Effects of an online program including mindfulness, exercise therapy and patient education compared to online exercise therapy and patient education for people with Patellofemoral Pain: protocol for a randomized clinical trial.

BACKGROUND: Patellofemoral pain (PFP) is a common knee disorder that causes persistent pain, lower self-reported function and quality of life. People with PFP also present with altered psychological factors, which are associated with higher levels of pain and dysfunction. Mindfulness-based interventions (MBI) generally consist of meditative practices developed to provide a holistic approach to chronic conditions. However, the effects of MBI on clinical and psychological outcomes for people with PFP remains understudied. METHODS: This assessor-blinded, parallel, two-arm randomized clinical trial aims to investigate the effects of adding an 8-week online MBI program to exercise therapy and patient education on clinical and psychological factors for people with PFP. We also aim to investigate whether psychological factors mediate changes in pain and function. Sixty-two participants with PFP will be recruited and randomized into one of two treatment groups (Mindfulness or Control group). Both groups will receive an 8-week intervention involving exercise therapy and education delivered through an online platform. The Mindfulness group will additionally receive a MBI component including formal and informal practices. Outcomes will be assessed online at baseline, intervention endpoint (follow-up 1) and 12 months after intervention completion (follow-up 2). Comparisons between groups will be performed at all time points with linear mixed models. A mediation analysis will be performed using a 3-variable framework. DISCUSSION: Exercise therapy and patient education are considered the "best management" options for PFP. However, unsatisfactory long-term prognosis remains an issue. It is known that people with PFP present with altered psychological factors, which should be considered during the evaluation and treatment of people with PFP. Adding a MBI to the current best treatment for PFP may improve short and long-term effects by addressing the underlying psychological factors. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-4yhbqwk, registered in April 6, 2021.

Exacerbating patellofemoral pain alters trunk and lower limb coordination patterns and hip-knee mechanics.

The exacerbation of patellofemoral pain (PFP) may lead to compensatory trunk and lower limb movement patterns in order to minimize patellofemoral joint loading. However, joint kinematics are often analysed in isolation, which limits the understanding of how the underlying segments were coordinated to produce limb postures and distribute load across the limb. In this study we used a dynamical systems approach to investigate how women with PFP coordinate trunk, hip, and knee motion and distribute hip-knee moment demands following symptom exacerbation. Coordination patterns and coordination variability of the trunk, hip, and knee from 61 women with PFP were obtained during stair descent, ascent, and step down tasks, before and after a pain exacerbation protocol. Hip-knee extensor moment impulse ratio was also calculated. Following the exacerbation of PFP, women utilized knee dominant coordination patterns less often (p = 0.039-0.027; d = 0.51-0.53), while coordination patterns with the trunk leaning forward were utilized more during stair negotiation (p = 0.043-<0.001; d = 0.52-0.96). Although no significant differences in hip-knee coordination patterns were found, there was an increase in the hip-knee impulse ratio during stair negotiation (p = 0.014-<0.001; d = 0.27-0.36). These findings seem to display a movement strategy utilized by women with PFP in order to distribute more load to the hip joint and less to the knee joint, possibly in an attempt to avoid/manage pain.

Differences in pain and function between adolescent athletes and physically active non-athletes with patellofemoral pain.

OBJECTIVES: To investigate pain level and function limitation in adolescent athletes and physically active non-athletes with PFP. DESIGN: Cross-sectional study. SETTING: Adolescent athletes were recruited at a sport center complex. Adolescent non-athletes were recruited from upper secondary schools. PARTICIPANTS: 108 adolescents diagnosed with PFP: 42 adolescent athletes and 66 adolescent non-athletes. MAIN OUTCOME MEASURES: To evaluate the level of pain, a visual analog scale (VAS) was used and to evaluate the overall function, the Knee Outcome in Osteoarthritis Survey (KOOS) was used. RESULTS: The adolescent athletes scored significantly higher in the VAS (Mean difference = 0.97 (95% CI = 0.35; 1.60) p = 0.003) compared to adolescent non-athletes. Adolescent athletes scored lower in the KOOS - Symptoms, Pain, Knee-related quality of life and Sport and recreation dimensions - than the non-athletes, however, the minimally clinically important difference was not achieved in Pain dimension. There was no significant difference in the Activities of daily living dimension of the KOOS. CONCLUSIONS: Adolescent athletes presented higher levels of pain and lower physical function status compared with physically active non-athletes. This provides an important insight to the management of PFP in adolescent athletes as worst functional status is linked with poor prognosis in patients with PFP.

Knee crepitus is prevalent in women with patellofemoral pain, but is not related with function, physical activity and pain.

OBJECTIVES: (i) To assess the reliability of knee crepitus measures, (ii) to investigate the association between knee crepitus and PFP; (iii) to investigate the relationship between knee crepitus with self-reported function, physical activity and pain. DESIGN: Cross-sectional. SETTING: Laboratory-based study. PARTICIPANTS: 165 women with PFP and 158 pain-free women. MAIN OUTCOME MEASURES: Knee crepitus test, anterior knee pain scale (AKPS) and self-reported worst knee pain in the last month, knee pain after 10 squats and knee pain after 10 stairs climbing. RESULTS: Knee crepitus clinical test presented high reliability Kappa value for PFP group was 0.860 and for pain-free group was 0.906. There is a significantly greater proportion of those with crepitus in the PFP group than in the pain-free group (OR = 4.19). Knee crepitus had no relationship with function (rpb = 0.03; p = 0.727), physical activity level (rpb = 0.010; p = 0.193), worst pain (rpb = 0.11; p = 0.141), pain climbing stairs (rpb = 0.10; p = 0.194) and pain squatting (rpb = 0.02; p = 0.802). CONCLUSION: Women who presents knee crepitus have 4 times greater odds to be in a group with PFP compared to those who do not. However, knee crepitus has no relationship with self-reported clinical outcomes of women with PFP.