Developing a Novel Clinical Care Model for Chronic Patellar Tendinopathy Utilizing Whole Person Healthcare

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Abstract Individuals with chronic MSK pain conditions who experience disability-related limitations in physical activity participation are at higher risk for poor physical and mental health outcomes. Chronic patellar tendinopathy is a highly prevalent chronic MSK condition that severely limits performance, physical activity, self-perceived function, and quality of life. Whole person health (WPH) is a comprehensive framework that considers interconnected domains (biological, behavioral, social, environmental) that foster health, and is designed to facilitate multicomponent therapeutic interventions. The applicant’s long-term career objective is to establish a funded research program that develops and evaluates a WPH model to decrease disability and improve quality of life for individuals with for chronic musculoskeletal pain conditions. Current standard of clinical care for patients with chronic patellar tendinopathy take a unifocal approach, emphasizing local tendon pain and capacity, does not incorporate other factors (psychological, social, environmental) that may contribute to the patient’s overall health. The overall objective of this study for this career development award is to develop a WHP framework that is responsive to the critical gaps in the literature and will inform future intervention approaches for patellar tendinopathy. The approach will expand the standard of care progressive loading exercise treatment (PLE) utilizing individualized biofeedback augmented movement retraining and behavioral graded exposure techniques to develop and refine a novel patellar tendon WPH intervention (WPH), and evaluate feasibility, acceptability, and responsiveness of key biopsychosocial outcomes (landing mechanics, psychological distress, tendon stiffness). The central hypothesis of this study is that individuals with chronic patellar tendinopathy who utilize novel WPH for patellar tendinopathy rehabilitation will demonstrate improvements in self-reported function, landing biomechanics, and tissue capacity. The hypothesis will be tested through three specific aims: 1) refine WPH intervention protocols through a small case series study using mixed-methods approach, 2) establish feasibility and acceptability benchmarks, and 3) determine safety and responsiveness of WPH compared to PLE on primary outcome of (a) patient self-reported function and psychological distress, and secondary outcomes of (b) landing biomechanics and (c) patellar tendon stiffness through a pilot randomized controlled study. The proposed work is innovative, in that: 1) it will be the first study to utilize a WPH framework compared to standard of care and evaluate a novel combination of outcomes for the treatment of chronic tendinopathy. The study is significant as it addresses an important gap in knowledge, moving beyond outdated traditional care models to create novel clinical care model designed to mitigate the debilitating effects of tendon pain on quality of life. Doing so takes a substantial step forward to enhance patient-oriented long-term outcomes for individuals with chronic musculoskeletal pain conditions.