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Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain? A randomised clinical trial [with consumer summary]
Esculier J-F, Bouyer LJ, Dubois B, Fremont P, Moore L, McFadyen B, Roy J-S
British Journal of Sports Medicine 2018 May;52(10):659-666
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

DESIGN: Single-blind randomised clinical trial. OBJECTIVE: To compare the effects of three 8-week rehabilitation programmes on symptoms and functional limitations of runners with patellofemoral pain (PFP). METHODS: Sixty-nine runners with PFP were randomly assigned to one of three intervention groups: (1) education on symptoms management and training modifications (education); (2) exercise programme in addition to education (exercises); (3) gait retraining in addition to education (gait retraining). Symptoms and functional limitations were assessed at baseline (T0), and after 4, 8 and 20 weeks (T4, T8 and T20) using the Knee Outcome Survey of the Activities of Daily Living Scale (KOS-ADLS) and visual analogue scales (VASs) for usual pain, worst pain and pain during running. Lower limb kinematics and kinetics during running, and isometric strength were also evaluated at T0 and T8. The effects of rehabilitation programmes were assessed using two-way analysis of variance. RESULTS: No significant group x time interactions (p < 0.447) were found for KOS-ADLS and VASs. All three groups showed similar improvements at T4, T8 and T20 compared with T0 (p < 0.05). Only the exercises group increased knee extension strength following rehabilitation (group x time p < 0.001) and only the gait retraining group (group x time p < 0.001) increased step rate (+7.0%) and decreased average vertical loading rate (-25.4%). CONCLUSION: Even though gait retraining and exercises improved their targeted mechanisms, their addition to education did not provide additional benefits on symptoms and functional limitations. Appropriate education on symptoms and management of training loads should be included as a primary component of treatment in runners with PFP. TRIAL REGISTRATION NUMBER: (NCT02352909).
Reproduced with permission from the BMJ Publishing Group.

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