Supervised rehabilitation versus self-managed rehabilitation for people with an acute first-time or recurrent patellar dislocation: the PRePPeD (Physiotherapy Rehabilitation Post Patellar Dislocation) external pilot randomised controlled trial and embedded qualitative study

Journal article

Aims: To determine the feasibility of a full-scale randomised controlled trial (RCT) comparing two exercise-based rehabilitation interventions for people with an acute patellar dislocation.

Methods: A two-group external pilot RCT and embedded qualitative study conducted in five English National Health Service hospitals. Participants were aged ≥14 years with an acute (recruited ≤21 days of injury) first-time or recurrent patellar dislocation. Randomisation was 1:1 to supervised rehabilitation (4-6 physiotherapy sessions of tailored advice and prescribed home exercise) or self-managed rehabilitation (one physiotherapy session of advice, exercise instruction, and provision of materials to guide self-management). Quantitative feasibility objectives were 1.) patients’ willingness to be randomised, 2.) participant recruitment, 3.) intervention adherence (overall proportion of supervised rehabilitation participants that attended at least four physiotherapy sessions and self-managed rehabilitation participants that attended at least one session), and 4.) retention. Follow-up was three, six, and nine months after randomisation. There was no blinding. Semi-structured interviews aimed to understand participants’ experience of recovery, and the acceptability to them of the RCT interventions and follow-up methods.

Results: 50/88 (57%, 95% CI 46% to 67%) eligible patients were willing to be randomised. Sites recruited a mean of 1.4 (95% CI 0.6 to 1.8) participants per month, intervention adherence was 72% (95% CI 58% to 83%), and nine-month participant retention was 62% (95% CI 48% to 74%). During follow-up, three participants redislocated their patella and another underwent patellar stabilisation surgery. Interviews with nine pilot RCT participants found that the experience of recovery was conveyed through the themes ‘coming to terms with the initial injury’ and ‘regaining my former self’. Interviews also indicated that the RCT interventions and follow-up methods were generally acceptable to participants.

Conclusions: A full-scale RCT comparing two exercise-based rehabilitation interventions is feasible with minor modifications. Modifications should prioritise improving retention and participant attendance at physiotherapy sessions.

Registration: ISRCTN14235231

Authors: Forde, C; Tutton, E; Costa, ML; Cook, JA; Franssen, M

• Publication status: Accepted
• Peer review status: Peer reviewed
• Publisher: British Editorial Society of Bone and Joint Surgery
• Journal: Bone and Joint Journal
• Acceptance date: 2025-10-13
• EISSN: 2049-4408
• ISSN: 2049-4394
• Language: English