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NCT Number: NCT07384858

Effects of Attentional Focus Strategies During Isokinetic Quadriceps Training on Strength and Functional Performance in Individuals With Patellofemoral Pain Syndrome.

Patellofemoral pain syndrome (PFPS) is a multifactorial musculoskeletal condition that is common particularly among young and physically active individuals, negatively affecting activities of daily living and physical performance. Although exercise therapy is considered the gold standard in the management of PFPS, there is limited evidence regarding the effectiveness of motor learning strategies applied during exercise. This study aims to shed light on how motor learning approaches can be optimized in clinical rehabilitation by comparing the effects of internal and external focus strategies used during exercise on muscle activation, functional performance, and pain.

This research will make a methodological contribution to the literature through the objective evaluation of muscle mechanical properties using isokinetic assessment and the MyotonPRO device. The findings are expected to clarify the effects of attentional focus strategies on therapeutic outcomes in PFPS rehabilitation and have the potential to provide an evidence-based guide for physiotherapy practice. In this way, the study may contribute to the development of new approaches aimed at improving both clinical effectiveness and patient adherence.

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Key information

Conditions

Patellofemoral Pain, PFP Joint Diseases Musculoskeletal Diseases Patellofemoral Pain Syndrome

Age range

18 year–45 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Istanbul University-Cerrahpasa

Istanbul, Turkey (Türkiye)

Location status: Recruiting

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Aged between 18 and 45 years.
  • Diagnosed with patellofemoral pain syndrome (PFPS).
  • Anterior or retropatellar knee pain persisting for at least four weeks with a VAS score > 3.
  • Pain exacerbated by at least two functional activities (e.g., squatting, stair climbing, prolonged sitting).
  • Willing to regularly participate in the 6-week program throughout the study period.

Exclusion criteria

  • History of patellar subluxation or dislocation.
  • Anterior or posterior cruciate ligament insufficiency.
  • Lower extremity fractures.
  • Neurological or systemic musculoskeletal disorders.
  • Rheumatoid arthritis or other inflammatory joint diseases.
  • History of knee surgery, meniscal injury, or any other underlying musculoskeletal condition that would prevent the participant from performing the exercises.
  • Pregnancy or postpartum period.
  • Participation in a similar exercise program within the last 3 months.
  • Radiographic evidence of osteoarthritis classified as Kellgren-Lawrence grade 2 or higher.

Treatment and study plan

Internal focus group

Other

Internal focus refers to directing attention to one's own body movements or muscle activity while performing a task (e.g., focusing on contracting a specific muscle). During isokinetic strength exercises, this group is instructed with commands such as: "Tighten your quadriceps" and "Straighten your knee."

External focus

Other

External focus refers to directing attention to the effect of a movement on the environment or an external object, rather than on the body itself. During isokinetic exercise, this group is given the instruction: "Increase and maintain the performance indicator on the screen."

Primary outcomes

  1. Kujala Patellofemoral Pain Score

    Time frame: baseline

    Kujala Patellofemoral Pain Score is a valid and reliable self-reported outcome measure specific to patellofemoral pain syndrome that assesses knee function and pain-related limitations during daily activities.

    The total score ranges from 0 to 100, with higher scores indicating better knee function and fewer symptoms.

  2. Kujala Patellofemoral Pain Score

    Time frame: Week 3 of the Treatment

    Kujala Patellofemoral Pain Score is a valid and reliable self-reported outcome measure specific to patellofemoral pain syndrome that assesses knee function and pain-related limitations during daily activities.

    The total score ranges from 0 to 100, with higher scores indicating better knee function and fewer symptoms.

  3. Kujala Patellofemoral Pain Score

    Time frame: Week 6 of the Treatment

    Kujala Patellofemoral Pain Score is a valid and reliable self-reported outcome measure specific to patellofemoral pain syndrome that assesses knee function and pain-related limitations during daily activities.

    The total score ranges from 0 to 100, with higher scores indicating better knee function and fewer symptoms.

Secondary outcomes

  1. Visual Analog Scale

    Time frame: baseline

    Visual Analog Scale (VAS) is a simple and reliable tool used to assess the intensity of knee pain. Participants rate their pain on a 0 to 10 cm scale, with higher scores indicating greater pain severity. It was used to evaluate changes in pain before and after exercise.

  2. Visual Analog Scale

    Time frame: Week 3 of the Treatment

    Visual Analog Scale (VAS) is a simple and reliable tool used to assess the intensity of knee pain. Participants rate their pain on a 0 to 10 cm scale, with higher scores indicating greater pain severity. It was used to evaluate changes in pain before and after exercise.

  3. Visual Analog Scale

    Time frame: Week 6 of the Treatment

    Visual Analog Scale (VAS) is a simple and reliable tool used to assess the intensity of knee pain. Participants rate their pain on a 0 to 10 cm scale, with higher scores indicating greater pain severity. It was used to evaluate changes in pain before and after exercise.

  4. Isokinetic Muscle Strength Assessment (Isoforce)

    Time frame: baseline

    Muscle performance will be objectively evaluated by measuring concentric strength values of the quadriceps muscle.

  5. Isokinetic Muscle Strength Assessment (Isoforce)

    Time frame: Week 3 of the Treatment

    Muscle performance will be objectively evaluated by measuring concentric strength values of the quadriceps muscle.

  6. Isokinetic Muscle Strength Assessment (Isoforce)

    Time frame: Week 6 of the Treatment

    Muscle performance will be objectively evaluated by measuring concentric strength values of the quadriceps muscle.

  7. Muscle Tone

    Time frame: baseline

    Muscle tone was assessed using the MyotonPRO device, expressed in Hertz (Hz), with higher values indicating increased resting muscle tone.

  8. Muscle Tone

    Time frame: Week 3 of the Treatment

    Muscle tone was assessed using the MyotonPRO device, expressed in Hertz (Hz), with higher values indicating increased resting muscle tone.

  9. Muscle Tone

    Time frame: Week 6 of the Treatment

    Muscle tone was assessed using the MyotonPRO device, expressed in Hertz (Hz), with higher values indicating increased resting muscle tone.

  10. Muscle Stiffness

    Time frame: baseline

    Muscle stiffness was measured using the MyotonPRO device, expressed in Newton per meter (N/m), with higher values indicating greater muscle stiffness.

  11. Muscle Stiffness

    Time frame: Week 3 of the Treatment

    Muscle stiffness was measured using the MyotonPRO device, expressed in Newton per meter (N/m), with higher values indicating greater muscle stiffness.

  12. Muscle Stiffness

    Time frame: Week 6 of the Treatment

    Muscle stiffness was measured using the MyotonPRO device, expressed in Newton per meter (N/m), with higher values indicating greater muscle stiffness.

  13. Muscle Elasticity

    Time frame: baseline

    Muscle elasticity was evaluated using the MyotonPRO device, expressed as logarithmic decrement, with lower values indicating better elastic properties.

  14. Muscle Elasticity

    Time frame: Week 3 of the Treatment

    Muscle elasticity was evaluated using the MyotonPRO device, expressed as logarithmic decrement, with lower values indicating better elastic properties.

  15. Muscle Elasticity

    Time frame: Week 6 of the Treatment

    Muscle elasticity was evaluated using the MyotonPRO device, expressed as logarithmic decrement, with lower values indicating better elastic properties.

  16. Step-Down Test

    Time frame: baseline

    Step-Down Test was used to assess lower-extremity control and functional performance. Participants were instructed to perform as many step-down repetitions as possible within 30 seconds. Performance was recorded as the number of completed repetitions, with higher scores indicating better functional capacity and dynamic knee stability.

  17. Step-Down Test

    Time frame: Week 3 of the Treatment

    Step-Down Test was used to assess lower-extremity control and functional performance. Participants were instructed to perform as many step-down repetitions as possible within 30 seconds. Performance was recorded as the number of completed repetitions, with higher scores indicating better functional capacity and dynamic knee stability.

  18. Step-Down Test

    Time frame: Week 6 of the Treatment

    Step-Down Test was used to assess lower-extremity control and functional performance. Participants were instructed to perform as many step-down repetitions as possible within 30 seconds. Performance was recorded as the number of completed repetitions, with higher scores indicating better functional capacity and dynamic knee stability.

  19. Single-Leg Hop Test

    Time frame: baseline

    Single-Leg Hop Test was used to assess functional performance and dynamic knee stability. Participants were instructed to perform a maximal forward hop on the affected limb. The hop distance was measured in centimeters (cm), with greater distances indicating better functional performance.

  20. Single-Leg Hop Test

    Time frame: Week 3 of the Treatment

    Single-Leg Hop Test was used to assess functional performance and dynamic knee stability. Participants were instructed to perform a maximal forward hop on the affected limb. The hop distance was measured in centimeters (cm), with greater distances indicating better functional performance.

  21. Single-Leg Hop Test

    Time frame: Week 6 of the Treatment

    Single-Leg Hop Test was used to assess functional performance and dynamic knee stability. Participants were instructed to perform a maximal forward hop on the affected limb. The hop distance was measured in centimeters (cm), with greater distances indicating better functional performance.

Study contacts

Contact information is provided by the study sponsor or research team.

SEDA ATEŞ, bachelor degree

CONTACT

[email protected]

90+ 5388543087

Sponsors and collaborators

Lead sponsor

Istanbul University - Cerrahpasa

Other

Registry information

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Feb 3, 2026
Registry last updated
Feb 11, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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