A sport-medicine-education collaborative intervention framework for patellar tendinopathy: theoretical foundation and implementation pathway

To develop an interdisciplinary collaborative framework for implementing Sport-Medicine-Education for managing patellar tendinopathy (PT; note that PT is used throughout this manuscript to refer exclusively to patellar tendinopathy, not physical therapy or physical therapist) and to establish its content validity through expert consensus using the Consolidated Framework for Implementation Research (CFIR), the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, and Education-Unload-Reload-Prevention. A multi-phase framework development process was utilized. Phase 1 included systematic literature synthesis with PRISMA guidance, identifying 170 records from PubMed (October 20, 2024), 155 articles to full-text review, and 73 studies eventually included, expert co-creation meetings (n = 15 experts), Delphi consensus generation (3 rounds, 92% agreement), and external validation, including feasibility consultation at three clinical sites. CFIR was utilized to determine implementation facilitators and barriers within five domains. Feasibility of the framework utilized RE-AIM dimensions with 16 specific measures. The integrative model includes three main dimensions: Sport Science (load management, biomechanical assessment, performance optimization), Medicine (clinical diagnosis, physical rehabilitation, pain management), and Health Education (patient education, self-management skills, behavioral support). Through the integration of literature synthesis, expert workshops, and Delphi consensus, 23 facilitators and 15 barriers to implementation were identified across the CFIR domains. The five-phase implementation pathway (Pre-implementation→Planning→Active Implementation→Sustainability→Scale-up) was rated for feasibility at 4.2 out of 5.0 on a 5-point Likert scale by the 15-member expert panel during the Delphi process. Based on Delphi consensus, the expert panel established the following RE-AIM target thresholds for future validation: reach of ≥ 70% of eligible patients, effectiveness of at least a 13-point improvement on the Victorian Institute of Sport Assessment-Patella (VISA-P), adoption across ≥ 3 institutions with complete MDT representation, ≥ 85% implementation fidelity, and ≥ 70% maintenance at 12 months. This study proposes a theory-driven collaborative framework for patellar tendinopathy management that integrates formalized implementation strategies with specified evaluation criteria. The model serves as a conceptual blueprint and implementation manual for the transition from fragmented to integrated multidisciplinary care, with the potential to enhance clinical outcomes and reduce recurrence rates. However, its real-world effectiveness requires empirical validation through prospective implementation studies.