PRePPeD – Physiotherapy Rehabilitation Post Patellar Dislocation
Kneecap (patella) dislocations are sudden painful injuries that mainly affect teenagers and young adults. After this injury, most patients are referred to a physiotherapist who will give them advice and exercises to help them recover.
We do not know if giving patients more physiotherapy sessions makes a difference to how well they recover after a kneecap dislocation. This is important to find out because 1.) attending physiotherapy can be inconvenient for patients and 2.) we want to make the best use of NHS resources. To find this out we would need to compare different physiotherapy treatments in a large study. To decide if a large study would work, we first need to compare these treatments in a smaller study called PRePPeD.
PRePPeD is comparing supervised versus self-managed rehabilitation for people aged 14 years or older with an acute first-time or recurrent patellar dislocation. We aim to recruit at least 50 participants from at least three NHS hospitals over a maximum of 12 months.
“Supervised rehabilitation” involves 4-6 physiotherapy sessions of advice and progressively challenging exercise over a maximum of 6 months. Self-managed rehabilitation involves one physiotherapy session; participants then self-manage their recovery using exercise videos and guidance available on a study website. Follow-up is remote by electronic questionnaire 3, 6, and 9 months after randomisation. We will also interview up to 20 participants to understand their experience of injury and recovery, and the acceptability of the study procedures and interventions.
In the NHS, most patients after patellar dislocation are referred to physiotherapy for exercise-based rehabilitation, but high-quality evidence to guide rehabilitation practice is lacking. Consequently, physiotherapy treatment and patient outcomes vary widely. Common problems after this injury include recurrent dislocation, reduced activity levels, and later surgery.
Previous trials that compared one versus multiple physiotherapy sessions of advice and exercise for people with other musculoskeletal injuries have shown conflicting findings. It is uncertain which of these approaches is most clinically and cost-effective after acute patellar dislocation. A full-scale randomised controlled trial would clarify this uncertainty. Whether a full-scale trial is feasible is unclear.
Aims and objectives
To determine the feasibility of conducting a full-scale trial comparing supervised versus self-managed rehabilitation for patients with an acute patellar dislocation by assessing:
- Patients’ willingness to be randomised
- Recruitment rate
- Intervention adherence
- Participants’ experience of recovery, and the acceptability of the study interventions and follow-up methods to participants
Multicentre, parallel, two-arm, external pilot RCT and qualitative study