Targeted Treatment Protocol in Patellofemoral Pain: Does Treatment Designed According to Subgroups Improve Clinical Outcomes in Patients Unresponsive to Multimodal Treatment?

Yosmaoğlu, Hayri Baran, Selfe, James ORCID: https://orcid.org/0000-0001-9931-4998, Sonmezer, Emel, Sahin, İlknur Ezgi, Duygu, Senay Çerezci, Acar Ozkoslu, Manolya, Richards, Jim and Janssen, Jessica (2020) Targeted Treatment Protocol in Patellofemoral Pain: Does Treatment Designed According to Subgroups Improve Clinical Outcomes in Patients Unresponsive to Multimodal Treatment? Sports Health, 12 (2). pp. 170-180. ISSN 1941-7381

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Abstract

BACKGROUND:Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain. HYPOTHESIS:Treatment designed according to subgroups will improve clinical outcomes in patients unresponsive to multimodal treatment. STUDY DESIGN:Prospective crossover intervention. LEVEL OF EVIDENCE:Level 3. METHODS:Patients with patellofemoral pain (PFP; n = 61; mean age, 27 ± 9 years) were enrolled. Patients with PFP received standard multimodal treatment 3 times a week for 6 weeks. Patients not responding to multimodal treatment were then classified into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot) using 6 simple clinical tests. They were subsequently administered 6 further weeks of targeted intervention, designed according to subgroup characteristics. Visual analog scale (VAS), perception of recovery scale (PRS), 5-Level European Quality 5 Dimensions (EQ-5D-5L), and self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (S-LANSS) were used to assess pain, knee function, and quality of life before and after the interventions. RESULTS:In total, 34% (n = 21) of patients demonstrated recovery after multimodal treatment. However, over 70% (n = 29/40) of nonresponders demonstrated recovery after targeted treatment. The VAS, PRS, S-LANSS, and EQ-5D-5L scores improved significantly after targeted intervention compared with after multimodal treatment (P < 0.001). The VAS score at rest was significantly lower in the "weak and pronated foot" and the "weak and tight" subgroups (P = 0.011 and P = 0.008, respectively). Posttreatment pain intensity on activity was significantly lower in the "strong" subgroup (P = 0.006). CONCLUSION:Targeted treatment designed according to subgroup characteristics improves clinical outcomes in patients unresponsive to multimodal treatment. CLINICAL RELEVANCE:Targeted intervention could be easily implemented after 6 simple clinical assessment tests to subgroup patients into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot). Targeted interventions applied according to the characteristics of these subgroups have more beneficial treatment effects than a current multimodal treatment program.