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Stratification of patellofemoral pain using clinical, biomechanical and imaging features

Drew, Benjamin Timothy (2018) Stratification of patellofemoral pain using clinical, biomechanical and imaging features. PhD thesis, University of Leeds.

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Patellofemoral pain (PFP) is a common musculoskeletal complaint and the efficacy of current therapies aimed at PFP is limited. The aetiology of PFP is widely considered to be multifactorial and as a result the clinical presentation is often heterogeneous. In an attempt to address this issue, an international PFP consensus statement, published in 2013, highlighted the need to sub-group patients with PFP to enable more stratified interventions. A multi-methodological approach was used in this thesis. A systematic review of the existing imaging literature in PFP demonstrated that PFP is associated with a number of imaging features in particular MRI bisect offset and CT congruence angle and that some of these features should be modifiable with conservative treatment. A retrospective analysis investigating the overall 3D shape and 3D equivalents of commonly used PFJ imaging features demonstrated no differences between a group with and without PFP, challenging the current perceptions on the structural associations to PFP. A cross-sectional cluster analysis using modifiable clinical, biomechanical and imaging features identified four subgroups that are present in PFP cohort with a Weak group showing the worst prognosis at 12 months. Lastly, a pragmatic randomised controlled feasibility study comparing matched treatment to usual care management showed that matching treatment to a specific subgroup is feasible in terms of adherence, retention and conversion to consent. In summary, the findings of this thesis improves our understanding of the structural associations to PFP; the subgroups that exist within the PFP population; the natural prognosis of these PFP subgroups; and the feasibility of targeting treatment at PFP subgroups within a clinical trial.

Item Type: Thesis (PhD)
Keywords: patellofemoral pain; knee; imaging; subgrouping
Academic Units: The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds)
Depositing User: Dr Benjamin Timothy Drew
Date Deposited: 30 Apr 2018 08:58
Last Modified: 30 Apr 2018 08:58
URI: http://etheses.whiterose.ac.uk/id/eprint/20191

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