A sequential cognitive and physical approach (SCOPA) for patellofemoral pain: a randomized controlled trial in adolescent patients

OBJECTIVE:: To compare a sequential treatment algorithm considering psychosocial and physical impairments, with a conventional rehabilitation approach considering only physical impairments in adolescents with patellofemoral pain. DESIGN:: A randomized, single-blind, controlled study. PARTICIPANTS:: Fifty-five adolescents (36 females; mean age 14.3 ± 1.8 years). INTERVENTIONS:: The sequential cognitive and physical approach (SCOPA) group ( n = 28) was treated based on sequential testing and treatment of activity-related fear, flexibility, kinematics, and strength. The comparator group ( n = 27) was treated with a non-sequential physical impairment-based approach. Both groups received treatment two times a week for up to six weeks. MEASUREMENTS:: Function (Anterior Knee Pain Scale), pain (Numeric Pain Rating Scale), and Global Rating of Change were assessed at baseline, three weeks, and six weeks, with a six-month follow-up. RESULTS:: Both groups had similar function (73.7 ± 9.6) and pain (6.0 ± 2.3) at baseline. A third of individuals with patellofemoral pain demonstrated elevated activity-related fear at baseline. Patients randomized to the SCOPA group had clinically significant greater improvements at six weeks in function (SCOPA, 95.0 ± 7.4 and comparator, 84.8 ± 10.4; mean difference: 10.2, 95% CI: 5.3, 15.1) and pain (SCOPA, 0.9 ± 1.9 and comparator, 2.7 ± 2.1; mean difference: 1.7, 95% CI: 0.5, 2.9). No differences were noted in Global Rating of Change. No between-group differences were noted in any outcome at six-month follow-up. CONCLUSION:: The sequential cognitive and physical approach resulted in greater improvements in short-term function and pain. By six months, both groups demonstrated similar clinically significant improvements in all outcomes.