Anterior Knee Pain Syndrome, Patellofemoral Pain Syndrome
Conditions
Keywords
Telerehabilitation, Artificial Intelligence, Mediapipe, Physitrack
Brief summary
Patellofemoral pain syndrome (PFPS) is a common cause of anterior knee pain in young, active adults and is often aggravated by prolonged sitting, stair use, squatting, and running. Exercise-based physiotherapy is the standard first-line treatment, but access to regular in-person supervision can be limited. This study compares two ways of delivering the same evidence-based exercise programme for PFPS: AI-based telerehabilitation, delivered remotely through the Physitrack platform with AI-assisted movement screening (MediaPipe), and conventional face-to-face physiotherapy. The study aimed to determine whether AI-based telerehabilitation is as effective as, or more effective than, conventional physiotherapy in reducing pain and improving physical function, and to evaluate how usable participants found the telerehabilitation platform
Detailed description
This randomized controlled trial enrolled 48 individuals with PFPS (mean age 29.48 ± 6.40 years, range 19-40; 28 female, 20 male), screened using a structured demographic/SNAPPS questionnaire and an AI based movement screen built on Google's MediaPipe pose-estimation model, which tracked angle of knee. Eligible participants were randomly allocated using the gold-fish-bowl method to the Telerehabilitation Group (n=24; mean age 29.33 ± 6.75, 16 female/8 male) or the Conventional Physiotherapy group (n=24; mean age 29.63 ± 6.16, 12 female/12 male). Both groups followed an identical exercise protocol delivered three times weekly for four weeks (12 sessions of approximately 40-45 minutes). The Telerehabilitation Group received the programme remotely via the Physitrack platform and PhysiApp, including video-guided exercises, an AI-enabled assistant, remote monitoring, and messaging with the treating physiotherapist. The Conventional Physiotherapy group received the identical exercise content face to face in a physiotherapy clinic under direct therapist supervision. Outcomes were assessed at baseline and after 4 weeks: pain (Numeric Pain Rating Scale, NPRS), knee function (Anterior Knee Pain/Kujala Scale, AKPS), knee-related quality of life (KOOS Patellofemoral Subscale, KOOS-PF), knee flexion/extension range of motion and quadriceps (Q) angle via goniometer, and for the telerehabilitation group only platform usability (Telehealth Usability Questionnaire, TUQ). Data were analyzed in SPSS version 22 using paired and independent-samples t-tests or their non-parametric equivalents as appropriate. All 48 randomized participants completed the trial with no dropout.
Interventions
BEHAVIORALAI Based Telerehabilitation
A structured PFPS exercise protocol delivered remotely through the Physitrack platform and PhysiApp, supported by an AI-enabled movement assistant for screening/feedback, video demonstrations, progress tracking, and secure messaging with the treating physiotherapist. 3 sessions/week for 4 weeks.
OTHERConventional Physiotherapy
The identical PFPS exercise protocol delivered face-to-face by a certified physiotherapist in a clinical setting, with direct supervision, real-time correction of technique, and verbal feedback. 3 sessions/week for 4 weeks.
Sponsors
University of Faisalabad
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
Double (Participant, Outcomes Assessor)
Intervention model description
This study followed a parallel-group randomized controlled design in which participants were allocated to one of two groups and remained in that group for the duration of the study. Both groups received conventional physiotherapy as standard care, while the experimental group received additional exteroceptive stimulation. Interventions were delivered concurrently over a four-week period, and outcomes were assessed at baseline and after completion of the intervention. No crossover between groups occurred.
Eligibility
Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 40 years. * Body mass index 18.5-24.9 kg/m². * Insidious (non-traumatic) onset of anterior knee pain, with positive Clark test. * Pain during at least two of: running, jumping, squatting, kneeling, walking up/down stairs, or prolonged sitting. * At least two positive clinical findings among apprehension test, patellar compression test, crepitus on compression, peripatellar tenderness, or pain on resisted knee extension. * SNAPPS questionnaire score ≥6. * Sitting in the same position \>4 hours/day for over a year. * Knee pain for at least 1 month, with activity-related pain above mild on NPRS. * Access to a mobile phone and internet.
Exclusion criteria
Meniscal, ligamentous, or tendon injury of the knee. * Patellar fracture, subluxation, or dislocation. * Surgical or conservative treatment of the affected knee within the previous 6 months. * Neuromuscular, metabolic, or rheumatologic disorder.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Intensity | Baseline (Session 1) and post-treatment (Week 4, after 12th session) | Measured using the Numeric Pain Rating Scale (NPRS), an 11-point scale where 0 = "no pain" and 10 = "worst imaginable pain". |
| Functional disability | Baseline (Session 1) and post-treatment (Week 4, after 12th session) | Measured using the Anterior Knee Pain Scale and Kujala Questionnaire (AKPS), a 13-item, 0-100 self-report measure of patellofemoral pain and function. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Range of Motion | Baseline (Session 1) and post-treatment (Week 4, after 12th session) | Active knee flexion, knee extension, and quadriceps (Q) angle measured with a universal goniometer. |
| Telehealth Useability | Baseline (Session 1) and post-treatment (Week 4, after 12th session) | Measured using the Telehealth Usability Questionnaire (TUQ), a 21-item, 7-point measure of usefulness, ease of use, interface quality, reliability, and satisfaction. |
Countries
Pakistan
Contacts
STUDY_CHAIRMuhammad Ateeb, PhD Public Health
University of Faisalabad
Outcome results
None listed