'Managing My Patellofemoral Pain’:the creation of an education leaflet for patients

STUDY DESIGN: Qualitative, including consultation with international experts and patients. PURPOSE: Develop a brief yet comprehensive evidence-based education leaflet to be used as an adjunct in the management of patellofemoral pain (PFP) through consultation with both experts (clinical academics) and individuals with PFP. BACKGROUND: Appropriate patient education is an essential component of effective PFP management. However, there are currently no published educational resources for clinicians and researchers treating individuals with PFP to help translate current evidence into clinical practice. METHODS: A preliminary education leaflet titled ‘Managing My Patellofemoral Pain’ was created using information from the ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’ and educational content used in published research. Feedback was sought from 21 experts (clinical academics) for accuracy, adequacy and clarity of the information in the leaflet using a semistructured questionnaire, and a number of suggested modifications were made as a result. Further feedback was sought from 20 patients diagnosed with PFP regarding the clarity and adequacy of information contained in the leaflet, and to determine additional educational resource needs. RESULTS: The leaflet created is titled ‘Managing My Patellofemoral Pain’ and the main topics of the leaflet are ‘What might cause my knee pain?’ and ‘Treatment options’, which are divided into exercise and additional treatments. Patient feedback was positive, and included a number of considerations for further education resource development. CONCLUSIONS: The ‘Managing My Patellofemoral Pain’ education leaflet may provide a valuable resource for patients, clinicians and researchers to assist the provision of education and translation of the current evidence

Capturing patient-reported area of knee pain: a concurrent validity study using digital technology in patients with patellofemoral pain

Background Patellofemoral pain (PFP) is often reported as a diffuse pain at the front of the knee during knee-loading activities. A patient’s description of pain location and distribution is commonly drawn on paper by clinicians, which is difficult to quantify, report and compare within and between patients. One way of overcoming these potential limitations is to have the patient draw their pain regions using digital platforms, such as personal computer tablets. Objective To assess the validity of using computer tablets to acquire a patient’s knee pain drawings as compared to paper-based records in patients with PFP. Methods Patients (N = 35) completed knee pain drawings on identical images (size and colour) of the knee as displayed on paper and a computer tablet. Pain area expressed as pixel density, was calculated as a percentage of the total drawable area for paper and digital records. Bland–Altman plots, intraclass correlation coefficient (ICC), Pearson’s correlation coefficients and one-sample tests were used in data analysis. Results No significant difference in pain area was found between the paper and digital records of mapping pain area (p = 0.98), with the mean difference = 0.002% (95% CI [−0.159–0.157%]). A very high agreement in pain area between paper and digital pain drawings (ICC = 0.966 (95% CI [0.93–0.98], F = 28.834, df = 31, p < 0.001). A strong linear correlation (R2 = 0.870) was found for pain area and the limits of agreement show less than ±1% difference between paper and digital drawings. Conclusion Pain drawings as acquired using paper and computer tablet are equivalent in terms of total area of reported knee pain. The advantages of digital recording platforms, such as quantification and reporting of pain area, could be realized in both research and clinical settings

Distribution and symmetrical patellofemoral pain patterns as revealed by high-resolution 3D body mapping:a cross-sectional study

Abstract Background Detailed pain mapping of extent and distribution in individuals with patellofemoral pain (PFP) within and around a complex structure such as the knee has yet to be explored. Methods Perceptions of on-going pain from adolescents and young adults (N = 35) with long-standing (>10 months) PFP were collected on high-resolution 3D digital body-schema of the knees. Location, area of pain, pain intensity, laterality, worse side of knee pain, symptom duration, and symmetry in bilateral knee pain were recorded. A threshold for naturally occurring variations in symmetrical knee pain drawings were collected from 18 healthy controls and used in combination with the development a symmetry index (0–1) to create a fuzzy rule for classifying symmetrical and non-symmetrical PFP patterns as compared to a PFP expert. The symmetry index was computed and tested using a correlation coefficient alone or in combination with the Jaccard index and the true and false positive rates (TPR and FPR, respectively) determined. Results The peripatellar region was the common report of pain location however, novel and nonconforming PFP patterns were identified and the majority of individuals (22 of 27) with bilateral PFP expressed highly-symmetric mirror-image pain. Individuals with symptom duration of 5 years or more had a greater area of pain, compared to those with symptoms for less than 5 years. The total area of pain was correlated to symptom duration for those with extended symptoms durations and a progression towards an “O” shaped pattern emerged. A TPR of 100% for identifying symmetrical knee pain patterns was found however the expert PFP tended to be stricter, as reflected in FPR of 20%. Conclusions A high proportion of PFP patterns or symptoms occur in mirrored locations and are exceptionally symmetrical, and long duration of symptoms appear to converge to an ‘O’ shape. Classifying symmetrical pain patterns is subjective however simple fuzzy rules and correlations can be used to increase objectivity. This study highlights a gap in knowledge of PFP symptom presentation, reveals what may be a natural progression of symptoms, and provides valuable clinical insight for both pain management and treatment