Skip to main content

Research Repository

Advanced Search

A loaded self-managed exercise programme for patellofemoral pain: a mixed methods feasibility study

Smith, Benjamin E.; Hendrick, Paul; Bateman, Marcus; Moffatt, Fiona; Skovdal Rathleff, Michael; Selfe, James; Smith, Toby O.; Logan, Pip

A loaded self-managed exercise programme for patellofemoral pain: a mixed methods feasibility study Thumbnail


Benjamin E. Smith

Paul Hendrick

Marcus Bateman

Fiona Moffatt

Michael Skovdal Rathleff

James Selfe

Toby O. Smith

Professor of Rehabilitation Research


A novel loaded self-managed exercise programme that includes pain education and self-management strategies may result in better outcomes for people with patellofemoral pain (PFP). However, establishing program feasibility is an essential first step before testing efficacy. The purpose of this study was to evaluate the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with PFP compared with usual physiotherapy.

In a mixed methods, pragmatic, randomised controlled feasibility study, 60 participants with PFP (57% female; mean age 29 years) were recruited from a physiotherapy clinic within a large UK teaching hospital. They were randomly allocated to receive either a loaded self-managed exercise programme (n=30) or usual physiotherapy (n=30). Feasibility indicators of process, resources, and management were collected through follow-up of standardised questionnaires six months after recruitment and semi-structured interviews with 20 participants and physiotherapists.

Recruitment rate was 5 participants per month; consent rate was 99%; adherence to intervention appointments was 87%; completeness of questionnaire data was 100%; and adherence to intervention delivery was 95%.
Three exercise diaries were returned at six months (5%). At six months, 25 questionnaire booklets were returned (9 in the loaded self-managed group, 16 in the usual physiotherapy group), with a total retention rate of 42%.
At six months, 56% (5/9) of respondents in the loaded self-managed group and 56% (9/16) in the usual physiotherapy group were classified as ‘recovered’.
Both groups demonstrated improvements in average pain (VAS), kinesiophobia, pain catastrophizing, general self-efficacy and EQ-5D-5L from baseline to six months.

The results of this feasibility study confirm that it is feasible and acceptable to deliver a loaded self-managed exercise programme to adults with PFP in an NHS physiotherapy outpatient setting. However, between group differences in lost to follow up and poor exercise diary completion mean we are uncertain on some feasibility aspects. These methodological issues need addressing prior to conducting a definitive RCT.


Smith, B. E., Hendrick, P., Bateman, M., Moffatt, F., Skovdal Rathleff, M., Selfe, J., …Logan, P. (2019). A loaded self-managed exercise programme for patellofemoral pain: a mixed methods feasibility study. BMC Musculoskeletal Disorders, 20, Article 129.

Journal Article Type Article
Acceptance Date Mar 15, 2019
Publication Date Mar 27, 2019
Deposit Date Mar 19, 2019
Publicly Available Date Mar 28, 2019
Journal BMC Musculoskeletal Disorders
Electronic ISSN 1471-2474
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 20
Article Number 129
Keywords Mixed-methods study, Feasibility, Patellofemoral pain, Anterior knee pain, Exercise therapy
Public URL
Publisher URL


You might also like

Downloadable Citations