Structured patient education plus exercise therapy versus exercise therapy alone in individuals with patellofemoral pain syndrome: A randomized controlled trial

Background Patellofemoral pain syndrome (PFPS) is associated with pain, functional limitations, and psychological factors. Although exercise therapy is a recommended treatment, the additional benefit of structured patient education remains unclear.Objective To compare the effects of adding structured patient education to exercise therapy versus exercise therapy alone on pain and clinical outcomes in individuals with PFPS.Methods In this assessor-blinded, two-arm, parallel-group randomized controlled trial, thirty adults with PFPS were randomly allocated to exercise therapy plus structured patient education (n = 15) or exercise therapy alone (n = 15). Both groups received 10 supervised exercise therapy sessions over 4 weeks, while the intervention group additionally received eight patient education sessions. The primary outcome was pain intensity measured using a Visual Analog Scale (VAS). Secondary outcomes included pain catastrophizing assessed using the Pain Catastrophizing Scale (PCS), kinesiophobia assessed using the Tampa Scale for Kinesiophobia (TSK), functional status assessed using the Kujala Patellofemoral Score (KPS), and perceived recovery assessed using the Global Rating of Change (GROC). Outcomes were assessed at baseline, post-intervention, and 2-month follow-up.Results Groups were comparable at baseline. Significant group × time interactions were observed for pain intensity (partial η2 = 0.492), pain catastrophizing (partial η2 = 0.801), kinesiophobia (partial η2 = 0.918), and functional status (partial η2 = 0.771) (all p < .001). Post-intervention, pain intensity did not differ significantly between groups (p = .054), whereas PCS, TSK, and KPS favored the intervention group (all p < .001). At 2-month follow-up, pain intensity was lower in the intervention group (1.47 ± 1.25 vs 4.47 ± 2.13), and improvements in PCS, TSK, and KPS were maintained (all p < .001). Patient-perceived recovery favored the intervention group at post-intervention and at 2-month follow-up (both p < .001), with large between-group effect sizes (Cohen’s d = 1.69 and 3.16, respectively). However, the between-group mean differences should be interpreted cautiously regarding clinical relevance.Conclusions Adding structured patient education to exercise therapy was associated with greater improvements in pain-related psychological outcomes, functional status, and patient-perceived recovery compared with exercise therapy alone in individuals with PFPS. Although both groups improved over time, the additional effect on pain intensity was observed only at the 2-month follow-up.Trial registration Iranian Registry of Clinical Trials: IRCT20240713062427N1.