Hott Alexandra, Liavaag Sigurd, Juel Niels Gunnar, Brox Jens Ivar
Department of Physical Medicine and Rehabilitation, Sorlandet Hospital Kristiansand, PO box 416, 4604, Kristiansand, Norway.
Department of Orthopedic Surgery, Sorlandet Hospital Arendal, PO box 783 Stoa, 4809, Arendal, Norway.
BMC Musculoskelet Disord. 2015 Feb 25;16:40. doi: 10.1186/s12891-015-0493-6.
Patellofemoral pain syndrome (PFPS), also known as Anterior Knee Pain, is a common cause of recurrent or chronic knee pain. The etiology is considered to be multifactorial but is not completely understood. At the current time the leading theory is that pathomechanics in the patellofemoral joint leads to PFPS. Traditionally, conservative treatment has focused on improving strength and timing in the quadriceps muscles. In recent years, evidence has been accumulating to support the importance of hip control and strengthening in PFPS. Two recent studies have shown promising results for hip strengthening as an isolated treatment for PFPS. The aim of this randomised controlled trial (RCT) is to compare isolated hip strengthening to traditional quadriceps-based training and a control group with free physical activity.
METHODS/DESIGN: An observer-blinded RCT will be performed. We intend to include 150 patients aged 16-40 years, referred from primary care practitioners to the department of Physical Medicine and Rehabilitation in Kristiansand, Norway for PFPS with more than three months duration. Patients meeting the inclusion criteria will be randomised using opaque sequentially numbered sealed envelopes to one of three groups: isolated hip strengthening, quadriceps based training, or a control group (free physical activity). All groups will receive standardized information about PFPS formulated with the intention to minimize fear avoidance and encourage self-mastery of symptoms. Standardized exercises will be performed under supervision of a study physiotherapist once per week in addition to home training two times per week for a total of six weeks. The primary outcome measure will be the Anterior Knee Pain Score (AKPS) at three and 12 months. Secondary outcome measures will include Visual analogue scale (VAS) for pain, hip abductor and quadriceps strength, the generic EuroQol (EQ-5D), Hopkins Symptom Checklist (HSCL), Knee self-efficacy score and Tampa score for Kinesiophobia.
This trial will help to elucidate the role of hip and quadriceps strengthening in the treatment of PFPS. Information as to the role of anxiety and depression, kinesiophobia and self-efficacy will be collected, also as regards prognosis and response to exercise therapy.
ClinicalTrials.gov reference: NCT02114294.
髌股疼痛综合征（PFPS），也称为膝前痛，是复发性或慢性膝关节疼痛的常见原因。其病因被认为是多因素的，但尚未完全明确。目前的主流理论是髌股关节的病理力学导致了PFPS。传统上，保守治疗侧重于提高股四头肌的力量和运动时机。近年来，越来越多的证据支持髋关节控制和强化在PFPS治疗中的重要性。最近的两项研究表明，单独进行髋关节强化训练对PFPS治疗有良好效果。这项随机对照试验（RCT）的目的是比较单独的髋关节强化训练、传统的基于股四头肌的训练以及自由进行体育活动的对照组。
方法/设计：将进行一项观察者盲法RCT。我们计划纳入150名年龄在16至40岁之间、由初级保健医生转诊至挪威克里斯蒂安桑物理医学与康复科、患有病程超过三个月的PFPS患者。符合纳入标准的患者将使用不透明的顺序编号密封信封随机分为三组之一：单独的髋关节强化训练组、基于股四头肌的训练组或对照组（自由进行体育活动）。所有组将收到关于PFPS的标准化信息，旨在尽量减少恐惧回避并鼓励患者自我控制症状。除了每周两次的家庭训练，共六周外，标准化锻炼将在研究物理治疗师的监督下每周进行一次。主要结局指标将是3个月和12个月时的膝前疼痛评分（AKPS）。次要结局指标将包括疼痛视觉模拟量表（VAS）、髋关节外展肌和股四头肌力量、通用欧洲生活质量量表（EQ - 5D）、霍普金斯症状清单（HSCL）、膝关节自我效能评分以及运动恐惧的坦帕评分。
这项试验将有助于阐明髋关节和股四头肌强化在PFPS治疗中的作用。还将收集关于焦虑和抑郁、运动恐惧以及自我效能在预后和运动疗法反应方面作用的信息。
ClinicalTrials.gov标识符：NCT02114294。
