PRePPeD - Physiotherapy Rehabilitation Post Patellar Dislocation
Research type
Research Study
Full title
Supervised versus self-managed rehabilitation for people after acute patellar dislocation: a multicentre external pilot randomised controlled trial and qualitative study
IRAS ID
312280
Contact name
Colin Forde
Contact email
Sponsor organisation
University of Oxford / Research Governance, Ethics and Assurance
ISRCTN Number
ISRCTN14235231
Duration of Study in the UK
2 years, 0 months, 12 days
Research summary
Summary of Research
Kneecap (patellar) dislocations mainly affect teenagers and young adults. To help recovery, patients are normally referred to physiotherapy. Despite this, some patients experience ongoing problems. The best physiotherapy treatment for this injury is unclear. Finding out the best physiotherapy treatment could improve patients’ recovery.
Aim:
We want to compare two physiotherapy treatments to find out which is better for people with a kneecap dislocation. This requires carrying out a large study. To decide if a large study would work, we will compare these treatments in this smaller study.Methods:
We aim to recruit at least 50 patients, aged 14 years or older, with a recent kneecap dislocation from at least 3 hospitals in England.Participants will be randomly allocated to either:
1. “Self-managed rehabilitation”: 1 session with a physiotherapist who will provide advice and exercises to help participants recover. Participants will then manage their own recovery by following advice and exercise videos on a website.
2. “Supervised rehabilitation”: 4-6 physiotherapy sessions over a maximum of 6 months. Physiotherapists will use the additional sessions to tailor advice and exercises to participants’ individual needs. Physiotherapists will also use strategies to help participants do their exercises.We will measure recovery by asking participants to complete online questionnaires when they enter the study, then 3, 6 and 9 months later.
We will interview up to 20 patients, including patients who declined study participation, to understand their experience of recovery and study participation (if applicable).
We will decide if a large study will work by assessing:
• how many patients who can take part, agree to take part
• the number of patients who agree to take part each month
• how many physiotherapy sessions participants attend
• how many participants return completed questionnaires
• what participants think of the studyFunding: National Institute for Health and Care Research Doctoral Fellowship
Summary of Results
Background Kneecap (patella) dislocations are painful injuries which mainly affect teenagers and young adults. After this injury, patients usually see a physiotherapist to help them recover. The physiotherapist gives patients advice, including how to manage knee pain and swelling and what activities are safe to resume. The physiotherapist also gives patients a programme of exercises to restore their knee movement and leg muscle strength. This aims to help patients to get back to their normal activities. Currently, we don’t know if attending more physiotherapy sessions improves patients’ recovery from a kneecap dislocation. This is important to find out because 1.) attending physiotherapy sessions can be inconvenient for patients and 2.) we want to make best use of NHS resources. To find this out, we would need to carry out a large study. The PRePPeD (Physiotherapy Rehabilitation Post Patellar Dislocation) study was a smaller study that aimed to find out if this larger study would work.What we did
Project 1: we recruited 50 people aged 14 years or older who had a recent kneecap dislocation from 5 NHS hospitals in England. These participants received one of two physiotherapy treatments. The physiotherapy treatment participants received was decided by a process called randomisation. This ensured the groups who received each physiotherapy treatment were similar and the comparison between groups was fair.
1. ‘Self-managed rehabilitation’: half of participants were asked to attend 1 session with a physiotherapist. The physiotherapist assessed their knee, then gave them advice about their recovery and told them what exercises to start doing. Participants then continued their recovery themselves by following guidance and a programme of exercises in a study workbook.
2. ‘Supervised rehabilitation’: the other half of participants were asked to attend 4 to 6 sessions with a physiotherapist. The physiotherapist used these sessions to assess the knee and decide what advice and exercises to give participants as they improved. These participants also had access to advice and exercises in a workbook.
To measure recovery, we asked participants questions about their knee, their general health, how active they were, and any healthcare appointments they had when they joined the study and again 3, 6, and 9 months later.
Project 2: 9 people from project 1 were also interviewed as part of an interview study. This aimed to understand their thoughts about the study and their injury, treatment and recovery. This helped us decide if a future larger study would work, and if so, how we could make it better.The results
Project 1: 50 out of 88 (57%) people who were asked to take part agreed. Each hospital recruited around one participant each month. 23 out of 26 (88%) people who were allocated to the ‘self-managed rehabilitation’ physiotherapy treatment attended their 1 physiotherapy session. Only 13 out of 24 (54%) people allocated to the ‘supervised rehabilitation’ physiotherapy treatment attended at least 4 physiotherapy sessions. 31 out of 50 (62%) participants answered the study questions at 9 months. These study questions showed that on average most people got better but they did not recover fully.
Project 2: the people interviewed felt their kneecap dislocation happened without warning. They were surprised that the kneecap could dislocate while doing normal day-to-day activities. When the kneecap dislocated it was very painful. After the kneecap was pushed back into place, the main problem was difficulty walking. This made doing normal activities, like driving and going to work or school, difficult for a while.
Over time, people got better. Their recovery was helped by gradually increasing how active they were. Advice and exercises from their physiotherapist also helped. Some people went on to recover fully and returned to all their normal activities. However, some people remained afraid that their kneecap would dislocate again, so they had not returned to everything they used to do.
Overall, the people interviewed found the physiotherapy treatments worked well. They also thought the questions that measured recovery were appropriate and easy to complete.What does this mean?
The results mean that we could carry out the large study that would find out if attending more physiotherapy sessions improves recovery from a kneecap dislocation. However, we would need to improve how many participants answer the study questions that measure recovery. Increasing the number of people in the ‘supervised rehabilitation’ physiotherapy treatment who attend at least 4 physiotherapy sessions would also be important.
Would you like to help design the large study?
We plan to carry out the large study. We would love to hear how you think this future study could be improved. If you would like to help design this future study, we would arrange to talk online, by telephone, or in person at a time that suits you. We would discuss our study plans and ask you how you think they could be improved. We will pay you for your time.
If you are interested in helping design the large study?
Please complete this short online form https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fforms.office.com%252Fe%252FWVKduK26LD%2FNBTI%2F-m7AAQ%2FAQ%2F15d95ac4-2d84-40c1-864b-61fe34fcb332%2F2%2FtNwisrTumP&data=05%7C02%7Capprovals%40hra.nhs.uk%7C7f937e80dcc84ab727ff08de01d55397%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638950212956041042%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=A5AbKYGnLYO5Bcl3YLbn13M3KdTUvF%2B7urVM1KkeWgI%3D&reserved=0REC name
East of Scotland Research Ethics Service REC 1
REC reference
22/ES/0035
Date of REC Opinion
23 Aug 2022
REC opinion
Favourable Opinion