A feasibility study of a novel,task-specific movement training intervention for women with patellofemoral pain

Abstract

Objective:

To investigate whether a novel, task-specific training intervention that focused on correcting pain-producing movement patterns was feasible and whether it would improve hip and knee kinematics, pain, and function in women with patellofemoral pain.

Design:

Prospective, non-randomized, within-group, double baseline, feasibility intervention study.

Subjects:

A total of 25 women with patellofemoral pain were enrolled.

Intervention:

The intervention, delivered 2×/week for six weeks, consisted of supervised, high-repetition practice of daily weight-bearing and recreational activities. Activities were selected and progressed based on participants’ interest and ability to maintain optimal alignment without increasing pain.

Main measures:

Primary feasibility outcomes were recruitment, retention, adherence, and treatment credibility (Credibility/Expectancy Questionnaire). Secondary outcomes assessing intervention effects were hip and knee kinematics, pain (visual analog scale: current, average in past week, maximum in past week), and function (Patient-Specific Functional Scale).

Results:

A total of 25 participants were recruited and 23 were retained (92% retention). Self-reported average daily adherence was 79% and participants were able to perform their prescribed home program correctly (reduced hip and knee frontal plane angles) by the second intervention visit. On average, treatment credibility was rated 25 (out of 27) and expectancy was rated 22 (out of 27). Hip and knee kinematics, pain, and function improved following the intervention when compared to the control phase.

Conclusion:

Based on the feasibility outcomes and preliminary intervention effects, this task-specific training intervention warrants further investigation and should be evaluated in a larger, randomized clinical trial.

Keywords

Anterior knee pain kinematics physical therapy gait retraining

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References

Nimon

Murray

Sandow

et al

Natural history of anterior knee pain: a 14- to 20-year follow-up of nonoperative management. J Pediatr Orthop 1998; 18: 118–122.

DeHaven

Lintner

DM.

Athletic injuries: comparison by age, sport, and gender. Am J Sport Med 1986; 14: 218–224.

Taunton

Ryan

Clement

et al

A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2002; 36: 95–101.

Powers

CM.

The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther 2003; 33: 639–646.

Boling

Bolgla

Mattacola

et al

Outcomes of a weight-bearing rehabilitation program for patients diagnosed with patellofemoral pain syndrome. Arch Phys Med Rehabil 2006; 87: 1428–1435.

Mascal

Landel

Powers

Management of patellofemoral pain targeting hip, pelvis, and trunk muscle function: 2 case reports. J Orthop Sports Phys Ther 2003; 33: 647–660.

Nakagawa

Muniz

Baldon Rde

et al

The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study. Clin Rehabil 2008; 22: 1051–1060.

Collins

Crossley

Beller

et al

Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. BMJ 2008; 337: a1735.

Ferber

Bolgla

Earl-Boehm

et al

Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial. J Athl Train 2015; 50: 366–377.

10.

Salsich

Graci

Maxam

DE.

The effects of movement pattern modification on lower extremity kinematics and pain in women with patellofemoral pain. J Orthop Sports Phys Ther 2012; 42: 1017–1024.

11.

Willy

Scholz

Davis

IS.

Mirror gait retraining for the treatment of patellofemoral pain in female runners. Clin Biomech 2012; 27: 1045–1051.

12.

Noehren

Scholz

Davis

The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. Br J Sports Med 2011; 45: 691–696.

13.

Salbach

Mayo

Wood-Dauphinee

et al

A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial. Clin Rehabil 2004; 18: 509–519.

14.

Birkenmeier

Prager

Lang

CE.

Translating animal doses of task-specific training to people with chronic stroke in one hour therapy sessions: a proof-of-concept study. Neurorehabil Neural Repair 2010; 24: 620–635.

15.

Crossley

van Middelkoop

Callaghan

et al

2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). Br J Sports Med 2016; 50: 844–852.

16.

Kannus

Natri

Paakkala

et al

An outcome study of chronic patellofemoral pain syndrome. Seven-year follow-up of patients in a randomized, controlled trial. J Bone Joint Surg Am 1999; 81: 355–363.

17.

Crossley

Bennell

Cowan

et al

Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid?

Arch Phys Med Rehabil 2004; 85: 815–822.

18.

Harris-Hayes

Steger-May

Koh

et al

Classification of lower extremity movement patterns based on visual assessment: reliability and correlation with 2-dimensional video analysis. J Athl Train 2014; 49: 304–310.

19.

Baecke

Burema

Frijters

JE.

A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 1982; 36: 936–942.

20.

Hubbard

Parsons

Neilson

et al

Task-specific training: evidence for and translation to clinical practice. Occup Ther Int 2009; 16: 175–189.

21.

Hoffman

Johnson

Zou

et al

Effect of classification-specific treatment on lumbopelvic motion during hip rotation in people with low back pain. Man Ther 2011; 16: 344–350.

22.

Devilly

Borkovec

TD.

Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry 2000; 31: 73–86.

23.

Chatman

Hyams

Neel

et al

The Patient-Specific Functional Scale: measurement properties in patients with knee dysfunction. Phys Ther 1997; 77: 820–829.

24.

Van Dillen

Norton

Sahrmann

et al

Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial. Man Ther 2016; 24: 52–64.

25.

Harris-Hayes

Holtzman

Earley

et al

Development and preliminary reliability testing of an assessment of patient independence in performing a treatment program: standardized scenarios. J Rehabil Med 2010; 42: 221–227.

26.

Scholtes

Salsich

GB.

A dynamic valgus index that combines hip and knee angles: assessment of utility in females with patellofemoral pain. Int J Sports Phys Ther 2017; 12: 333–340.

27.

Bennell

Campbell

Egerton

et al

Telephone coaching to enhance a home-based physical activity program for knee osteoarthritis: a randomized clinical trial. Arthritis Care Res 2017; 69: 84–94.

28.

Graci

Van Dillen

Salsich

GB.

Gender differences in trunk, pelvis and lower limb kinematics during a single leg squat. Gait Posture 2012; 36: 461–466.

29.

Stratford

Gill

Westaway

et al

Assessing disability and change on individual patients: a report of a patient specific measure. Physioth Can 1995; 47: 258–263.

30.

Kujala

Jaakkola

Koskinen

et al

Scoring of patellofemoral disorders. Arthroscopy 1993; 9: 159–163.

31.

Plisky

Gorman

Butler

et al

The reliability of an instrumented device for measuring components of the star excursion balance test. N Am J Sports Phys Ther 2009; 4: 92–99.

32.

Beekhuizen

Davis

Kolber

et al

Test-retest reliability and minimal detectable change of the hexagon agility test. J Strength Cond Res 2009; 23: 2167–2171.

33.

Ruwe

Gage

Ozonoff

et al

Clinical determination of femoral anteversion. A comparison with established techniques. J Bone Joint Surg Am 1992; 74: 820–830.

34.

Crossley

Stefanik

Selfe

et al

2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med 2016; 50: 839–843.

35.

Schiphof

van Middelkoop

de Klerk

et al

Crepitus is a first indication of patellofemoral osteoarthritis (and not of tibiofemoral osteoarthritis). Osteoarthritis Cartilage 2014; 22: 631–638.

36.

Bower

Brueton

Gamble

et al

Interventions to improve recruitment and retention in clinical trials: a survey and workshop to assess current practice and future priorities. Trials 2014; 15: 399.

37.

Brueton

Stevenson

Vale

et al

Use of strategies to improve retention in primary care randomised trials: a qualitative study with in-depth interviews. BMJ Open 2014; 4: e003835.

38.

Essery

Geraghty

Kirby

et al

Predictors of adherence to home-based physical therapies: a systematic review. Disabil Rehabil 2017; 39: 519–534.

39.

Dobson

Bennell

French

et al

Barriers and facilitators to exercise participation in people with hip and/or knee osteoarthritis: synthesis of the literature using behavior change theory. Am J Phys Med Rehabil 2016; 95: 372–389.

40.

Liao

Yang

et al

Femur rotation increases patella cartilage stress in females with patellofemoral pain. Med Sci Sports Exerc 2015; 47: 1775–1780.

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