Faculty of Medicine, Laval University, Quebec, Canada.
Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec, Canada.
Br J Sports Med. 2018 May;52(10):659-666. doi: 10.1136/bjsports-2016-096988. Epub 2017 May 5.
Single-blind randomised clinical trial.
To compare the effects of three 8-week rehabilitation programmes on symptoms and functional limitations of runners with patellofemoral pain (PFP).
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 (T), and after 4, 8 and 20 weeks (T, T and T) 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 T and T. The effects of rehabilitation programmes were assessed using two-way analysis of variance.
No significant group × time interactions (p<0.447) were found for KOS-ADLS and VASs. All three groups showed similar improvements at T, T and T compared with T (p<0.05). Only the exercises group increased knee extension strength following rehabilitation (group × time: p<0.001) and only the gait retraining group (group × time: p<0.001) increased step rate (+7.0%) and decreased average vertical loading rate (-25.4%).
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.
ClinicalTrials.gov (NCT02352909).
单盲随机临床试验。
比较三种 8 周康复方案对髌股疼痛（PFP）跑步者症状和功能限制的影响。
将 69 名髌股疼痛跑步者随机分为三组干预组：（1）症状管理和训练调整教育（教育组）；（2）除教育外的运动方案（运动组）；（3）除教育外的步态再训练（步态组）。在基线（T）时以及在第 4、8 和 20 周（T、T 和 T）时，使用日常生活活动膝关节量表（KOS-ADLS）和视觉模拟量表（VAS）评估症状和功能限制，用于日常疼痛、最痛和跑步时疼痛。在 T 和 T 时还评估了跑步时下肢运动学和动力学以及等长强度。使用双向方差分析评估康复方案的效果。
KOS-ADLS 和 VAS 未发现显著的组×时间交互作用（p<0.447）。与 T 相比，所有三组在 T、T 和 T 时均显示出相似的改善（p<0.05）。仅运动组在康复后增加了膝关节伸展力量（组×时间：p<0.001），仅步态组（组×时间：p<0.001）增加了步速（+7.0%）和降低了平均垂直加载率（-25.4%）。
尽管步态再训练和运动改善了其针对性的机制，但将其添加到教育中并没有为症状和功能限制提供额外的益处。对于患有 PFP 的跑步者，应将适当的症状和训练负荷管理教育作为治疗的主要组成部分。
ClinicalTrials.gov（NCT02352909）。
