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Effectiveness of isolated hip exercise, knee exercise, or free physical activity for patellofemoral pain: a randomized controlled trial
Hott A, Brox JI, Pripp AH, Juel NG, Paulsen G, Liavaag S
The American Journal of Sports Medicine 2019 May;47(6):1312-1322
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*

BACKGROUND: Exercise for patellofemoral pain (PFP) is traditionally knee focused, targeting quadriceps muscles. In recent years, hip-focused exercise has gained popularity. Patient education is likely an important factor but is underresearched. PURPOSE: To compare 3 treatment methods for PFP, each combined with patient education: hip-focused exercise, knee-focused exercise, or free physical activity. STUDY DESIGN: Randomized controlled trial; level of evidence, 1. METHODS: A single-blind randomized controlled trial was performed with 112 patients who were 16 to 40 years old (mean 27.6 years) and had a symptom duration > 3 months (mean 39 months) with a clinical diagnosis of PFP and no radiograph or magnetic resonance evidence of other pathology. Patients were randomized to a 6-week intervention consisting of patient education combined with isolated hip-focused exercise (n = 39), traditional knee-focused exercise (n = 37), or free physical activity (n = 36). The primary outcome was Anterior Knee Pain Scale (0 to 100) at 3 months. Secondary outcomes were visual analog scale for pain, Tampa Scale for Kinesiophobia, Knee Self-efficacy Scale, EuroQol, step-down, and isometric strength. RESULTS: There were no between-group differences in any primary or secondary outcomes at 3 months except for hip abduction strength and knee extension strength. Between-group differences at 3 months for Anterior Knee Pain Scale were as follows: knee versus control 0.2 (95% CI -5.5 to 6.0); hip versus control 1.0 (95% CI -4.6 to 6.6); and hip versus knee 0.8 (95% CI -4.8 to 6.4). The whole cohort of patients improved for all outcomes at 3 months except for knee extension strength. CONCLUSION: The authors found no difference in short-term effectiveness in combining patient education with knee-focused exercise, hip-focused exercise, or free training for patients with PFP. REGISTRATION: NCT02114294 ( identifier).

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