Original Research

Community-based rehabilitation implementation framework to address patellofemoral pain amongst runners in under-resourced communities: Delphi consensus

Siyabonga Kunene, Nomathemba Taukobong, Serela Ramklass
South African Journal of Physiotherapy | Vol 77, No 1 | a1531 | DOI: https://doi.org/10.4102/sajp.v77i1.1531 | © 2021 Siyabonga Kunene, Nomathemba Taukobong, Serela Ramklass | This work is licensed under CC Attribution 4.0
Submitted: 08 September 2020 | Published: 22 June 2021

About the author(s)

Siyabonga Kunene, Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Nomathemba Taukobong, Department of Institutional Planning, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
Serela Ramklass, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa


Background: Runners in under-resourced communities in parts of South Africa present with a high prevalence of patellofemoral pain (PFP), which affects their level of participation in sporting activities. Therefore, a specific rehabilitation approach is necessary to manage the PFP-related needs of these runners within their means and reach.

Objective: To develop a community-based rehabilitation (CBR) implementation framework for PFP amongst runners in under-resourced communities.

Method: Our study used the Delphi technique to develop an appropriate rehabilitation implementation framework for PFP in community-based settings. Sport medicine experts, involved in the treatment and rehabilitation of PFP, were recruited to participate. The Delphi process consisted of three rounds to attain consensus amongst the experts on the components and elements that could be contained in a rehabilitation implementation framework for the management of PFP. Experts rated the framework items using a five-point Likert scale.

Results: A total of 19 experts participated in our study: 10 were females and 9 were males of whom 13 were aged between 36 and 55 years. Most were local experts (15) with 11–20 years of clinical experience. Four core rehabilitation implementation items were identified through the Delphi process. These were: (1) the establishment of transdisciplinary rehabilitation teams, (2) upskilling of available clinicians, their assistants and trainers, (3) implementation of a CBR programme at low-level or no-cost and (4) referral of cases to secondary or tertiary institutions for further management.

Conclusion: Consensus was reached for a comprehensive CBR implementation framework aimed at addressing the specific needs of runners with PFP in under-resourced communities.

Clinical implications: A further study to test the feasibility of the agreed-upon intervention is recommended.


patellofemoral pain; community-based rehabilitation; runners; under-resourced communities; Delphi technique


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