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Runners experience diverse lower extremity injuries, and the most common is patellofemoral pain (PFP)-commonly known as "runner's knee" and characterized by pain around and/or behind the kneecap. The aim of this study is to evaluate the effectiveness of a 6-week, self-directed, web-based education program for runners competing in the 2026 Boston Marathon. The study will evaluate outcomes, including pain, function, and marathon performance, in runners who use a web-based educational program designed to help them understand and manage knee pain. There will be two groups: Group 1 will receive the 6-week web-based educational program prior to the 2026 Boston Marathon, while Group 2 will serve as the wait-and-see control group (no intervention) prior to the marathon and then receive the same program 6 weeks after completing the marathon.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pre-Marathon Education | Experimental | This group will receive the educational platform for 6 weeks prior to the 2026 Boston Marathon. Participants will have access to MyKneeCap.com, a web-based platform designed to provide runners with evidence-based education on the physical and non-physical factors contributing to patellofemoral pain, as well as strategies for self-managing symptoms tailored specifically for runners. |
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| Wait-and-See Control / Post-Marathon Education | Other | This group will serve as a wait-and-see control (no intervention) prior to the 2026 Boston Marathon. After completing the marathon, participants will receive access to MyKneeCap.com, a web-based platform designed to provide runners with evidence-based education on the physical and non-physical factors contributing to patellofemoral pain, as well as strategies for self-managing symptoms tailored specifically for runners. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Education Platform-MyKneeCap.com | Behavioral | This intervention uses MyKneeCap.com, a free, web-based educational platform designed to help runners understand their knee pain. The platform provides information about patellofemoral pain and includes exercise programs aimed at reducing pain and improving knee function. This intervention does not involve any drugs, devices, or other procedural components. |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical outcomes (pain) | Pain will be assessed for current pain and worst pain in the previous week using a 10-cm visual analog scale (VAS; 0=no pain; 10=worst pain imaginable), a reliable, valid, and responsive tool for evaluating treatment outcomes for patellofemoral pain. | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Clinical outcomes (self-reported function) | Self-reported function will be evaluated using the 11-item Knee Injury and Osteoarthritis Outcome Score-Patellofemoral subscale (KOOS-PF; 0=extreme disability; 100=no disability), a reliable tool with the highest content validity for patellofemoral pain. | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Clinical outcomes (global rating of change) | Global rating of change will be assessed for perceived recovery using a 7-point Likert scale (much worse, worse, slightly worse, no change, slightly better, better, or much better). The global rating of change scale is a reliable, clinically relevant, and patient-centered measure for interpreting meaningful improvements. | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Measure | Description | Time Frame |
|---|---|---|
| Psychological function (fear-avoidance beliefs) | Fear-avoidance beliefs will be quantified using the 5-item Fear-Avoidance Beliefs Questionnaire-Physical Activity subscale (FABQ-PA; 0=no fear-avoidance; 24=extreme fear-avoidance). The FABQ-PA is a reliable and valid tool and represents a key psychological profile in patellofemoral pain management. | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Sungwan Kim, PhD | Boston Children's Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Boston Children's Hospital | Waltham | Massachusetts | 02453 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19229444 | Background | Piva SR, Gil AB, Moore CG, Fitzgerald GK. Responsiveness of the activities of daily living scale of the knee outcome survey and numeric pain rating scale in patients with patellofemoral pain. J Rehabil Med. 2009 Feb;41(3):129-35. doi: 10.2340/16501977-0295. | |
| Background | Evans JD. Straightforward statistics for the behavioral sciences. Thomson Brooks/Cole Publishing Co; 1996 | ||
| Background | Cohen J. Statistical power analysis for the behavioral sciences. Academic press; 1988 | ||
| 34965513 |
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All IPD that will be shared will be de-identified and for manuscript and publishing purposes only. PHI data will not be accessible outside of the research team, and only de-identified data will be a part of the manuscript.
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IPD will be analyzed for the manuscript, and all will be de-identified. This is approximately from the end of the study collection June 2026 to September 2026 for analysis.
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| ID | Term |
|---|---|
| D046788 | Patellofemoral Pain Syndrome |
| ID | Term |
|---|---|
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
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We will conduct a two-arm, parallel-group, single-blinded randomized controlled trial to evaluate the effect of the intervention prior to the marathon (Group 1: treatment vs. Group 2: wait-and-see control). After the marathon, Group 2 will receive the same intervention, and outcomes will be assessed in a quasi-experimental pre-post design (i.e., as a single treatment group).
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| Psychological function (pain self-efficacy) | Pain self-efficacy will be quantified using the 10-item Pain Self-Efficacy Questionnaire (PSEQ; 0=no self-efficacy; 60=extreme self-efficacy). The PSEQ is a reliable and valid tool and represents a key psychological profile in patellofemoral pain management. | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Patient satisfaction | Satisfaction during the preceding six weeks of marathon training will be rated on a 5-point Likert scale (very dissatisfied, somewhat dissatisfied, neither, somewhat satisfied, or very satisfied). | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Marathon performance (finish time) | Finish time will be evaluated by comparing the official finish time to the participant's intended finish time (in minutes). | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Marathon performance (division ranking) | Division ranking will be evaluated by comparing the division ranking to the participant's intended division ranking (in rank). | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Medical service use | Intra-event medical encounters for knee pain will be self-recorded (in count). | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Secondary musculoskeletal complaints | Lower extremity pain or injuries (other than patellofemoral pain) sustained during the race will be self-recorded (in count). | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Return to running readiness | Perceived readiness to return to competitive running will be assessed on a 5-point Likert scale (not at all, slightly, moderately, very, or extremely). | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Barriers and facilitators (confidence in self-management) | Confidence in self-management ("I am confident in my ability to manage my symptoms and treatment plan on my own") will be measured using a 5-point Likert scale (strongly disagree, disagree, neither, agree, strongly agree). | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Barriers and facilitators (usability of the education platform) | Usability of the education platform ("The web-based education platform is easy to use and navigate") will be measured using a 5-point Likert scale (strongly disagree, disagree, neither, agree, strongly agree). | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Barriers and facilitators (treatment expectations) | Treatment expectations ("I believe that the web-based education and exercise program will help improve my condition") will be measured using a 5-point Likert scale (strongly disagree, disagree, neither, agree, strongly agree). | 6-weeks leading up to the Boston Marathon, or 6-weeks post completion of Boston Marathon |
| Background |
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