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17 Quadriceps or hip exercises for patellofemoral pain? A randomized controlled equivalence trial
  1. Rudi Hansen1,
  2. Christoffer Brushøj2,
  3. Michael Skovdal Rathleff3,4,
  4. Peter Magnusson1,2,
  5. Marius Henriksen5
  1. 1Department Of Physical And Occupational Therapy, Bispebjerg And Frederiksberg Hospital, Nielsine Nielsensvej 10, Denmark
  2. 2Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital, Nielsine Nielsensvej 11, Denmark
  3. 3Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2 , Denmark
  4. 4Center for General Practice at Aalborg University, Fyrkildevej 7.1., Denmark
  5. 5The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, Denmark


Introduction Exercise therapy comprising exercises for the hip and the knee is recommended for improving pain and function in patients with patellofemoral pain (PFP). However, there is uncertainty about which type of exercises that are most effective. We aimed to assess effectiveness equivalence between two commonly prescribed exercise programs targeting either the quadriceps or the hip muscles in patients with PFP.

Materials and Methods This randomised controlled equivalence trial included 200 participants with a clinical diagnosis of PFP. Participants were randomly assigned to either a 12-week quadriceps-focused (QE) or a hip-focused (HE) exercise program. The primary outcome was the change in Anterior Knee Pain Scale (AKPS) (0–100) from baseline to 12-week follow-up. Prespecified equivalence margins of ±8 points on the AKPS were chosen to demonstrate comparable efficacy. Key secondary outcomes were the Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS) pain, physical function, and knee-related quality of life subscales.

Results The least squares mean changes in AKPS (primary outcome) were 7.5 for QE and 7.2 for HE (difference 0.3 points, 95% CI −1.9 to 2.4; test for equivalence p<0.0001). None of the group differences in key secondary outcomes exceeded predefined equivalence margins.

Conclusion 12-week focused quadriceps and hip focused exercise protocols were equivalent in changes in symptoms and function for patients with PFP.

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