Impact of telehealth-based therapeutic exercise on pain, functional performance and dynamic knee valgus in young adult females with patellofemoral pain: a randomised controlled trial

Abstract

Objectives: This study aimed to evaluate the effectiveness of a telehealth-based therapeutic exercise (TTE) programme with real-time video conference supervision for young adult females with patellofemoral pain (PFP).

Methods: The study design was a randomised controlled trial. Forty-two participants with PFP were allocated to either the TTE group or the control (C) group. The TTE group received a 4-week telehealth-based exercise programme supervised through real-time video conferencing, while the C group followed a self-guided stretching exercise. Pain intensity was assessed using the Visual Analogue Scale, while functional performance was evaluated with hop tests and the step-down test. Dynamic knee valgus was measured by the frontal plane projection angle during a single-leg squat. In addition, the study used a specific health questionnaire which evaluated knee pain and function, including the self-administered Kujala Patellofemoral Questionnaire (KPQ). All outcomes were assessed both before and after the intervention.

Results: After the 4-week interventions, the results showed a significant interaction between the group and the time of pain intensity, functional performance and dynamic knee valgus (p<0.001). The TTE group demonstrated significant pain reduction (p<0.001) and improved KPQ score (p<0.001), while the C group showed no significant changes. TTE participants also exhibited improved functional performance in the hop and step-down tests. Additionally, dynamic knee valgus was significantly decreased in the TTE group.

Conclusion: The telehealth-based exercise programmes offer a convenient and effective alternative for managing PFP symptoms, providing remotely accessible and specialised care.

Keywords: Exercise rehabilitation; Knee; Patellofemoral Pain Syndrome; Performance.

Figure 1. Consolidated Standards of Reporting Trials diagram of participant flow through the study.

Figure 2. Hip and knee strengthening exercises ((A) side-lying hip abduction, (B) hip external rotation (Clamshell), (C) bridging while holding a small ball between the knees and (D) straight leg raising).

Figure 3. Neuromuscular training ((A) wall slides with a mini squat at 45° of knee flexion, (B) forward step-up, (C) lateral step-up and (D) step-down).

Figure 4. Estimated marginal means for all variables: Visual Analog Scale (VAS), Kujala Patellofemoral Questionnaire (KPQ), Hop tests, step-down and frontal plane projection angle (FPPA).