Patellofemoral pain over time: Protocol for a prospective, longitudinal study investigating physical and non-physical features

Ana Flavia Balotari Botta; Marina Cabral Waiteman; Matheus Henrique Maiolini Ducatti; Carmen Lúcia Gomes Garcia; Lucca André Liporoni Bego Farinelli; David Matthew Bazett-Jones; Ronaldo Valdir Briani; Fábio Mícolis de Azevedo

doi:10.3389/fspor.2022.1081943

Patellofemoral pain over time: Protocol for a prospective, longitudinal study investigating physical and non-physical features

Front Sports Act Living. 2023 Jan 11:4:1081943. doi: 10.3389/fspor.2022.1081943. eCollection 2022.

Authors

Ana Flavia Balotari Botta¹, Marina Cabral Waiteman¹, Matheus Henrique Maiolini Ducatti¹, Carmen Lúcia Gomes Garcia¹, Lucca André Liporoni Bego Farinelli¹, David Matthew Bazett-Jones², Ronaldo Valdir Briani¹, Fábio Mícolis de Azevedo¹

Affiliations

¹ Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil.
² University of Toledo, Department of Exercise and Rehabilitation Sciences, Toledo, Ohio, United States.

Abstract

Background: This is a protocol for a prospective longitudinal study that aims to investigate: (1) group-by-time changes over a minimum of 15 months follow-up in patellofemoral pain (PFP) symptoms, biomechanical, muscle function, pain processing, and psychological features; (2) the extent to which changes in biomechanical, muscle function, pain processing, and psychological features are associated with changes in self-reported pain, physical performance measures, self-reported function, health-related quality of life (HRQOL), and physical activity level.

Methods: Individuals with PFP (n = 144) and control individuals (n = 85) without PFP were assessed at baseline. Outcomes assessed included: 3D kinematics and kinetics during single leg squat, step-down and single leg hop; maximal torque and rate of torque development of hip abductors and knee extensors/flexors; force steadiness of hip abductors and knee extensors; anterior and lateral trunk endurance; pressure pain thresholds at the center of patella and contralateral shoulder; kinesiophobia (Tampa Scale for Kinesiophobia); pain catastrophizing (Pain Catastrophizing Scale); worst self-reported pain (Visual Analogue Scale); physical performance measures (Single Leg Hop Test and Forward Step-Down Test); self-reported function (Anterior Knee Pain Scale); HRQOL (Medical Outcome Short-Form 36), and physical activity level (Baecke's Questionnaire). Follow-up assessments will be identical to the baseline and will be performed after a minimum of 15 months. Generalized linear mixed model (GLMM) will be used to investigate group-by-time differences. Linear regression models will be used to determine the extent to which changes in biomechanical, muscle function, pain processing, and psychological features are associated with changes in self-reported pain, physical performance measures, self-reported function, HRQOL, and physical activity level.

Discussion: Physical and non-physical features have been previously associated with PFP. However, the present study will be the first to investigate their integrated evolution as part of the natural history of PFP and its progression. In doing so, we will be able to determine their behavior in the long-term, as well as how they prospectively associate with each other and with clinical outcomes. Ultimately, this will provide a greater understanding of predictors of long-term outcome and possible targets for interventions.

Keywords: catastrophism; fear of movement; knee cap pain; movement analysis; pain sensitization.

Grants and funding

This work is supported by Sao Paulo Research Foundation (FAPESP) with a grant (number: 2020/14715-5) and scholarships (numbers: 2022/10236-0; 2022/10069-7; 2020/12703-0; 2020/12257-0). The funder plays no role in the design, conduct, or reporting.