title: Effects of rehabilitation approaches for runners with patellofemoral pain: protocol of a randomised clinical trial addressing specific underlying mechanisms.
abstract: BACKGROUND
  Patellofemoral pain (PFP) is highly prevalent in runners, and often leads to functional limitations and cessation of running. Training errors as well as decreased lower limb strength and control during running have all been associated with PFP. While strengthening and gait retraining are commonly used by clinicians, no randomised clinical trial has compared these modalities in runners with PFP. The primary objective of this randomised clinical trial will be to compare the effects of three rehabilitation programs targeting different key factors on symptoms and functional limitations of runners with PFP. The secondary objective will be to explore the factors leading to clinical improvement.
  
  
  METHODS
  We will conduct a single-blind randomised clinical trial to compare three different 8 week rehabilitation programs: Group 1 will receive education on symptoms management based on training modifications; Group 2 will receive an exercise program targeting lower limb strengthening and control in addition to the education component of Group 1; Group 3 will receive running gait retraining advice as well as the education component of Group 1. Sixty-nine runners with PFP will be recruited and will be seen by independent physiotherapists on five visits through 8 weeks. The primary outcome measure will be symptoms and functional limitations measured by the Knee Outcome Survey - Activities of Daily Living Scale questionnaire at baseline, and at the four, eight and 20 weeks follow-up. Secondary outcomes will include pain level measured using visual analog scales, and running mileage. Lower limb kinematics and kinetics during running, and isometric strength will also be evaluated at baseline and 8 weeks follow-up. The effects of rehabilitation programs on measures of symptoms and functional limitations will be assessed using a 2-way ANOVA (Groups x Time). Regression analyses will be used to identify if changes in running mechanics or strength are determinants of clinical success.
  
  
  CONCLUSIONS
  Studies with a high level of evidence are needed to determine the best rehabilitation interventions for runners with PFP. This randomised clinical trial will be the first to compare programs targeting different key factors linked with PFP. Results may guide clinicians and improve their clinical outcomes when treating runners with PFP.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02352909. Registered on December 3, 2014.
authors.affiliation: Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. jean-francois.esculier.1@ulaval.ca.|Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1M 2S8, Canada. jean-francois.esculier.1@ulaval.ca.|The Running Clinic, C.P. 1075, Lac-Beauport, QC, G3B 2J8, Canada. jean-francois.esculier.1@ulaval.ca.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Esculier
authors.affiliation: Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. laurent.bouyer@rea.ulaval.ca.|Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1M 2S8, Canada. laurent.bouyer@rea.ulaval.ca.
authors.forename: Laurent J
authors.initials: LJ
authors.lastname: Bouyer
authors.affiliation: The Running Clinic, C.P. 1075, Lac-Beauport, QC, G3B 2J8, Canada. blaisedubois@me.com.
authors.forename: Blaise
authors.initials: B
authors.lastname: Dubois
authors.affiliation: Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. pierre.fremont@fmed.ulaval.ca.
authors.forename: Pierre
authors.initials: P
authors.lastname: Frémont
authors.affiliation: Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. lynne.moore@fmed.ulaval.ca.
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.affiliation: Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. jean-sebastien.roy@rea.ulaval.ca.|Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1M 2S8, Canada. jean-sebastien.roy@rea.ulaval.ca.
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Roy
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D010147:Pain Measurement / Q000379:methods; D046788:Patellofemoral Pain Syndrome / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D055070:Resistance Training / Q000379:methods; D012420:Running / Q000293:injuries* / Q000502:physiology; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult