodsSixty-nine runners with PFP were randomly assigned to one of three intervention groups: (1) education on symptoms management and training modifications (education); (2) exercise programme in addition to education (exercises); (3) gait retraining in addition to education (gait retraining). Symptoms and functional limitations were assessed at baseline (T0), and after 4, 8 and 20 weeks (T4, T8 and T20) using the Knee Outcome Survey of the Activities of Daily Living Scale (KOS-ADLS) and visual analogue scales (VASs) for usual pain, worst pain and pain during running. Lower limb kinematics and kinetics during running, and isometric strength were also evaluated at T0 and T8. The effects of rehabilitation programmes were assessed using two-way analysis of variance.ResultsNo significant group × time interactions (p<0.447) were found for KOS-ADLS and VASs. All three groups showed similar improvements at T4, T8 and T20 compared with T0 (p<0.05). Only the exercises group increased knee extension strength following rehabilitation (group × time: p<0.001) and only the gait retraining group (group × time: p<0.001) increased step rate (+7.0%) and decreased average vertical loading rate (−25.4%).ConclusionEven though gait retraining and exercises improved their targeted mechanisms, their addition to education did not provide additional benefits on symptoms and functional limitations. Appropriate education on symptoms and management of training loads should be included as a primary component of treatment in runners with PFP.Trial registration numberClinicalTrials.gov (NCT02352909).

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Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial

Yearbook of Sports Medicine ◽

10.1016/s0162-0908(09)79447-4 ◽

2009 ◽

Vol 2009 ◽

pp. 45-46

Author(s):

D. Feldman

Keyword(s):

Clinical Trial ◽

Pain Syndrome ◽

Randomised Clinical Trial ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Foot Orthoses

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Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial

Yearbook of Sports Medicine ◽

10.1016/s0162-0908(09)79443-7 ◽

2009 ◽

Vol 2009 ◽

pp. 44-45

Author(s):

K. Khan

Keyword(s):

Clinical Trial ◽

Pain Syndrome ◽

Randomised Clinical Trial ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Foot Orthoses

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Effects of an intensive lifestyle intervention on the underlying mechanisms of improved glycaemic control in individuals with type 2 diabetes: a secondary analysis of a randomised clinical trial

Diabetologia ◽

10.1007/s00125-020-05249-7 ◽

2020 ◽

Vol 63 (11) ◽

pp. 2410-2422

Author(s):

Mette Y. Johansen ◽

Kristian Karstoft ◽

Christopher S. MacDonald ◽

Katrine B. Hansen ◽

Helga Ellingsgaard ◽

...

Keyword(s):

Type 2 Diabetes ◽

Clinical Trial ◽

Glycaemic Control ◽

Lifestyle Intervention ◽

Secondary Analysis ◽

Randomised Clinical Trial ◽

Intensive Lifestyle Intervention ◽

Underlying Mechanisms ◽

Improved Glycaemic Control

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Does foot mobility affect the outcome in the management of patellofemoral pain with foot orthoses versus hip exercises? A randomised clinical trial

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-100935 ◽

2020 ◽

Vol 54 (23) ◽

pp. 1416-1422 ◽

Cited By ~ 2

Author(s):

Mark Matthews ◽

Michael Skovdal Rathleff ◽

Andrew Claus ◽

Tom McPoil ◽

Robert Nee ◽

...

Keyword(s):

Clinical Trial ◽

A Priori ◽

Randomised Clinical Trial ◽

Patellofemoral Pain ◽

Foot Orthoses ◽

Success Rates ◽

Insidious Onset ◽

Registration Number ◽

Foot Pronation

ObjectivesTo test (i) if greater foot pronation (measured as midfoot width mobility) is associated with better outcomes with foot orthoses treatment, compared with hip exercises and (ii) if hip exercises are superior to foot orthoses, irrespective of midfoot width mobility.MethodsA two-arm parallel, randomised superiority clinical trial was conducted in Australia and Denmark. Participants (18–40 years) were included who reported an insidious onset of knee pain (≥6 weeks duration); ≥3/10 numerical pain rating, that was aggravated by activities (eg, stairs, squatting, running). Participants were stratified by midfoot width mobility (high ≥11 mm change in midfoot width) and site, randomised to foot orthoses or hip exercises and blinded to objectives and stratification. Success was defined a priori as much better or better on a patient-perceived 7-point scale at 12 weeks.ResultsOf 218 stratified and randomised participants, 192 completed 12-week follow-up. This study found no difference in success rates between foot orthoses versus hip exercises in those with high (6/21 vs 9/20; 29% vs 45%, respectively) or low (42/79 vs 37/72; 53% vs 51%) midfoot width mobility. There was no association between midfoot width mobility and treatment outcome (Interaction effect p=0.19). This study found no difference in success rate between foot orthoses versus hip exercises (48/100 vs 46/92; 48% vs 50%).ConclusionMidfoot width mobility should not be used to help clinicians decide which patient with patellofemoral pain might benefit most from foot orthoses. Clinicians and patients may consider either foot orthoses or hip exercises in managing patellofemoral pain.Trial registration numberACTRN12614000260628.

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Effects of neuromuscular training and strengthening of trunk and lower limbs muscles in women with Patellofemoral Pain: A protocol of randomized controlled clinical trial, blinded

Trials ◽

10.1186/s13063-019-3650-7 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Natália Camin Silva ◽

Matheus de Castro Silva ◽

Morisa Garcia Guimarães ◽

Manoela Beatriz de Oliveira Nascimento ◽

Lilian Ramiro Felicio

Keyword(s):

Clinical Trial ◽

Lower Limb ◽

Randomised Clinical Trial ◽

Pain Scale ◽

Patellofemoral Pain ◽

Lower Limbs ◽

Neuromuscular Training ◽

Controlled Clinical Trial ◽

Intervention Protocol ◽

Strengthening Exercises

Abstract Background Patellofemoral pain (PFP) often affects young women, and the etiology is multifactorial and poorly understood. Conservative intervention has been focused on risk factors or aggravating factors and is composed of hip- and knee-strengthening exercises, as this population often has muscle weakness and poor motor control during daily and sports activities. The objective of this study was to evaluate the additional effects of neuromuscular training in a conservative treatment of trunk-, hip-, and knee-muscle strengthening on pain, function, and kinematics of the trunk, pelvis, and lower limb in women with PFP. Methods This is a randomised clinical trial, controlled, blinded. Ninety women who are active and engage in physical activity up to twice a week will be recruited. All participants will undergo an individual physiotherapy assessment and then will be allocated randomly into two groups. Thereafter, both groups will undergo a 12-week intervention protocol: group 1 will perform strengthening exercises for the trunk, hip, and knee muscles, while group 2 will receive the same treatment, with the inclusion of neuromuscular training exercises on the fourth week. At the end of the intervention, the volunteers will be evaluated. The primary outcomes will be pain intensity (using a Visual Analog Scale: over the last month, squat 90°, and step of 26 cm during 1 min), functional capacity (Anterior Knee Pain Scale and Activities of Daily Living Scale), and 2D kinematics of the trunk, pelvis, and lower limb during the single-leg squat. The secondary outcomes correspond to the isometric muscular strength of the lower limb and the level of satisfaction from the intervention. Discussion The present study was initiated on 28 January 2018 and is currently in progress, scheduled for completion in July 2019. The results of this study should contribute to the physiotherapeutic treatment of women with PFP by aggregating information on the benefits of adding neuromuscular training to strengthening of the trunk and lower-limb muscles. Trial registration Registro Brasileiro de Ensaios Clínicos, ID: RBR-8c7267. Registered on 2 August 2017.

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