Three-Year Outcome after a 1-Month Physiotherapy Program of Local and Individualized Global Treatment for Patellofemoral Pain Followed by Self-Management

Abstract

Objective: The main aim of this study was to assess whether improvements after a 1-month patellofemoral pain (PFP) program addressing local and global deficits were maintained for 3 years. Design: This prospective cohort study comprised 4 treatment phases including a randomized trial during week 1. Setting: The study was conducted in a private physiotherapy practice. Patients: Thirty-seven patients (55 knees) from an original cohort of 41 patients (60 knees) with PFP were followed for 3 years after referral by doctors to participate in this study. Interventions: Patients received 4 treatments: local treatment focusing on quadriceps strengthening, quadriceps stretching, and taping for fortnight 1, supplemented with individualized global treatment focusing on lower limb posture and movement patterns for fortnight 2, followed by ongoing self-management. Main Outcome Measures: Seven outcome measures, assessed at 4 time points, were quadriceps strength, quadriceps length, eccentric knee control, and 4 pain measures. Long-term measures included return to sporting activity, pain recurrence, exercise compliance, and Kujala score. Results: Improvements after fortnight 1 (P < 0.001) and fortnight 2 (P < 0.05) were maintained over 3 years for 6 of 7 measures. On testing, 73% were pain free and the remaining 27% had less pain than pretreatment. Kujala scores improved 27%. Eighty-two percent resumed any sport stopped and 54% of patients started new sports/activities. Patellofemoral pain recurred in 7% and 89% of patients was still exercising 3 years posttreatment. Conclusions: Significant improvements after physiotherapy, incorporating local and individually targeted treatment, were maintained for 3 years in a compliant cohort.