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How can we implement exercise therapy for patellofemoral pain if we don’t know what was prescribed? A systematic review
  1. Sinead Holden1,2,
  2. Michael Skovdal Rathleff1,3,
  3. Martin Bach Jensen1,
  4. Christian J Barton4
  1. 1 Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  2. 2 Center for Neuroplasticity and Pain (CNAP), SMI,Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
  3. 3 SMI, Department of Health Science and Technology, Aalborg University
  4. 4 La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Sinead Holden, Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Fyrkildevej 7,1, 9220 Aalborg, Denmark; siho{at}


Objective To evaluate the completeness of exercise prescription in randomised controlled trials (RCTs) for patellofemoral pain (PFP), identify which elements are most frequently missing and supplement recommendations based on additional data from authors.

Design Systematic review.

Data sources All studies included in the most recent Cochrane review were evaluated. Additionally, the Cochrane search was updated in June 2016 in Cochrane, MEDLINE, EMBASE, PEDro, CINAHL and AMED databases. Two raters independently assessed completeness of reporting using the Toigo and Boutellier mechanobiological exercise descriptors, and Template for Intervention Description and Replication (TIDieR) checklist. Authors were also contacted to provide additional information.

Eligibility criteria for selecting studies RCTs of exercise interventions for PFP.

Results We included 38 RCTs. The level of exercise prescription detail was low, with no study providing complete information. The most commonly reported exercise descriptors were the ’duration of the experimental period' (n=38/38) and ’number of exercise interventions' (n=35). From TIDieR, the most commonly reported items were the ’intervention name' (n=38) and ’rationale' (n=36).

The least reported items from the exercise descriptors were ’volitional muscular failure', ’temporal distribution of contraction modes', ’time under tension' and ’recovery between exercise sessions' (all n=2/38). From TIDieR, the least reported item was ‘How well (fidelity and adherence)’ (n=3/38).

36 authors were contacted, with 22 replies and 13 providing additional exercise prescription details .

Conclusion Exercise prescriptions in RCTs with proven efficacy for PFP are poorly reported, impairing their implementation in clinical practice.

PROSPERO registration number CRD42016039138.

  • exercise rehabilitation
  • evidence based
  • implementation
  • knowledge translation

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  • Handling editor Karim M Khan

  • Contributors SH, MSR, MBJ and CJB all participated in the study design, protocol and registration. SH and CJB were responsible for selecting articles for inclusion. MBJ and CJB conducted the risk of bias assessment. SH and MSR were responsible for data extraction. SH drafted the manuscript and all authors provided critical input and final approval. SH is the guarantor.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.