Evaluating the Effectiveness of Clinical Practice Guideline Adherence for Patellofemoral Pain (knEE-CAPP): Protocol for a Multisite, Parallel-Arm Randomized Clinical Trial in the Military Health System.

IMPORTANCE: Patellofemoral pain (PFP) frequently affects military personnel, caused by the physical demands of duty-related training. Clinical practice guidelines (CPG) can guide PFP management, yet physical therapist practice patterns vary and often exclude CPG-recommended, evidence-based interventions. OBJECTIVE: The Evaluating the Effectiveness of Clinical practice guideline Adherence for Patellofemoral Pain (knEE-CAPP) trial assesses whether a CPG-adherent physical therapy approach more significantly reduces pain, disability, health care utilization, and analgesic medication prescription in Service members with PFP as compared to usual physical therapist care. DESIGN: This is a multisite, parallel arm randomized controlled trial. SETTING: The study will be conducted at 4 outpatient military physical therapist clinics. PARTICIPANTS: Male and female active-duty Service members (n = 440) ages 18 years or older with PFP will be included. INTERVENTION: Participants will be randomized to receive CPG-adherent or usual physical therapist care. CPG-adherent care includes a standardized examination and treatment protocol based on the 2019 American Physical Therapy Association's PFP CPG Decision Tree Model. This model subcategorizes impairments to guide targeted interventions. Usual care encompasses care delivered by outpatient physical therapist providers without research team directives. MAIN OUTCOMES AND MEASURES: Anterior Knee Pain Scale (a patient-reported measure of knee-specific function) and Numeric Pain Rating Scale (a patient-reported measure of knee pain intensity). RESULTS: Changes in Anterior Knee Pain Scale and Numeric Pain Rating Scale scores at 3-month follow-up will be compared between arms. Secondary outcomes (perceived duty- and deployment-related confidence, knee-related health care utilization, and analgesic medication prescription) will be compared up to 12-months post-randomization. CONCLUSIONS: This trial will determine the effectiveness of a standardized, CPG-adherent approach to PFP management for optimizing function, reducing long-term health care costs, and improving readiness for duty. RELEVANCE: A protocolized, CPG-adherent approach that can be implemented across health care settings is proposed.

Duke Scholars

Author Daniel I. Rhon Orthopaedic Surgery