Hott A, Brox JI, Pripp AH, et al. Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain: A Randomized Controlled Trial. Am J Sports Med. 2019 May;47(6):1312-1322. doi: 10.1177/0363546519830644. Epub 2019 Apr 8. (Original study)

BACKGROUND: Exercise for patellofemoral pain (PFP) is traditionally knee focused, targeting quadriceps muscles. In recent years, hip-focused exercise has gained popularity. Patient education is likely an important factor but is underresearched.

PURPOSE: To compare 3 treatment methods for PFP, each combined with patient education: hip-focused exercise, knee-focused exercise, or free physical activity.

STUDY DESIGN: Randomized controlled trial; Level of evidence, 1.

METHODS: A single-blind randomized controlled trial was performed with 112 patients who were 16 to 40 years old (mean, 27.6 years) and had a symptom duration >3 months (mean, 39 months) with a clinical diagnosis of PFP and no radiograph or magnetic resonance evidence of other pathology. Patients were randomized to a 6-week intervention consisting of patient education combined with isolated hip-focused exercise (n = 39), traditional knee-focused exercise (n = 37), or free physical activity (n = 36). The primary outcome was Anterior Knee Pain Scale (0-100) at 3 months. Secondary outcomes were visual analog scale for pain, Tampa Scale for Kinesiophobia, Knee Self-efficacy Scale, EuroQol, step-down, and isometric strength.

RESULTS: There were no between-group differences in any primary or secondary outcomes at 3 months except for hip abduction strength and knee extension strength. Between-group differences at 3 months for Anterior Knee Pain Scale were as follows: knee versus control, 0.2 (95% CI, -5.5 to 6.0); hip versus control, 1.0 (95% CI, -4.6 to 6.6); and hip versus knee, 0.8 (95% CI, -4.8 to 6.4). The whole cohort of patients improved for all outcomes at 3 months except for knee extension strength.

CONCLUSION: The authors found no difference in short-term effectiveness in combining patient education with knee-focused exercise, hip-focused exercise, or free training for patients with PFP.

REGISTRATION: NCT02114294 ( identifier).

Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Comments from MORE raters

Rehab Clinician (OT/PT) rater

This study utilized a unique control group that was encouraged to be physically active. Other than improvements in strength, there were no differences in effectiveness between the specific exercise groups and this physically active control group.

Rehab Clinician (OT/PT) rater

The study findings show no difference in the short-term effectiveness of combining patient education with knee exercise, hip exercise, or free training. Guided exercises improved muscle strength but did not translate to additional gains in other outcomes over the control group.

Rehab Clinician (OT/PT) rater

This is a very relevant article. Possibly the reason for similar outcomes in the hip vs knee groups is that many muscles cover both joints. It would have been interesting to have had an additional group doing both hip and knee exercises, as this is physiologically probably more relevant.
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