Activity Modification and Load Management of Adolescents With Patellofemoral Pain: A Prospective Intervention Study Including 151 Adolescents

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Abstract

BACKGROUND: Patellofemoral pain (PFP) affects 7% of adolescents, especially those who are highly active. Exercise-focused treatments show limited effect and overlook activity modification and load management. As many adolescents continue at high levels of sports despite pain, a new strategy addressing this problem is warranted.

PURPOSE: To investigate the effects of a treatment strategy for adolescents that focuses on activity modification and load management.

STUDY DESIGN: Cohort study; Level of evidence, 2.

METHODS: Adolescents aged 10 to 14 years with PFP were included (N = 151). The 12-week intervention included 4 supervised sessions with a physical therapist, which adolescents and parents were required to attend. The intervention included activity modification (weeks 1-4) to reduce loading of the patellofemoral joint via an activity ladder and pain monitoring, home-based exercises (weeks 5-8), and return-to-sport guidance (weeks 9-12). Primary outcome was a 7-point global rating of change, ranging from "much improved" to "much worse." Adolescents were considered to have a successful outcome if they reported "much improved" or "improved." The primary endpoint was at 12 weeks, with additional follow-up at 4, 24, and 52 weeks. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS), hip and knee torque, sports participation, satisfaction with treatment, and use of painkillers.

RESULTS: At 12 weeks, 87% completed the full questionnaire, of which 86% reported a successful outcome, as compared with 77% (95% CI, 68%-83%) at 6 months and 81% (95% CI, 73%-88%) at 12 months. There were large clinically relevant improvements in 3 KOOS subscales: Pain, Sport/Recreation, and Quality of Life (13-24 points). Hip and knee torque increased by 20% to 33%. In total, 68% were back playing sport after 3 months, which increased to 79% at 6 months and 81% at 12 months. The majority were satisfied with the treatment (90%) and would recommend it to a friend (95%). No specific patient characteristics were associated with prognosis.

CONCLUSION: A treatment strategy focusing on activity modification and load management was associated with high rates of successful outcome among adolescents with PFP at 12 and 52 weeks. These short- and longer-term outcomes were supported by improvements in symptoms and objective measures of hip and knee torque.

REGISTRATION: NCT02402673 (ClinicalTrials.gov identifier).

Original languageEnglish
JournalThe American Journal of Sports Medicine
ISSN0363-5465
DOIs
Publication statusE-pub ahead of print - 16 May 2019

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Prospective Studies
Pain
Sports
Torque
Hip
Knee Injuries
Knee
Knee Osteoarthritis
Exercise
Patellofemoral Joint
Therapeutics
Recreation
Physical Therapists
Cohort Studies
Parents
Quality of Life

Cite this

@article{f25c1b78f3f740e096fd1d2575e5a317,
title = "Activity Modification and Load Management of Adolescents With Patellofemoral Pain: A Prospective Intervention Study Including 151 Adolescents",
abstract = "BACKGROUND: Patellofemoral pain (PFP) affects 7{\%} of adolescents, especially those who are highly active. Exercise-focused treatments show limited effect and overlook activity modification and load management. As many adolescents continue at high levels of sports despite pain, a new strategy addressing this problem is warranted.PURPOSE: To investigate the effects of a treatment strategy for adolescents that focuses on activity modification and load management.STUDY DESIGN: Cohort study; Level of evidence, 2.METHODS: Adolescents aged 10 to 14 years with PFP were included (N = 151). The 12-week intervention included 4 supervised sessions with a physical therapist, which adolescents and parents were required to attend. The intervention included activity modification (weeks 1-4) to reduce loading of the patellofemoral joint via an activity ladder and pain monitoring, home-based exercises (weeks 5-8), and return-to-sport guidance (weeks 9-12). Primary outcome was a 7-point global rating of change, ranging from {"}much improved{"} to {"}much worse.{"} Adolescents were considered to have a successful outcome if they reported {"}much improved{"} or {"}improved.{"} The primary endpoint was at 12 weeks, with additional follow-up at 4, 24, and 52 weeks. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS), hip and knee torque, sports participation, satisfaction with treatment, and use of painkillers.RESULTS: At 12 weeks, 87{\%} completed the full questionnaire, of which 86{\%} reported a successful outcome, as compared with 77{\%} (95{\%} CI, 68{\%}-83{\%}) at 6 months and 81{\%} (95{\%} CI, 73{\%}-88{\%}) at 12 months. There were large clinically relevant improvements in 3 KOOS subscales: Pain, Sport/Recreation, and Quality of Life (13-24 points). Hip and knee torque increased by 20{\%} to 33{\%}. In total, 68{\%} were back playing sport after 3 months, which increased to 79{\%} at 6 months and 81{\%} at 12 months. The majority were satisfied with the treatment (90{\%}) and would recommend it to a friend (95{\%}). No specific patient characteristics were associated with prognosis.CONCLUSION: A treatment strategy focusing on activity modification and load management was associated with high rates of successful outcome among adolescents with PFP at 12 and 52 weeks. These short- and longer-term outcomes were supported by improvements in symptoms and objective measures of hip and knee torque.REGISTRATION: NCT02402673 (ClinicalTrials.gov identifier).",
author = "Rathleff, {Michael Skovdal} and Thomas Graven-Nielsen and Per H{\"o}lmich and Lukasz Winiarski and Kasper Krommes and Sin{\'e}ad Holden and Kristian Thorborg",
year = "2019",
month = "5",
day = "16",
doi = "10.1177/0363546519843915",
language = "English",
journal = "The American Journal of Sports Medicine",
issn = "0363-5465",
publisher = "SAGE Publications",

}

TY - JOUR

T1 - Activity Modification and Load Management of Adolescents With Patellofemoral Pain

T2 - A Prospective Intervention Study Including 151 Adolescents

AU - Rathleff, Michael Skovdal

AU - Graven-Nielsen, Thomas

AU - Hölmich, Per

AU - Winiarski, Lukasz

AU - Krommes, Kasper

AU - Holden, Sinéad

AU - Thorborg, Kristian

PY - 2019/5/16

Y1 - 2019/5/16

N2 - BACKGROUND: Patellofemoral pain (PFP) affects 7% of adolescents, especially those who are highly active. Exercise-focused treatments show limited effect and overlook activity modification and load management. As many adolescents continue at high levels of sports despite pain, a new strategy addressing this problem is warranted.PURPOSE: To investigate the effects of a treatment strategy for adolescents that focuses on activity modification and load management.STUDY DESIGN: Cohort study; Level of evidence, 2.METHODS: Adolescents aged 10 to 14 years with PFP were included (N = 151). The 12-week intervention included 4 supervised sessions with a physical therapist, which adolescents and parents were required to attend. The intervention included activity modification (weeks 1-4) to reduce loading of the patellofemoral joint via an activity ladder and pain monitoring, home-based exercises (weeks 5-8), and return-to-sport guidance (weeks 9-12). Primary outcome was a 7-point global rating of change, ranging from "much improved" to "much worse." Adolescents were considered to have a successful outcome if they reported "much improved" or "improved." The primary endpoint was at 12 weeks, with additional follow-up at 4, 24, and 52 weeks. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS), hip and knee torque, sports participation, satisfaction with treatment, and use of painkillers.RESULTS: At 12 weeks, 87% completed the full questionnaire, of which 86% reported a successful outcome, as compared with 77% (95% CI, 68%-83%) at 6 months and 81% (95% CI, 73%-88%) at 12 months. There were large clinically relevant improvements in 3 KOOS subscales: Pain, Sport/Recreation, and Quality of Life (13-24 points). Hip and knee torque increased by 20% to 33%. In total, 68% were back playing sport after 3 months, which increased to 79% at 6 months and 81% at 12 months. The majority were satisfied with the treatment (90%) and would recommend it to a friend (95%). No specific patient characteristics were associated with prognosis.CONCLUSION: A treatment strategy focusing on activity modification and load management was associated with high rates of successful outcome among adolescents with PFP at 12 and 52 weeks. These short- and longer-term outcomes were supported by improvements in symptoms and objective measures of hip and knee torque.REGISTRATION: NCT02402673 (ClinicalTrials.gov identifier).

AB - BACKGROUND: Patellofemoral pain (PFP) affects 7% of adolescents, especially those who are highly active. Exercise-focused treatments show limited effect and overlook activity modification and load management. As many adolescents continue at high levels of sports despite pain, a new strategy addressing this problem is warranted.PURPOSE: To investigate the effects of a treatment strategy for adolescents that focuses on activity modification and load management.STUDY DESIGN: Cohort study; Level of evidence, 2.METHODS: Adolescents aged 10 to 14 years with PFP were included (N = 151). The 12-week intervention included 4 supervised sessions with a physical therapist, which adolescents and parents were required to attend. The intervention included activity modification (weeks 1-4) to reduce loading of the patellofemoral joint via an activity ladder and pain monitoring, home-based exercises (weeks 5-8), and return-to-sport guidance (weeks 9-12). Primary outcome was a 7-point global rating of change, ranging from "much improved" to "much worse." Adolescents were considered to have a successful outcome if they reported "much improved" or "improved." The primary endpoint was at 12 weeks, with additional follow-up at 4, 24, and 52 weeks. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS), hip and knee torque, sports participation, satisfaction with treatment, and use of painkillers.RESULTS: At 12 weeks, 87% completed the full questionnaire, of which 86% reported a successful outcome, as compared with 77% (95% CI, 68%-83%) at 6 months and 81% (95% CI, 73%-88%) at 12 months. There were large clinically relevant improvements in 3 KOOS subscales: Pain, Sport/Recreation, and Quality of Life (13-24 points). Hip and knee torque increased by 20% to 33%. In total, 68% were back playing sport after 3 months, which increased to 79% at 6 months and 81% at 12 months. The majority were satisfied with the treatment (90%) and would recommend it to a friend (95%). No specific patient characteristics were associated with prognosis.CONCLUSION: A treatment strategy focusing on activity modification and load management was associated with high rates of successful outcome among adolescents with PFP at 12 and 52 weeks. These short- and longer-term outcomes were supported by improvements in symptoms and objective measures of hip and knee torque.REGISTRATION: NCT02402673 (ClinicalTrials.gov identifier).

U2 - 10.1177/0363546519843915

DO - 10.1177/0363546519843915

M3 - Journal article

JO - The American Journal of Sports Medicine

JF - The American Journal of Sports Medicine

SN - 0363-5465

ER -