Clinicians’ experience of the diagnosis and management of patellofemoral pain: A qualitative exploration

Background Patellofemoral pain (PFP) is common, with a poor long-term prognosis. There is a lack of clarity about the clinical reasoning of recognised inter-disciplinary experts. Objectives To help identify best practice by exploring the clinical reasoning of a range of experts that regularly diagnose and treat PFP. Design Qualitative study with semi-structured interviews. Method Recruitment resulted in a convenience sample for semi-structured interviews, which were recorded and transcribed verbatim. Data were analysed until theoretical saturation, as determined by multiple investigators. Findings Interviews with 19 clinical experts (15 men, 4 women; mean experience 18.6 years ± 8.6) from four broad professions yielded four themes. Firstly, the assessment and diagnosis process should include a thorough history and examination to rule in PFP. Secondly, information provision should aim to increase patients’ understanding, aid in controlling symptoms, and facilitate behaviour change. Thirdly, active rehabilitation, which was a salient theme and included advocacy of combined hip and knee exercise that is adapted to the individual. Finally, treatment adjuncts, which can be used selectively to modify symptoms, may include running retraining, taping, or foot orthoses. Conclusions PFP should be diagnosed clinically, and tailored treatment programmes should be prescribed for people with PFP. Exercise was considered the most effective treatment and underlying psychological factors should be addressed to improve prognosis.