In the JournalsPerspective

Knee-focused exercise with patient education did not show significant benefit vs other exercises for patellofemoral pain

There was no difference in the short-term effectiveness between patient education combined with either knee- or hip-focused exercise and free physical activity for patients with patellofemoral pain, according to recently published results.

“The limited effect size for the whole study population raises the question whether

the observed improvement represents a natural course of improvement or a regression to the mean,” the authors wrote. “We cannot draw conclusions about long-term effectiveness.”

They added, “Guided exercises improved muscle strength but did not translate to additional gains in other outcomes over the control group.”

In the single-blind, randomized controlled trial of 112 patients aged 16 to 40 years old who had a clinical diagnosis of patellofemoral pain and had symptoms for more than 3 months, investigators assigned 37 patients to a 6-week intervention with patient education combined with isolated hip-focused exercise; 39 patients to patient education combined with traditional knee-focused exercise; and 36 patients to patient education combined with free physical activity. The anterior knee pain scale score at 3 months was the primary outcome. Other outcomes included the visual analog scale score for pain, Tampa Scale for Kinesiophobia, knee self-efficacy scale, EuroQoL score and step-down and isometric strength.

At 3 months, the outcomes were not significantly different between the three treatment groups apart from hip abduction strength and knee extension strength. At 3 months, the between group differences for the anterior knee pain scale scores for knee vs. control, hip vs. control and hip vs. knee were 0.2, 1 and 0.8, respectively. Apart from the knee extension strength, all patients saw improvements in all outcomes. – by Monica Jaramillo

D isclosures: Hott reports research support from DePuy and Smith & Nephew. Please see the full study for a list of all other authors’ relevant financial disclosures.

There was no difference in the short-term effectiveness between patient education combined with either knee- or hip-focused exercise and free physical activity for patients with patellofemoral pain, according to recently published results.

“The limited effect size for the whole study population raises the question whether

the observed improvement represents a natural course of improvement or a regression to the mean,” the authors wrote. “We cannot draw conclusions about long-term effectiveness.”

They added, “Guided exercises improved muscle strength but did not translate to additional gains in other outcomes over the control group.”

In the single-blind, randomized controlled trial of 112 patients aged 16 to 40 years old who had a clinical diagnosis of patellofemoral pain and had symptoms for more than 3 months, investigators assigned 37 patients to a 6-week intervention with patient education combined with isolated hip-focused exercise; 39 patients to patient education combined with traditional knee-focused exercise; and 36 patients to patient education combined with free physical activity. The anterior knee pain scale score at 3 months was the primary outcome. Other outcomes included the visual analog scale score for pain, Tampa Scale for Kinesiophobia, knee self-efficacy scale, EuroQoL score and step-down and isometric strength.

At 3 months, the outcomes were not significantly different between the three treatment groups apart from hip abduction strength and knee extension strength. At 3 months, the between group differences for the anterior knee pain scale scores for knee vs. control, hip vs. control and hip vs. knee were 0.2, 1 and 0.8, respectively. Apart from the knee extension strength, all patients saw improvements in all outcomes. – by Monica Jaramillo

D isclosures: Hott reports research support from DePuy and Smith & Nephew. Please see the full study for a list of all other authors’ relevant financial disclosures.

    Perspective
    James Bicos

    James Bicos

    I was asked to look at the article by Hott and colleagues on knee-focused exercise with patient education did not show significant benefit vs. other exercises for patellofemoral pain. The article was a single-blind randomized controlled trial looking at 112 patients with a clinical diagnosis of patellofemoral pain who were divided into three groups for intervention: patient education and hip exercises; patient intervention and knee exercises; and patient education with free physical activity. The end result was that there were no statistically significant differences between the groups.

    The results, in my opinion, are not surprising as most people with patellofemoral pain need some sort of exercise to get stronger. As important as physical therapy is, what this article shows is that any activity to get people moving and exercise is beneficial for the knee pain. 

    Although well written, I don’t think this adds much to our current literature on patellofemoral pain and its management. I think it is important to educate patients on their diagnosis and empower them to be an active participant in their treatment management.



    • James Bicos, MD
    • Assistant professor, Oakland University William Beaumont School of Medicine
      Fellowship director, William Beaumont Sports Medicine Fellowship
      Michigan Orthopedic Surgeons/Performance Orthopedics
      Bingham Farms, Michigan

    Disclosures: Bicos reports no relevant financial disclosures.

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