title: Targeted physiotherapy for patellofemoral joint osteoarthritis: a protocol for a randomised, single-blind controlled trial.
abstract: BACKGROUND
  The patellofemoral joint (PFJ) is one compartment of the knee that is frequently affected by osteoarthritis (OA) and is a potent source of OA symptoms. However, there is a dearth of evidence for compartment-specific treatments for PFJ OA. Therefore, this project aims to evaluate whether a physiotherapy treatment, targeted to the PFJ, results in greater improvements in pain and physical function than a physiotherapy education intervention in people with symptomatic and radiographic PFJ OA.
  
  
  METHODS
  90 people with PFJ OA (PFJ-specific history, signs and symptoms and radiographic evidence of PFJ OA) will be recruited from the community and randomly allocated into one of two treatments. A randomised controlled trial adhering to CONSORT guidelines will evaluate the efficacy of physiotherapy (8 individual sessions over 12 weeks, as well as a home exercise program 4 times/week) compared to a physiotherapist-delivered OA education control treatment (8 individual sessions over 12 weeks). Physiotherapy treatment will consist of (i) quadriceps muscle retraining; (ii) quadriceps and hip muscle strengthening; (iii) patellar taping; (iv) manual PFJ and soft tissue mobilisation; and (v) OA education. Resistance and dosage of exercises will be tailored to the participant's functional level and clinical state. Primary outcomes will be evaluated by a blinded examiner at baseline, 12 weeks and 9 months using validated and reliable pain, physical function and perceived global effect scales. All analyses will be conducted on an intention-to-treat basis using linear mixed regression models, including respective baseline scores as a covariate, subjects as a random effect, treatment condition as a fixed factor and the covariate by treatment interaction.
  
  
  CONCLUSIONS
  This RCT is targeting PFJ OA, an important sub-group of knee OA patients, with a specifically designed conservative intervention. The project's outcome will influence PFJ OA rehabilitation, with the potential to reduce the personal and societal burden of this increasing public health problem.
  
  
  BACKGROUND
  Australia New Zealand Clinical Trials Registry ACTRN12608000288325.
authors.affiliation: Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Australia. k.crossley@unimelb.edu.au
authors.forename: Kay M
authors.initials: KM
authors.lastname: Crossley
authors.forename: Bill
authors.initials: B
authors.lastname: Vicenzino
authors.forename: Marcus G
authors.initials: MG
authors.lastname: Pandy
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Schache
authors.forename: Rana S
authors.initials: RS
authors.lastname: Hinman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055052:Athletic Tape; D005269:Femur / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D016014:Linear Models; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D020370:Osteoarthritis, Knee / Q000503:physiopathology* / Q000534:rehabilitation / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010329:Patella / Q000503:physiopathology; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D016037:Single-Blind Method; D016896:Treatment Outcome
references.citation: Am J Sports Med. 1995 Jul-Aug;23(4):465-71
references.pmid: 7573659
references.citation: Osteoarthritis Cartilage. 2007 Nov;15(11):1235-40
references.pmid: 17570690
references.citation: Radiology. 2006 Jun;239(3):811-7
references.pmid: 16714463
references.citation: J Rheumatol. 1988 Dec;15(12):1833-40
references.pmid: 3068365
references.citation: Osteoarthritis Cartilage. 1995 Sep;3 Suppl A:3-70
references.pmid: 8581752
references.citation: Rheumatology (Oxford). 2007 Jul;46(7):1057-62
references.pmid: 17500072
references.citation: Lancet. 2000 Jun 10;355(9220):2037-40
references.pmid: 10885355
references.citation: Rheumatology (Oxford). 2006 Jun;45(6):757-60
references.pmid: 16418199
references.citation: BMC Musculoskelet Disord. 2005 Jan 28;6:3
references.pmid: 15679884
references.citation: Arthritis Res Ther. 2007;9(2):R26
references.pmid: 17343731
references.citation: Clin Biomech (Bristol, Avon). 2008 Feb;23(2):203-11
references.pmid: 17942202
references.citation: J Rheumatol. 2003 Jun;30(6):1311-7
references.pmid: 12784408
references.citation: Am J Sports Med. 2002 Nov-Dec;30(6):857-65
references.pmid: 12435653
references.citation: Rheumatology (Oxford). 2003 Jul;42(7):865-9
references.pmid: 12730546
references.citation: J Athl Train. 1998 Jan;33(1):16-20
references.pmid: 16558478
references.citation: BMC Musculoskelet Disord. 2008 Feb 27;9:27
references.pmid: 18304317
references.citation: Clin Biomech (Bristol, Avon). 2000 Oct;15(8):611-8
references.pmid: 10936434
references.citation: Arthritis Rheum. 2008 Jan 15;59(1):73-83
references.pmid: 18163413
references.citation: Arch Phys Med Rehabil. 2001 Feb;82(2):183-9
references.pmid: 11239308
references.citation: Rheumatology (Oxford). 2007 Aug;46(8):1303-8
references.pmid: 17525117
references.citation: J Orthop Sports Phys Ther. 2003 Nov;33(11):671-6
references.pmid: 14669962
references.citation: Am J Sports Med. 2004 Apr-May;32(3):621-8
references.pmid: 15090376
references.citation: J Biomech. 2005 Oct;38(10):2095-101
references.pmid: 16084210
references.citation: Osteoarthritis Cartilage. 2003 Oct;11(10):725-9
references.pmid: 13129691
references.citation: Arthritis Rheum. 2000 Aug;43(8):1874-80
references.pmid: 10943879
references.citation: Ann Rheum Dis. 2004 Apr;63(4):402-7
references.pmid: 15020334
references.citation: J Orthop Sports Phys Ther. 1998 Aug;28(2):88-96
references.pmid: 9699158
references.citation: Ann Rheum Dis. 2003 Dec;62(12):1145-55
references.pmid: 14644851
references.citation: Med Sci Sports Exerc. 2004 Jan;36(1):93-101
references.pmid: 14707774
references.citation: Med J Aust. 2004 Mar 1;180(S5):S6-10
references.pmid: 14984356
references.citation: Arthritis Rheum. 2006 Jan;54(1):230-5
references.pmid: 16385522
references.citation: Curr Opin Rheumatol. 2005 Sep;17(5):634-40
references.pmid: 16093845
references.citation: Acta Radiol. 1998 Jan;39(1):24-31
references.pmid: 9498865
references.citation: Rheumatology (Oxford). 2002 Dec;41(12):1388-94
references.pmid: 12468818
references.citation: BMJ. 1996 Sep 7;313(7057):570-1
references.pmid: 8806240
references.citation: Ann Rheum Dis. 2006 Apr;65(4):515-9
references.pmid: 16166105
references.citation: Clin J Sport Med. 2001 Apr;11(2):103-10
references.pmid: 11403109
references.citation: Med Sci Sports Exerc. 2002 Dec;34(12):1879-85
references.pmid: 12471291
references.citation: BMJ. 2003 Jul 19;327(7407):135
references.pmid: 12869456
references.citation: J Orthop Res. 2003 May;21(3):553-8
references.pmid: 12706031
references.citation: Osteoarthritis Cartilage. 2007 Oct;15(10):1120-7
references.pmid: 17502158
references.citation: Arthritis Rheum. 2000 Sep;43(9):1905-15
references.pmid: 11014340
references.citation: Ann Rheum Dis. 2005 Jan;64(1):29-33
references.pmid: 15208174
references.citation: Ann Rheum Dis. 1998 Oct;57(10):595-601
references.pmid: 9893570
references.citation: Knee Surg Sports Traumatol Arthrosc. 2003 Jul;11(4):244-51
references.pmid: 12695878
references.citation: Arch Phys Med Rehabil. 2002 Jul;83(7):989-95
references.pmid: 12098160
references.citation: Osteoarthritis Cartilage. 1996 Jun;4(2):143-7
references.pmid: 8806116
references.citation: Clin Orthop Relat Res. 1990 Mar;(252):190-7
references.pmid: 2302884