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A loaded self-managed exercise programme for patellofemoral pain: a mixed methods feasibility study.

Benjamin E Smith1,2, Paul Hendrick3, Marcus Bateman4

  • 1Physiotherapy Department (Level 3) London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE1 2QY, UK. benjamin.smith3@nhs.net.

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PubMed
Summary

This study found a loaded self-managed exercise program is feasible for patellofemoral pain (PFP). Further research is needed to address methodological issues before a definitive randomized controlled trial (RCT) can be conducted.

Keywords:
Anterior knee painExercise therapyFeasibilityMixed-methods studyPatellofemoral pain

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Area of Science:

  • Orthopedics
  • Sports Medicine
  • Rehabilitation Science

Background:

  • Patellofemoral pain (PFP) is a common condition.
  • A novel loaded self-managed exercise program incorporating pain education and self-management strategies shows potential for improved outcomes in PFP patients.
  • Feasibility and acceptability are crucial prerequisites for evaluating the efficacy of new interventions.

Purpose of the Study:

  • To assess the feasibility and acceptability of a loaded self-managed exercise program for individuals with PFP.
  • To determine the feasibility of conducting a definitive randomized controlled trial (RCT) comparing this program to usual physiotherapy.
  • To evaluate the clinical and cost-effectiveness of the loaded self-managed exercise program.

Main Methods:

  • A mixed-methods, pragmatic, randomized controlled feasibility study was conducted.
  • Sixty participants with PFP were recruited from a UK teaching hospital physiotherapy clinic.
  • Participants were randomized to either a loaded self-managed exercise program (n=30) or usual physiotherapy (n=30).
  • Feasibility indicators were collected via questionnaires at six months and semi-structured interviews with participants and physiotherapists.

Main Results:

  • High recruitment (5 participants/month) and consent rates (99%) were observed.
  • Adherence to intervention appointments (87%) and delivery (95%) were high; questionnaire data completeness was 100%.
  • Overall retention rate was 42% at six months, with low exercise diary completion (5%). Both groups showed improvements in pain, kinesiophobia, pain catastrophizing, self-efficacy, and quality of life.

Conclusions:

  • The loaded self-managed exercise program is feasible and acceptable for adults with PFP in an NHS physiotherapy outpatient setting.
  • Uncertainty remains regarding feasibility due to between-group differences in lost-to-follow-up and poor exercise diary completion.
  • Methodological issues identified in this feasibility study require addressing before initiating a definitive RCT.