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Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofemoral pain: a cluster randomised trial
  1. M S Rathleff1,2,
  2. E M Roos3,
  3. J L Olesen4,5,6,
  4. S Rasmussen1,2,6
  1. 1Department of Health, Aarhus University, Aarhus, Denmark
  2. 2Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark
  3. 3Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  4. 4Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
  5. 5Institute of Sports Medicine Copenhagen, Copenhagen University Hospital, Bispebjerg, Denmark
  6. 6Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  1. Correspondence to Dr Michael Skovdal Rathleff, Sdr Skovvej 15, Aalborg 9000, Denmark; michaelrathleff{at}gmail.com

Abstract

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.

Trial registration number clinicaltrials.gov reference: NCT01438762.

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