title: Early intervention for adolescents with patellofemoral pain syndrome--a pragmatic cluster randomised controlled trial.
abstract: BACKGROUND
  Self-reported knee pain is highly prevalent among adolescents. As much as 50% of the non-specific knee pain may be attributed to Patellofemoral Pain Syndrome (PFPS). In the short term, exercise therapy appears to have a better effect than patient education consisting of written information and general advice on exercise or compared with placebo treatment. But the long-term effect of exercise therapy compared with patient education is conflicting. The purpose of this study is to examine the short- and long-term effectiveness of patient education compared with patient education and multimodal physiotherapy applied at a very early stage of the condition among adolescents.
  
  
  METHODS
  This study is a single blind pragmatic cluster randomised controlled trial. Four upper secondary schools have been invited to participate in the study (approximately 2500 students, aged 15-19 years). Students are asked to answer an online questionnaire regarding musculoskeletal pain. The students who report knee pain are contacted by telephone and offered a clinical examination by a rheumatologist. Subjects who fit the inclusion criteria and are diagnosed with PFPS are invited to participate in the study. A minimum of 102 students with PFPS are then cluster-randomised into two intervention groups based on which school they attend. Both intervention groups receive written information and education. In addition to patient education, one group receives multimodal physiotherapy consisting primarily of neuromuscular training of the muscles around the foot, knee and hip and home exercises. The students with PFPS fill out self-reported questionnaires at baseline, 3, 6, 12 and 24 months after inclusion in the study. The primary outcome measure is perception of recovery measured on a 7-point Likert scale ranging from "completely recovered" to "worse than ever" at 12 months.
  
  
  CONCLUSIONS
  This study is designed to investigate the effectiveness of patient education compared with patient education combined with multimodal physiotherapy. If patient education and multimodal physiotherapy applied at an early stage of Patellofemoral Pain Syndrome proves effective, it may serve as a basis for optimising the clinical pathway for those suffering from the condition, where specific emphasis can be placed on early diagnosis and early treatment.
  
  
  BACKGROUND
  clinicaltrials.gov reference: NCT01438762.
authors.affiliation: Graduate School of Health Sciences, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark. misr@rn.dk
authors.forename: Michael S
authors.initials: MS
authors.lastname: Rathleff
authors.forename: Ewa M
authors.initials: EM
authors.lastname: Roos
authors.forename: Jens L
authors.initials: JL
authors.lastname: Olesen
authors.forename: Sten
authors.initials: S
authors.lastname: Rasmussen
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016000:Cluster Analysis; D003131:Combined Modality Therapy; D003718:Denmark; D042241:Early Diagnosis; D061345:Early Medical Intervention; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010147:Pain Measurement; D046788:Patellofemoral Pain Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010353:Patient Education as Topic; D018579:Patient Selection; D026741:Physical Therapy Modalities; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012107:Research Design; D012720:Severity of Illness Index; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult