JMIR Publications

ABSTRACT

Background:

Patellofemoral pain (PFP) affects one in four adults, impairs joint- and health-related quality of life, and is believed to be on a trajectory with knee osteoarthritis. We developed a novel 2-phase stepped care approach for PFP, combining (i) self-directed web-based education and exercise-therapy with (ii) physiotherapy supported education and exercise-therapy.

Objective:

To (i) determine the feasibility of our stepped care approach; (ii) explore patient-reported outcomes following self-directed web-based education and exercise-therapy in people with PFP (phase 1); and (iii) estimate differences in treatments effects between face-to-face and telerehabilitation delivery of physiotherapy to support further education and exercise-therapy (phase 2) in those not completely recovered following self-directed care.

Methods:

Phase 1 involved 6-weeks of self-directed web-based education and exercise-therapy. Phase 2 involved random allocation to a further 12-weeks of physiotherapist led education and exercise-therapy delivered face-to-face or via telerehabilitation for participants who did not rate themselves as ‘completely recovered’ following phase 1. Feasibility indicators of process were collected as primary outcomes alongside patient-reported outcomes: global rating of change and worst pain in the previous week, disability, knee-related quality of life, pain catastrophism, kinesiophobia and knee self-efficacy. All participants were assessed at baseline, 6-weeks and 18-weeks.

Results:

Seventy-one participants were screened to identify 35 participants with PFP to enter the study (2 per week). 100% (35/35) and 88% (31/35) participants were followed up at 6- and 18 weeks respectively. Phase 1: Participants accessed the website an average of 6 days (15% of days). 20% (7/35) reported they were ‘completely recovered’ at 6-weeks, with large improvements for pain across the cohort (Mean difference (MD) 95%CI = 28.64 [18.88; 38.39]) identified. Phase 2: 93% (26/28) of participants followed up and not completely recovered at 6-weeks agreed to be enrolled in phase 2, attending an average of 4.5 and 5.2 physiotherapy sessions in the face-to-face group and telerehabilitation groups respectively. No statistically significant differences were found between face-to-face and telerehabilitation groups for any outcome. Overall, the novel stepped care approach was associated with marked improvement or complete recovery in 40% (14/35) following phase 1, and 71% (25/35) following phase 2.

Conclusions:

Self-directed web-based education and exercise-therapy for people with PFP is feasible, and may improve healthcare efficiency, with one in five people reporting complete recovery at 6-weeks. Both face-to-face and telerehabilitation physiotherapy should be considered for those continuing to seek care, with no difference in outcomes between these delivery modes. Determining the efficacy of self-directed web-based education and exercise as a stand-alone intervention, and as part of a stepped care model including additional physiotherapy, may help guide more efficient healthcare for people with PFP. Clinical Trial: The protocol was a priori registered and approved by the Australian New Zealand Clinical Trials Registry (ACTRN12618000224224).