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Logo of bmcmudisBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Musculoskeletal Disorders
 
BMC Musculoskelet Disord. 2012; 13: 9.
Published online Jan 27, 2012. doi:  10.1186/1471-2474-13-9
PMCID: PMC3328242
Early intervention for adolescents with Patellofemoral Pain Syndrome - a pragmatic cluster randomised controlled trial
Michael S Rathleff,corresponding author1,2 Ewa M Roos,3 Jens L Olesen,4 and Sten Rasmussen2
1Graduate School of Health Sciences, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark
2Orthopaedic Surgery Research Unit, Aalborg Hospital - Aarhus University Hospital, Soendre Skov 15, 9000 Aalborg, Denmark
3Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
4Department of Rheumatology, Aalborg Hospital - Aarhus University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark
corresponding authorCorresponding author.
Michael S Rathleff: misr/at/rn.dk; Ewa M Roos: eroos/at/health.sdu.dk; Jens L Olesen: jlo/at/rn.dk; Sten Rasmussen: sten.rasmussen/at/rn.dk
Received December 13, 2011; Accepted January 27, 2012.
Abstract
Background
Self-reported knee pain is highly prevalent among adolescents. As much as 50% of the non-specific knee pain may be attributed to Patellofemoral Pain Syndrome (PFPS). In the short term, exercise therapy appears to have a better effect than patient education consisting of written information and general advice on exercise or compared with placebo treatment. But the long-term effect of exercise therapy compared with patient education is conflicting. The purpose of this study is to examine the short- and long-term effectiveness of patient education compared with patient education and multimodal physiotherapy applied at a very early stage of the condition among adolescents.
Methods/Design
This study is a single blind pragmatic cluster randomised controlled trial. Four upper secondary schools have been invited to participate in the study (approximately 2500 students, aged 15-19 years). Students are asked to answer an online questionnaire regarding musculoskeletal pain. The students who report knee pain are contacted by telephone and offered a clinical examination by a rheumatologist. Subjects who fit the inclusion criteria and are diagnosed with PFPS are invited to participate in the study. A minimum of 102 students with PFPS are then cluster-randomised into two intervention groups based on which school they attend. Both intervention groups receive written information and education. In addition to patient education, one group receives multimodal physiotherapy consisting primarily of neuromuscular training of the muscles around the foot, knee and hip and home exercises.
The students with PFPS fill out self-reported questionnaires at baseline, 3, 6, 12 and 24 months after inclusion in the study. The primary outcome measure is perception of recovery measured on a 7-point Likert scale ranging from "completely recovered" to "worse than ever" at 12 months.
Discussion
This study is designed to investigate the effectiveness of patient education compared with patient education combined with multimodal physiotherapy. If patient education and multimodal physiotherapy applied at an early stage of Patellofemoral Pain Syndrome proves effective, it may serve as a basis for optimising the clinical pathway for those suffering from the condition, where specific emphasis can be placed on early diagnosis and early treatment.
Trial Registration
clinicaltrials.gov reference: NCT01438762
Keywords: Patellofemoral Pain Syndrome, Anterior Knee Pain, Physiotherapy, Adolescents
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