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A four-year, two-phase, multicenter prospective study of the incidence, associated factors, and efficacy of a prevention program for patellofemoral pain: the adult-PFP cohort

Grant number: 22/06403-9
Support Opportunities:Generation Program Research Grant
Duration: May 01, 2023 - April 30, 2028
Field of knowledge:Health Sciences - Physiotherapy and Occupational Therapy
Principal Investigator:Ronaldo Valdir Briani
Grantee:Ronaldo Valdir Briani
Host Institution: Faculdade de Ciências e Tecnologia (FCT). Universidade Estadual Paulista (UNESP). Campus de Presidente Prudente. Presidente Prudente , SP, Brazil
Associated researchers: Bradley Stephen Neal ; Crystian Bitencourt Soares de Oliveira ; Danilo Santos Catelli ; David Matthew Bazett-Jones ; Fábio Mícolis de Azevedo ; Fábio Viadanna Serrão ; Fernando Henrique Magalhães ; Michelle Clara Boling ; Neal Robert Glaviano ; Victor Spiandor Beretta
Associated scholarship(s):24/02828-0 - Reliability, standard error of measurement and minimum detectable difference of biomechanical variables, muscle torque, level of physical activity and pressure pain thresholds: A multicenter study between five laboratories, BP.IC
24/00257-6 - Scientific technical training for biomechanical analysis of human movement., BP.TT
23/11083-6 - Factors associated with the development of patellofemoral pain in the general adult population: a 2-year multicenter prospective observational study, BP.DR
23/07003-7 - Incidence of patellofemoral pain in the general adult population: A prospective multicenter study, BP.MS
23/05472-0 - A four-year, two-phase, multicenter prospective study of the incidence, associated factors, and efficacy of a prevention program for patellofemoral pain: the adult-PFP cohort, BP.GR


Patellofemoral Pain (PFP) is a common and persistent musculoskeletal disorder characterized by an insidious onset of pain at, around or behind the patella during daily and functional activities. It affects approximately 23% of the general adult population, and is responsible for 11% to 17% of all knee pain evaluated in general practice. PFP is associated with poorer health-related quality of life, subjective and objective function, and a six-fold increase in symptoms of anxiety and depression. PFP has also been hypothesized as a precursor of patellofemoral osteoarthritis. Despite this alarming evidence in the incidence of PFP, the factors associated with its development, and the efficacy of prevention programs remain under-evaluated in the general adult population. To successfully prevent the occurrence of a musculoskeletal disorder, it is necessary to move through the 'sequence of prevention'; determining the incidence (stage one) and predictors of development (stage two) in order to develop a preventative strategy (stage three) and test its effectiveness (stage four). In this research project we have the audacious aim of conducting a four-year, two-phase, multicenter prospective study that can satisfy the four stages of the sequence of prevention. The first phase will be a prospective observational study carried out to determine the incidence and factors associated with PFP development in the general adult population. With the results from phase one, we will develop a prevention program for PFP and test its efficacy in a randomized controlled trial (phase two). We will recruit 650 participants for each phase of this research project. Participants will be recruited from five different cities, three from Brazil (Presidente Prudente, São Carlos and São Paulo) and two from the United States of America (Toledo and Storrs). Asymptomatic individuals will be followed up for 2 years in each phase to determine the occurrence of PFP. In phase one, besides PFP incidence, demographic, biomechanical, muscle strength, physical activity, pain pressure threshold and psychological data will be obtained and used in a Classification and Regression Trees (CART) model to determine the predictors of PFP development and their interaction. Following the development of a prevention program based on the results from phase one, its efficacy in reducing the incidence of PFP will be tested in a randomized controlled trial in phase two. All variables from phase one will also be collected in phase two and their mediating effect on PFP incidence will be determined. Identifying those at a greater risk of developing PFP and prescribing efficacious prevention programs would provide a significant shift in the clinical care for those who suffer from this disabling condition, giving our proposed research project significant social and scientific potential. (AU)

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