Development of a Core Domain Set for Patellofemoral Pain

People with patellofemoral pain experience pain at the front of the knee and around the kneecap, which is aggravated by activities that typically load the patellofemoral joint (e.g. squatting, stair walking, running).[1] Patellofemoral pain has an annual prevalence of 23% in the general population, and a point prevalence of 6-7% in adolescents.[2, 3] Notably, up to 40% of adolescents and almost 60% of adults will continue to experience pain up 10 years later.[4] Consistent with this poor long-term outlook, a recent living network meta-analysis highlighted that while recommended treatments provide benefit over a wait-and-see approach at 3 months, the results at 12 months are rather sobering.[5] Compounding this situation is research that shows people with patellofemoral pain report poorer quality of life, impaired physical functioning, and a range of psychological symptoms (e.g. anxiety and depressive symptoms, pain catastrophizing, fear of movement).[6-8]

One of the challenges during the recent network meta-analysis was synthesis of data from a range of outcomes across the different studies.[9, 10] This proves problematic when developing evidence-based clinical practice guidelines and evidence synthesis.[11] A strategy to meet this challenge is to develop a core outcome measure set that covers all health-related aspects (i.e. domains) of people with patellofemoral pain. Currently there is no published widely agreed upon set of domains (i.e. core domain set) for people who have patellofemoral pain.

We propose to develop a core domain set for people with patellofemoral pain. We will do this through broad consultation/collaboration with people who have patellofemoral pain and those who work with or study people who have patellofemoral pain (e.g. researchers, clinicians). This will involve an iterative multi-stage process. First, we will conduct a scoping review of the published research of clinical studies to identify all outcome measures reported – to provide an insight into what researchers perceive to be meaningful health-related aspects of people who have patellofemoral pain. This will be followed by a number of qualitative and quantitative consensus-based methods, which are, for example, concept mapping, focus groups, consensus surveys and meetings.

1. Crossley, K.M., et al., 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. British Journal of Sports Medicine, 2016. 50(14): p. 839 - 843.
2. Rathleff, M.S., et al., Is Knee Pain During Adolescence a Self-limiting Condition? Prognosis of Patellofemoral Pain and Other Types of Knee Pain. The American Journal of Sports Medicine, 2016. 44(5): p. 1165 - 1171.
3. Smith, B.E., et al., Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PLoS One, 2018. 13(1): p. e0190892.
4. Lankhorst, N.E., et al., Factors that predict a poor outcome 5-8 years after the diagnosis of patellofemoral pain: a multicentre observational analysis. British Journal of Sports Medicine, 2016. 50(14): p. 881 - 886.
5. Winters, M., et al., Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis. Br J Sports Med, 2020.
6. Coburn, S.L., et al., Quality of life in individuals with patellofemoral pain: A systematic review including meta-analysis. Phys Ther Sport, 2018. 33: p. 96-108.
7. Maclachlan, L.R., et al., Psychological and pain profiles in persons with patellofemoral pain as the primary symptom. European journal of pain (London, England), 2020. 94(1): p. 85.
8. Maclachlan, L.R., et al., The psychological features of patellofemoral pain: a cross-sectional study. Scand J Pain, 2018. 18(2): p. 261-271.
9. Barton, C.J., et al., REPORT-PFP: a consensus from the International Patellofemoral Research Network to improve REPORTing of quantitative PatelloFemoral Pain studies. Br J Sports Med, 2021. 55(20): p. 1135-1143.
10. van der Heijden, R.A., et al., Exercise for treating patellofemoral pain syndrome. Cochrane Database of Systematic Reviews, 2015(1).
11. Saldanha, I.J., et al., Outcome choice and definition in systematic reviews leads to few eligible studies included in meta-analyses: a case study. BMC Med Res Methodol, 2020. 20(1): p. 30.


Natalie Collins*1,2:
Kay Crossley*2:
Alex Donaldson3:
Marienke van Middelkoop*4:
Michael Skovdal Rathleff*5,6:
Alessandro Andreucci6:
Manuela Besomi1:
Danilo de Oliveira Silva2:
Marcella Ferraz Pazzinatto2:
Neal Glaviano7:
Sinead Holden5,6,8
Kristian Lyng5,6:
Liam Maclachlan1,9:
Mark Matthews10:
Natalie Mazzella 11:
Jade Tan2,12:
Guido van Leeuwen4:
Narelle Wyndow1:
Bill Vicenzino*1: @Bill_Vicenzino

*Supervisors (Steering Committee)

1 Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Australia
2 La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Australia
3 Centre for Sport and Social Impact, La Trobe University, Australia
4 Department of General Practice, Erasmus MC Medical University Center Rotterdam, The Netherlands
5 Center for General Practice at Aalborg University, Aalborg, Denmark
6 Department of Health Science and Technology, Aalborg University Denmark
7 Department of Kinesiology, University of Connecticut, Storrs, CT, United States
8 UCD Clinical Research Centre, School of Medicine, University College Dublin, Ireland
9 Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women’s Hospital, Brisbane, Australia
10 Sports and Exercise Science Research Institute, School of Sport, Ulster University, Northern Ireland
11 Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
12 Podiatric Medicine and Surgery, School of Allied Health, University of Western Australia, Australia

Further Study Information

Current Stage: Ongoing
Date: November 2020 - June 2023
Funding source(s): No funding sources

Health Area

Disease Category: Rehabilitation

Disease Name: Patellofemoral pain

Target Population

Age Range: 10 - 120

Sex: Either

Nature of Intervention: Any

Stakeholders Involved

- Clinical experts
- Consumers (patients)
- Epidemiologists
- Researchers

Study Type

- COS for clinical trials or clinical research
- COS for practice


- Consensus meeting
- Delphi process
- Focus group(s)
- Literature review

We will undertake a number of iterations and methods in developing the core domains. We will undertake a scoping review to scope outcome measures used in the scientific literature, a concept mapping exercise and at least one consensus meeting in developing the core domains. At this stage, we have left open the possibility of utilizing other consensus deriving processes such as Delphi, focus groups and semi-structured interviews. To some extent this will be governed by stakeholder engagement - ie, patient recruitment/involvement in particular.

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