Background

Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain.

Hypothesis

The hypotheses were that the assessment and subgroup classification is clinically feasible, and that targeted treatment designed according to the characteristics of three subgroups of PFP patients would show clinical benefits over and above a multimodal intervention.

Study Design

A prospective crossover intervention.

Level of Evidence

Level III

Methods

PFP patients (n=61, mean age: 27±9 years) were enrolled. PFP patients received standard multimodal treatment three times a week for 6 weeks. Patients not responding to multimodal treatment were then classified into one of 3 subgroups “strong”, “weak and tight” and “weak and pronated foot” using six simple clinical tests. They subsequently were administered a further 6 weeks of targeted intervention designed according to subgroup characteristics. Visual Analog Scale (VAS), Perception of Recovery Scale (PRS), EQ-5D-5L, and S-LANSS were used to assess pain, knee function and quality of life before and after the interventions.

Results

36% of the patients (21 patients) demonstrated recovery following multimodal treatment. However, over 70% (29 patients) of these non-responders demonstrated recovery after targeted treatment. The VAS, PRS, S-LANSS, and EQ-5D-5L scores improved significantly after targeted intervention compared to after multimodal treatment (p<0.001). The VAS score at rest was significantly lower in the weak and pronated foot, and weak and2 tight subgroups (p=0.011, p=0.008) respectively. Post-treatment 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 following six simple clinical assessment tests to subgroup patients into one of three subgroups (strong, weak and tight, 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.