A sequential cognitive and physical approach (SCOPA) for patellofemoral pain: a randomized controlled trial in...

To compare a sequential treatment algorithm considering psychosocial and physical impairments, with a conventional rehabilitation approach considering only physical impairments in adolescents with patellofemoral pain.

A randomized, single-blind, controlled study.

Fifty-five adolescents (36 females; mean age 14.3 ± 1.8 years).

The sequential cognitive and physical approach (SCOPA) group ( n = 28) was treated based on sequential testing and treatment of activity-related fear, flexibility, kinematics, and strength. The comparator group ( n = 27) was treated with a non-sequential physical impairment-based approach. Both groups received treatment two times a week for up to six weeks.

Function (Anterior Knee Pain Scale), pain (Numeric Pain Rating Scale), and Global Rating of Change were assessed at baseline, three weeks, and six weeks, with a six-month follow-up.

Both groups had similar function (73.7 ± 9.6) and pain (6.0 ± 2.3) at baseline. A third of individuals with patellofemoral pain demonstrated elevated activity-related fear at baseline. Patients randomized to the SCOPA group had clinically significant greater improvements at six weeks in function (SCOPA, 95.0 ± 7.4 and comparator, 84.8 ± 10.4; mean difference: 10.2, 95% CI: 5.3, 15.1) and pain (SCOPA, 0.9 ± 1.9 and comparator, 2.7 ± 2.1; mean difference: 1.7, 95% CI: 0.5, 2.9). No differences were noted in Global Rating of Change. No between-group differences were noted in any outcome at six-month follow-up.

The sequential cognitive and physical approach resulted in greater improvements in short-term function and pain. By six months, both groups demonstrated similar clinically significant improvements in all outcomes.