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Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Study protocol

Efficacy of live feedback to improve objectively monitored compliance to prescribed, home-based, exercise therapy-dosage in 15 to 19 year old adolescents with patellofemoral pain- a study protocol of a randomized controlled superiority trial (The XRCISE-AS-INSTRUcted-1 trial)

Authors: Henrik Riel, Mark Matthews, Bill Vicenzino, Thomas Bandholm, Kristian Thorborg, Michael Skovdal Rathleff

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

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Abstract

Background

Patellofemoral pain is one of the most frequent knee conditions among adolescents with a prevalence of 7 %. Evidence-based treatment consists of patient education combined with hip and quadriceps strengthening. Recent evidence suggests that a large proportion of adolescents does not follow their exercise prescription, performing too few repetitions or too fast below the prescribed time under tension. Live feedback, such as a metronome or exercise games, has previously shown promising results in improving the quality of exercises. The aim of this study is to investigate if live feedback from a sensor (BandCizer™) and an iPad will improve the ability of adolescents with PFP to perform exercises as prescribed.

Methods

This study is a randomized, controlled, participant-blinded, superiority trial with a 2-group parallel design. Forty 15 to 19 year old adolescents with patellofemoral pain will be randomized to receive either live visual and auditory feedback on time under tension or no feedback on time under tension during a 6-week intervention period. Adolescents will be instructed to perform three elastic band exercises. Feedback will be provided by BandCizer™ and an iPad. The adolescents perform the exercises twice a week unsupervised and once a week during a supervised group training session. The primary outcome will be the mean deviation of the prescribed time under tension per repetition in seconds during the course of the intervention.

Discussion

Low compliance is a major problem among adolescents with patellofemoral pain. Providing the adolescents with real time feedback on time under tension from a sensor and an iPad could potentially help the adolescents perform the exercises as prescribed. This may increase the total exercise dosage they receive during treatment which may help improve patient outcomes.

Trial registration

Registered at ClinicalTrials.gov (identifier: NCT02674841) on February 4th 2016.
Literature
1.
go back to reference Rathleff MS, Skuldbøl SK, Rasch MNB, Roos EM, Rasmussen S, Olesen JL. Care-seeking behaviour of adolescents with knee pain: a population-based study among 504 adolescents. BMC Musculoskelet Disord. 2013;14:225.CrossRefPubMedPubMedCentral Rathleff MS, Skuldbøl SK, Rasch MNB, Roos EM, Rasmussen S, Olesen JL. Care-seeking behaviour of adolescents with knee pain: a population-based study among 504 adolescents. BMC Musculoskelet Disord. 2013;14:225.CrossRefPubMedPubMedCentral
2.
go back to reference Rixe JA, Glick JE, Brady J, Olympia RP. A review of the management of patellofemoral pain syndrome. Phys Sportsmed. 2013;41(3):19–28.CrossRefPubMed Rixe JA, Glick JE, Brady J, Olympia RP. A review of the management of patellofemoral pain syndrome. Phys Sportsmed. 2013;41(3):19–28.CrossRefPubMed
3.
go back to reference Rathleff MS, Roos EM, Olesen JL, Rasmussen S, Arendt-Nielsen L. Lower mechanical pressure pain thresholds in female adolescents with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2013;43(6):414–21.CrossRefPubMed Rathleff MS, Roos EM, Olesen JL, Rasmussen S, Arendt-Nielsen L. Lower mechanical pressure pain thresholds in female adolescents with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2013;43(6):414–21.CrossRefPubMed
4.
go back to reference Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. The “Best Practice Guide to Conservative Management of Patellofemoral Pain”: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med. 2015;49(14):923–34.CrossRefPubMed Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. The “Best Practice Guide to Conservative Management of Patellofemoral Pain”: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med. 2015;49(14):923–34.CrossRefPubMed
5.
go back to reference Collins NJ, Bisset LM, Crossley KM, Vicenzino B. Efficacy of nonsurgical interventions for anterior knee pain: systematic review and meta-analysis of randomized trials. Sports Med. 2012;42(1):31–49.CrossRefPubMed Collins NJ, Bisset LM, Crossley KM, Vicenzino B. Efficacy of nonsurgical interventions for anterior knee pain: systematic review and meta-analysis of randomized trials. Sports Med. 2012;42(1):31–49.CrossRefPubMed
6.
go back to reference Rathleff MS, Vicenzino B, Middelkoop M, Graven-Nielsen T, van Linschoten R, Hölmich P, et al. Patellofemoral Pain in Adolescence and Adulthood: Same Same, but Different? Sports Med. 2015;45(11):1489–95.CrossRefPubMed Rathleff MS, Vicenzino B, Middelkoop M, Graven-Nielsen T, van Linschoten R, Hölmich P, et al. Patellofemoral Pain in Adolescence and Adulthood: Same Same, but Different? Sports Med. 2015;45(11):1489–95.CrossRefPubMed
7.
go back to reference Rathleff MS, Roos EM, Olesen JL, Rasmussen S. Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofemoral pain: a cluster randomised trial. Br J Sports Med. 2014;49(6):406–12.CrossRefPubMed Rathleff MS, Roos EM, Olesen JL, Rasmussen S. Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofemoral pain: a cluster randomised trial. Br J Sports Med. 2014;49(6):406–12.CrossRefPubMed
8.
go back to reference Østerås B, Østerås H, Torstensen TA, Vasseljen O. Dose-response effects of medical exercise therapy in patients with patellofemoral pain syndrome: a randomised controlled clinical trial. Physiotherapy. 2013;99(2):126–31.CrossRefPubMed Østerås B, Østerås H, Torstensen TA, Vasseljen O. Dose-response effects of medical exercise therapy in patients with patellofemoral pain syndrome: a randomised controlled clinical trial. Physiotherapy. 2013;99(2):126–31.CrossRefPubMed
9.
go back to reference American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687–708.CrossRef American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687–708.CrossRef
10.
go back to reference Koomar J, Burpee JD, DeJean V, Frick S, Kawar MJ, Fischer DM. Theoretical and clinical perspectives on the Interactive Metronome: a view from occupational therapy practice. Am J Occup Ther. 2001;55(2):163–6.CrossRefPubMed Koomar J, Burpee JD, DeJean V, Frick S, Kawar MJ, Fischer DM. Theoretical and clinical perspectives on the Interactive Metronome: a view from occupational therapy practice. Am J Occup Ther. 2001;55(2):163–6.CrossRefPubMed
11.
go back to reference Moras G, Rodríguez-Jiménez S, Busquets A, Tous-Fajardo J, Pozzo M, Mujika I. A Metronome for Controlling the Mean Velocity During the Bench Press Exercise. J Strength Cond Res. 2009;23(3):926–31.CrossRefPubMed Moras G, Rodríguez-Jiménez S, Busquets A, Tous-Fajardo J, Pozzo M, Mujika I. A Metronome for Controlling the Mean Velocity During the Bench Press Exercise. J Strength Cond Res. 2009;23(3):926–31.CrossRefPubMed
12.
go back to reference Taylor M, Griffin M. The use of gaming technology for rehabilitation in people with multiple sclerosis. Mult Scler J. 2015;21(4):355–71.CrossRef Taylor M, Griffin M. The use of gaming technology for rehabilitation in people with multiple sclerosis. Mult Scler J. 2015;21(4):355–71.CrossRef
13.
go back to reference Bollen JC, Dean SG, Siegert RJ, Howe TE, Goodwin VA. A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties. BMJ Open. 2014;4(6):e005044.CrossRefPubMedPubMedCentral Bollen JC, Dean SG, Siegert RJ, Howe TE, Goodwin VA. A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties. BMJ Open. 2014;4(6):e005044.CrossRefPubMedPubMedCentral
14.
go back to reference Rathleff MS, Thorborg K, Rode LA, McGirr KA, Sørensen AS, Bøgild A, et al. Adherence to Commonly Prescribed, Home-Based Strength Training Exercises for the Lower Extremity Can Be Objectively Monitored Using the Bandcizer. J Strength Cond Res. 2015;29(3):627–36.CrossRefPubMed Rathleff MS, Thorborg K, Rode LA, McGirr KA, Sørensen AS, Bøgild A, et al. Adherence to Commonly Prescribed, Home-Based Strength Training Exercises for the Lower Extremity Can Be Objectively Monitored Using the Bandcizer. J Strength Cond Res. 2015;29(3):627–36.CrossRefPubMed
15.
go back to reference McGirr K, Harring SI, Kennedy TSR, Pedersen MFS, Hirata RP, Thorborg K, et al. An elastic exercise band mounted with a bandcizer™ can differentiate between commonly prescribed home exercises for the shoulder. Int J Sports Phys Ther. 2015;10(3):332–40.PubMedPubMedCentral McGirr K, Harring SI, Kennedy TSR, Pedersen MFS, Hirata RP, Thorborg K, et al. An elastic exercise band mounted with a bandcizer™ can differentiate between commonly prescribed home exercises for the shoulder. Int J Sports Phys Ther. 2015;10(3):332–40.PubMedPubMedCentral
16.
go back to reference Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P, CONSORT Group. Methods and processes of the CONSORT Group: example of an extension for trials assessing nonpharmacologic treatments. Ann Intern Med. 2008;148(4):W60–6.PubMed Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P, CONSORT Group. Methods and processes of the CONSORT Group: example of an extension for trials assessing nonpharmacologic treatments. Ann Intern Med. 2008;148(4):W60–6.PubMed
17.
go back to reference Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348(mar07 3):g1687.CrossRefPubMed Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348(mar07 3):g1687.CrossRefPubMed
18.
go back to reference Chan A-W, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586.CrossRefPubMedPubMedCentral Chan A-W, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586.CrossRefPubMedPubMedCentral
19.
go back to reference van Linschoten R, van Middelkoop M, Berger MY, Heintjes EM, Verhaar JA, Willemsen SP, et al. Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial. BMJ. 2009;339:b4074.CrossRefPubMedPubMedCentral van Linschoten R, van Middelkoop M, Berger MY, Heintjes EM, Verhaar JA, Willemsen SP, et al. Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial. BMJ. 2009;339:b4074.CrossRefPubMedPubMedCentral
20.
go back to reference Bolgla LA, Boling MC. An update for the conservative management of patellofemoral pain syndrome: a systematic review of the literature from 2000 to 2010. Int J Sports Phys Ther. 2011;6(2):112–25.PubMedPubMedCentral Bolgla LA, Boling MC. An update for the conservative management of patellofemoral pain syndrome: a systematic review of the literature from 2000 to 2010. Int J Sports Phys Ther. 2011;6(2):112–25.PubMedPubMedCentral
21.
go back to reference Toigo M, Boutellier U. New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. Eur J Appl Physiol. 2006;97(6):643–63.CrossRefPubMed Toigo M, Boutellier U. New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. Eur J Appl Physiol. 2006;97(6):643–63.CrossRefPubMed
22.
go back to reference McKay CD, Verhagen E. “Compliance” versus “adherence” in sport injury prevention: why definition matters. Br J Sports Med. 2016;50(7):382–3. McKay CD, Verhagen E. “Compliance” versus “adherence” in sport injury prevention: why definition matters. Br J Sports Med. 2016;50(7):382–3.
23.
go back to reference Faber M, Andersen MH, Sevel C, Thorborg K, Bandholm T, Rathleff M. The majority are not performing home-exercises correctly two weeks after their initial instruction—an assessor-blinded study. PeerJ. 2015;3:e1102.CrossRefPubMedPubMedCentral Faber M, Andersen MH, Sevel C, Thorborg K, Bandholm T, Rathleff M. The majority are not performing home-exercises correctly two weeks after their initial instruction—an assessor-blinded study. PeerJ. 2015;3:e1102.CrossRefPubMedPubMedCentral
24.
go back to reference Tran QT, Docherty D, Behm D. The effects of varying time under tension and volume load on acute neuromuscular responses. Eur J Appl Physiol. 2006;98(4):402–10.CrossRefPubMed Tran QT, Docherty D, Behm D. The effects of varying time under tension and volume load on acute neuromuscular responses. Eur J Appl Physiol. 2006;98(4):402–10.CrossRefPubMed
25.
26.
go back to reference American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687–708.CrossRef American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687–708.CrossRef
27.
go back to reference Rathleff CR, Baird WN, Olesen JL, Roos EM, Rasmussen S, Rathleff MS. Hip and Knee Strength Is Not Affected in 12-16 Year Old Adolescents with Patellofemoral Pain - A Cross-Sectional Population-Based Study. PLoS One. 2013;8(11):e79153.CrossRefPubMedPubMedCentral Rathleff CR, Baird WN, Olesen JL, Roos EM, Rasmussen S, Rathleff MS. Hip and Knee Strength Is Not Affected in 12-16 Year Old Adolescents with Patellofemoral Pain - A Cross-Sectional Population-Based Study. PLoS One. 2013;8(11):e79153.CrossRefPubMedPubMedCentral
28.
go back to reference Thorborg K, Petersen J, Magnusson SP, Hölmich P. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports. 2009;20(3):493–501.CrossRefPubMed Thorborg K, Petersen J, Magnusson SP, Hölmich P. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports. 2009;20(3):493–501.CrossRefPubMed
29.
go back to reference Crossley K, Bennell K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. Am J Sports Med. 2002;30(6):857–65.PubMed Crossley K, Bennell K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. Am J Sports Med. 2002;30(6):857–65.PubMed
30.
go back to reference Kettunen JA, Harilainen A, Sandelin J, Schlenzka D, Hietaniemi K, Seitsalo S, et al. Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: 5-year follow-up. Br J Sports Med. 2012;46(4):243–6.CrossRefPubMed Kettunen JA, Harilainen A, Sandelin J, Schlenzka D, Hietaniemi K, Seitsalo S, et al. Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: 5-year follow-up. Br J Sports Med. 2012;46(4):243–6.CrossRefPubMed
31.
go back to reference Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005;8(2):94–104.CrossRefPubMed Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005;8(2):94–104.CrossRefPubMed
33.
go back to reference Taichman DB, Backus J, Baethge C, Bauchner H, de Leeuw PW, Drazen JM, et al. Sharing clinical trial data: a proposal from the International Committee of Medical Journal Editors. Rev Méd Chil. 2016;144(1):11–3.CrossRefPubMed Taichman DB, Backus J, Baethge C, Bauchner H, de Leeuw PW, Drazen JM, et al. Sharing clinical trial data: a proposal from the International Committee of Medical Journal Editors. Rev Méd Chil. 2016;144(1):11–3.CrossRefPubMed
34.
go back to reference Ferber R, Bolgla L, Earl-Boehm JE, Emery C, Hamstra-Wright K. Strengthening of the Hip and Core Versus Knee Muscles for the Treatment of Patellofemoral Pain: A Multicenter Randomized Controlled Trial. J Athl Train. 2015;50(4):366–77.CrossRefPubMedPubMedCentral Ferber R, Bolgla L, Earl-Boehm JE, Emery C, Hamstra-Wright K. Strengthening of the Hip and Core Versus Knee Muscles for the Treatment of Patellofemoral Pain: A Multicenter Randomized Controlled Trial. J Athl Train. 2015;50(4):366–77.CrossRefPubMedPubMedCentral
35.
go back to reference Yelvar GDY, Baltaci G, Tunay VB, Atay AO. The effect of postural stabilization exercises on pain and function in females with patellofemoral pain syndrome. Acta Orthopaedica et Traumatologica Turcica. 2015;49(2):166–74. Yelvar GDY, Baltaci G, Tunay VB, Atay AO. The effect of postural stabilization exercises on pain and function in females with patellofemoral pain syndrome. Acta Orthopaedica et Traumatologica Turcica. 2015;49(2):166–74.
36.
go back to reference Andersen LL, Andersen CH, Mortensen OS, Poulsen OM, Bjørnlund IBT, Zebis MK. Muscle activation and perceived loading during rehabilitation exercises: comparison of dumbbells and elastic resistance. Phys Ther. 2010;90(4):538–49.CrossRefPubMed Andersen LL, Andersen CH, Mortensen OS, Poulsen OM, Bjørnlund IBT, Zebis MK. Muscle activation and perceived loading during rehabilitation exercises: comparison of dumbbells and elastic resistance. Phys Ther. 2010;90(4):538–49.CrossRefPubMed
37.
go back to reference Hoffmann TC, Maher CG, Briffa T, Sherrington C, Bennell K, Alison J, et al. Prescribing exercise interventions for patients with chronic conditions. CMAJ. 2016 Apr 19;188(7):510–8. Hoffmann TC, Maher CG, Briffa T, Sherrington C, Bennell K, Alison J, et al. Prescribing exercise interventions for patients with chronic conditions. CMAJ. 2016 Apr 19;188(7):510–8.
Metadata
Title
Efficacy of live feedback to improve objectively monitored compliance to prescribed, home-based, exercise therapy-dosage in 15 to 19 year old adolescents with patellofemoral pain- a study protocol of a randomized controlled superiority trial (The XRCISE-AS-INSTRUcted-1 trial)
Authors
Henrik Riel
Mark Matthews
Bill Vicenzino
Thomas Bandholm
Kristian Thorborg
Michael Skovdal Rathleff
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-1103-y

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