Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofemoral pain: a cluster randomised trial.
BACKGROUND
Patellofemoral pain (PFP) is common among adolescents and associated with long-lasting pain and disability. Patient education and exercise therapy are commonly used treatments in primary and secondary care but the effect of these treatments in adolescents is unknown. We aimed to determine the effect of exercise therapy as an add-on therapy to patient education compared with education alone.


METHODS
121 adolescents from 15-19 years of age were cluster randomised to patient education or patient education combined with exercise therapy. Patient education covered self-management of pain and information on PFP. Exercise therapy consisted of supervised exercises on school premises (3/week for 3 months) and instructions on home-based exercises. Adherence to exercises was assessed as attendance and weekly text messages. Primary outcome measure was self-reported recovery (seven-point Likert scale) at 12 months with additional follow-ups at 3, 6 and 24 months.


RESULTS
Adolescents randomised to patient education and exercise therapy were more likely to have recovered at 12 months (OR, 1.73, 95% CI 1.02 to 2.93, number needed to treat (NNT) of 11). Similar results were observed at 3 and 6 months (OR 1.88 and 1.43) while the effect was further increased at 24 months (OR of 2.52, NNT of 5). A higher total number of weekly exercise sessions increased the odds of recovery.


CONCLUSIONS
In adolescent PFP, the addition of exercise therapy for 3 months was more effective than patient education alone. The effect was apparent at 3 months and increased up to 2 years. Adherence to exercises was important and improved the odds of recovery.


BACKGROUND
clinicaltrials.gov reference: NCT01438762.
Department of Health, Aarhus University, Aarhus, Denmark Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark.
M S
MS
Rathleff
Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
E M
EM
Roos
Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark Institute of Sports Medicine Copenhagen, Copenhagen University Hospital, Bispebjerg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
J L
JL
Olesen
Department of Health, Aarhus University, Aarhus, Denmark Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
S
S
Rasmussen
D000293:Adolescent; D016000:Cluster Analysis; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D046788:Patellofemoral Pain Syndrome / Q000628:therapy*; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D012572:School Health Services; D016896:Treatment Outcome
Adolescent; Exercise rehabilitation; Knee