Telerehabilitation vs. Conventional PT for Patellofemoral Pain Syndrome

Comparative Effects of Hybrid Telerehabilitation, Telerehabilitation and Conventional Physical Therapy in Treating Patients With Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal disorders affecting approximately 25% of active young adults, and it is frequently associated with persistent anterior knee pain, functional limitations, and reduced quality of life. Despite the widespread use of conventional face-to-face physical therapy, many patients experience barriers related to accessibility, cost, and long-term adherence to rehabilitation programs

Study Overview

• Status: Active, not recruiting
• Conditions: Patellofemoral Pain Syndrome
• Intervention / Treatment: Other: Physical Therapy Approaches

Detailed Description

Patellofemoral pain syndrome (PFPS) is a common, overuse-related musculoskeletal condition causing widespread anterior knee pain that is exacerbated by joint-loading activities like running, squatting, and climbing stairs. Affecting over 22% of the general population, PFPS is a complex disorder with high recurrence rates that frequently frustrate both patients and clinicians. Its etiology is multifactorial, stemming from structural and neuromuscular impairments, particularly quadriceps weakness and reduced gluteal activation, which lead to dynamic knee valgus and excessive joint stress. While conventional in-person physical therapy focusing on targeted strengthening remains the standard treatment, digital healthcare alternatives are rapidly expanding. Telerehabilitation delivers physical therapy remotely using telecommunication technologies through real-time synchronous or recorded asynchronous methods. To combine the benefits of both approaches, hybrid telerehabilitation integrates remote digital tracking with periodic face-to-face clinical sessions. Ultimately, these remote and hybrid models aim to improve patient adherence and reduce financial or logistical barriers like travel time, while maintaining the diagnostic accuracy and personalized feedback of traditional, hands-on care.

• Study Type: Interventional
• Enrollment (Actual): 42
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Giza, Egypt
    • Egypt

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Participants must have a prior clinical diagnosis of PFPS made by an orthopedic physician, which was then confirmed and verified by the principal investigator through physical therapy assessment. The diagnosis is characterized by anterior or retropatellar knee pain aggravated by at least one activity that loads the patellofemoral joint during weight bearing, such as stair climbing, squatting, running, or prolonged sitting.
2. Participants aged between 18 and 35 years.
3. Participants with BMI ≤ 25 kg/m² to ensure inclusion of individuals within a normal weight range.
4. Insidious onset of anterior knee pain with a duration greater than 12 weeks.
5. Experienced a minimum pain level of 3/10 on a visual analogue scale (VAS) during activity within the previous week.

Exclusion Criteria:

Participants meeting any of the following conditions will be excluded from the study:

1. Individuals with previous knee surgery, fracture, ligament reconstruction, patellar dislocation, osteoarthritis, meniscal injuries, inflammatory joint disease, or other conditions that may mimic or contribute to anterior knee pain.
2. Participants with neurological, cardiovascular, or systemic musculoskeletal disorders that may affect gait, strength, or exercise tolerance
3. Pregnant women will be excluded due to potential alterations in joint biomechanics and safety considerations during exercise interventions.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Hybrid Telerehabilitation; Participants allocated to the Hybrid Telerehabilitation group will receive a combination of face to-face and remotely supervised exercise sessions over the 6-week intervention period. Face-to-face sessions will be used for comprehensive movement assessment, hands-on instruction of new exercises, verification of correct technique, and progression of exercise intensity and resistance. Remotely supervised sessions will be conducted using a secure video-conferencing platform (e.g., Zoom), allowing real-time visual monitoring of exercise execution and provision of verbal and visual feedback by the therapist. Camera positioning guidelines will be provided to ensure adequate visualization of frontal and sagittal plane lower-limb alignment during exercises, particularly during closed-chain and functional tasks.	Other: Physical Therapy Approaches; All three groups (Hybrid Telerehabilitation, Pure Telerehabilitation, and Conventional Physical Therapy) followed identical exercise progressions over 6 weeks (3 sessions/week, 18 sessions total) targeting proximal hip and knee strengthening. Exercise dosage, intensity, and progression remained standardized across delivery modes to isolate rehabilitation method effects. The exercise program will progress through three phases to allow gradual restoration of strength, control, and functional ability.
Experimental: Telerehabilitation; Participants in the Telerehabilitation group will complete all 18 exercise sessions (3 sessions per week for 6 weeks) remotely without attending in-person clinic visits. All sessions will be supervised synchronously by the same physical therapist using a real-time video-conferencing platform (e.g., Zoom). Before the start of the intervention, participants will receive standardized instructions regarding camera placement, exercise space setup, and safety considerations to ensure accurate observation of movement quality during training sessions.	Other: Physical Therapy Approaches; All three groups (Hybrid Telerehabilitation, Pure Telerehabilitation, and Conventional Physical Therapy) followed identical exercise progressions over 6 weeks (3 sessions/week, 18 sessions total) targeting proximal hip and knee strengthening. Exercise dosage, intensity, and progression remained standardized across delivery modes to isolate rehabilitation method effects. The exercise program will progress through three phases to allow gradual restoration of strength, control, and functional ability.
Experimental: Conventional Physical Therapy; Participants assigned to the Conventional Physical Therapy group will receive all 18 exercise sessions through traditional face-to-face supervised treatment at the outpatient physical therapy clinic. Sessions will be conducted three times per week for six consecutive weeks, under the direct supervision of a licensed physical therapist. This model represents standard clinical practice for the management of patellofemoral pain syndrome and allows continuous monitoring of exercise performance, immediate correction of faulty movement patterns, and direct verbal feedback during training. During each session, the therapist will ensure correct execution of both hip- and knee focused exercises, reinforce appropriate lower-limb alignment, and adjust exercise intensity and resistance according to predefined progression criteria.	Other: Physical Therapy Approaches; All three groups (Hybrid Telerehabilitation, Pure Telerehabilitation, and Conventional Physical Therapy) followed identical exercise progressions over 6 weeks (3 sessions/week, 18 sessions total) targeting proximal hip and knee strengthening. Exercise dosage, intensity, and progression remained standardized across delivery modes to isolate rehabilitation method effects. The exercise program will progress through three phases to allow gradual restoration of strength, control, and functional ability.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity	The pain intensity was assessed using the Visual Analogue Scale (VAS), where patients rated their pain at rest and during movement over the previous week on a 0-10 cm scale, with 0 indicating no pain and 10 representing unbearable pain. Pain scores were recorded before and after the intervention. Interpretation of clinical relevance often goes beyond statistical significance, and the minimal clinically important difference (MCID) for pain intensity on the VAS has been investigated in a range of musculoskeletal conditions	up to 6 weeks
Knee function assessment	Knee function will be evaluated using the Kujala Anterior Knee Pain Scale (AKPS), which is a condition-specific, self-administered questionnaire designed to assess pain severity and functional limitations associated with patellofemoral pain syndrome. Participants will be asked to complete the questionnaire independently by responding to 13 weighted items that address symptoms and difficulty during daily and sports-related activities that load the patellofemoral joint, including walking, running, stair climbing, squatting, jumping, and prolonged sitting with the knee flexed	up to 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dynamic knee valgus assessment	A two-dimensional video analysis measured the knee valgus/varus frontal-plane projection angle (FPPA) during the Single-Legged Drop Jump test following established methodology	up to 6 weeks
Quadriceps muscle strength assessment	Quadriceps muscle strength will be assessed using the peak torque normalized to body weight (peak torque/body weight, Nm/kg ×100), which will be recorded during maximal knee extension at 60° of knee flexion	up to 6 weeks

Collaborators and Investigators

• Sponsor: Cairo University

Study record dates

Study Major Dates

• Study Start (Actual): May 20, 2026
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): October 1, 2026

Study Registration Dates

• First Submitted: June 2, 2026
• First Submitted That Met QC Criteria: June 2, 2026
• First Posted (Actual): June 5, 2026

Study Record Updates

• Last Update Posted (Actual): June 5, 2026
• Last Update Submitted That Met QC Criteria: June 2, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Telerehabilitation; Patellofemoral Pain Syndrome; Conventional Physical Therapy; Hybrid Telerehabilitation
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases; Patellofemoral Pain Syndrome
• Other Study ID Numbers: P.T.REC/012/006508

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No