Esculier Jean-Francois, Bouyer Laurent J, Dubois Blaise, Frémont Pierre, Moore Lynne, Roy Jean-Sébastien
Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.
Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1M 2S8, Canada.
BMC Musculoskelet Disord. 2016 Jan 6;17:5. doi: 10.1186/s12891-015-0859-9.
Patellofemoral pain (PFP) is highly prevalent in runners, and often leads to functional limitations and cessation of running. Training errors as well as decreased lower limb strength and control during running have all been associated with PFP. While strengthening and gait retraining are commonly used by clinicians, no randomised clinical trial has compared these modalities in runners with PFP. The primary objective of this randomised clinical trial will be to compare the effects of three rehabilitation programs targeting different key factors on symptoms and functional limitations of runners with PFP. The secondary objective will be to explore the factors leading to clinical improvement.
METHODS/DESIGN: We will conduct a single-blind randomised clinical trial to compare three different 8 week rehabilitation programs: Group 1 will receive education on symptoms management based on training modifications; Group 2 will receive an exercise program targeting lower limb strengthening and control in addition to the education component of Group 1; Group 3 will receive running gait retraining advice as well as the education component of Group 1. Sixty-nine runners with PFP will be recruited and will be seen by independent physiotherapists on five visits through 8 weeks. The primary outcome measure will be symptoms and functional limitations measured by the Knee Outcome Survey - Activities of Daily Living Scale questionnaire at baseline, and at the four, eight and 20 weeks follow-up. Secondary outcomes will include pain level measured using visual analog scales, and running mileage. Lower limb kinematics and kinetics during running, and isometric strength will also be evaluated at baseline and 8 weeks follow-up. The effects of rehabilitation programs on measures of symptoms and functional limitations will be assessed using a 2-way ANOVA (Groups x Time). Regression analyses will be used to identify if changes in running mechanics or strength are determinants of clinical success.
Studies with a high level of evidence are needed to determine the best rehabilitation interventions for runners with PFP. This randomised clinical trial will be the first to compare programs targeting different key factors linked with PFP. Results may guide clinicians and improve their clinical outcomes when treating runners with PFP.
ClinicalTrials.gov: NCT02352909. Registered on December 3, 2014.
髌股疼痛（PFP）在跑步者中非常普遍，常导致功能受限和跑步中断。训练错误以及跑步过程中下肢力量和控制能力下降均与PFP有关。虽然临床医生常用强化训练和步态再训练，但尚无随机临床试验比较这些方法对患有PFP的跑步者的效果。这项随机临床试验的主要目的是比较针对不同关键因素的三种康复计划对患有PFP的跑步者的症状和功能受限的影响。次要目的是探索导致临床改善的因素。
方法/设计：我们将进行一项单盲随机临床试验，比较三种不同的为期8周的康复计划：第1组将接受基于训练调整的症状管理教育；第2组除了第1组的教育内容外，还将接受针对下肢强化和控制的运动计划；第3组将接受跑步步态再训练建议以及第1组的教育内容。将招募69名患有PFP的跑步者，并由独立的物理治疗师在8周内进行5次问诊。主要结局指标将是在基线以及第4、8和20周随访时通过膝关节功能调查-日常生活活动量表问卷测量的症状和功能受限情况。次要结局指标将包括使用视觉模拟量表测量的疼痛程度以及跑步里程。还将在基线和8周随访时评估跑步过程中的下肢运动学和动力学以及等长力量。将使用双向方差分析（组×时间）评估康复计划对症状和功能受限指标的影响。回归分析将用于确定跑步力学或力量的变化是否是临床成功的决定因素。
需要有高水平证据的研究来确定针对患有PFP的跑步者的最佳康复干预措施。这项随机临床试验将首次比较针对与PFP相关的不同关键因素的计划。结果可能会指导临床医生并改善他们治疗患有PFP的跑步者时的临床结局。
ClinicalTrials.gov：NCT02352909。于2014年12月3日注册。
