TRIP

Supervised exercise versus usual care for patellofemoral pain syndrome.

Clinical Journal of Sport Medicine, 2010

Comment on: OBJECTIVE: To compare the effectiveness of supervised exercise therapy with usual care on self-reported recovery, pain, and function in persons with patellofemoral pain syndrome.
Sample size was calculated with 80% power to show a minimum clinically important difference of 22% in recovery after 1 year, at P <or= 0.05.
PARTICIPANTS: Inclusion criteria were: age, 14 to 40 years; presence of symptoms for between 2 months and 2 years; >or=3 of: pain when ascending or descending stairs, squatting, running, cycling, or sitting with flexed knees; grinding of the patella; and a positive clinical patellar test.
Exclusion criteria were knee osteoarthritis, patellar tendinopathy, or other pathological conditions of the knee, previous knee injuries or surgery or treatment with supervised exercise.
Patients were recruited by general practitioners or sport physicians (n randomized = 131; mean age, 24y; 70% 18y or older; 64% women; bilateral knee symptoms, 60%; participation in sport, 76%).
INTERVENTION: The standardized 25-minute exercise protocol was tailored to individual achievement and supervised by a physical therapist.
It comprised warm-up, followed by static and dynamic exercises for the quadriceps, adductor, and gluteal muscles, and included balance and thigh-muscle flexibility components.
The intervention and control patients received a pamphlet from their physicians about patellofemoral pain syndrome, advice to refrain from sports activities that provoked pain, and instructions for daily isometric quadriceps contractions.
End points included perceived recovery since baseline (7-point scale from "completely recovered" to "worse than ever"), functional disability measured on the Kujala Patellofemoral Scale (0 = complete disability to 100 = fully functional) and pain severity at rest and on activity (0 = no pain to 10 = unbearable pain).
MAIN RESULTS: After 3 months, in intention-to-treat analysis, the groups did not differ in proportions recovered; however, when the category "slightly recovered" was included, a greater proportion of the exercise group had improved (81% vs 53%; adjusted odds ratio, 4.07; 95% confidence interval [CI], 1.86 to 8.90).