OBJECTIVE: To compare a sequential treatment algorithm considering psychosocial and physical impairments, with a conventional rehabilitation approach considering only physical impairments in adolescents with patellofemoral pain. DESIGN: A randomized, single-blind, controlled study. PARTICIPANTS: Fifty-five adolescents (36 females; mean age 14.3 +/- 1.8 years). INTERVENTIONS: The sequential cognitive and physical approach (SCOPA) group (n = 28) was treated based on sequential testing and treatment of activity-related fear, flexibility, kinematics, and strength. The comparator group (n = 27) was treated with a non-sequential physical impairment-based approach. Both groups received treatment two times a week for up to six weeks. MEASUREMENTS: Function (Anterior Knee Pain Scale), pain (numeric pain rating scale), and Global Rating of Change were assessed at baseline, three weeks, and six weeks, with a six-month follow-up. RESULTS: Both groups had similar function (73.7 +/- 9.6) and pain (6.0 +/- 2.3) at baseline. A third of individuals with patellofemoral pain demonstrated elevated activity-related fear at baseline. Patients randomized to the SCOPA group had clinically significant greater improvements at six weeks in function (SCOPA 95.0 +/- 7.4 and comparator 84.8 +/- 10.4; mean difference 10.2, 95% CI 5.3 to 15.1) and pain (SCOPA 0.9 +/- 1.9 and comparator 2.7 +/- 2.1; mean difference 1.7, 95% CI 0.5 to 2.9). No differences were noted in Global Rating of Change. No between-group differences were noted in any outcome at six-month follow-up. CONCLUSION: The sequential cognitive and physical approach resulted in greater improvements in short-term function and pain. By six months, both groups demonstrated similar clinically significant improvements in all outcomes.

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