Reaching a consensus on a patellofemoral pain syndrome self-management programme for recreational cyclists in Saudi Arabia: A modified Delphi study

Abstract

Background: Recreational cycling is increasingly popular in Al Madinah, Saudi Arabia. However, many cyclists lack structured self-management programmes (SMPs) to address patellofemoral pain syndrome (PFPS), a common overuse injury that significantly affects knee function and cycling performance. Despite the growing interest in cycling, a critical gap remains in culturally relevant, evidence-based SMP.
Objectives: Our study aimed to develop expert consensus on the essential components of SMP for recreational cyclists with PFPS.
Method: Our study employed a two-round modified Delphi to develop expert consensus on the components of an SMP for recreational cyclists with PFPS. A panel of 25 experts, comprising physiotherapists, biokinetists, sports medicine professionals and exercise physiologists, participated in Round 1, with 19 experts (76% retention) completing Round 2. The process involved rating proposed programme objectives, principles, outcome measures and pain relief strategies using a four-point Likert scale. Consensus was defined as ≥ 70% of respondents selecting either ‘disagree’ to ‘strongly agree’.
Results: Consensus was reached on strengthening exercises (88%), evidence-based practice (84%), pain education (84%), PFPS education (92%) and knee pain management (92%). Round 2 results were streamlined and ranked according to pain, function, adherence, cultural resources and engagement supports, following clarifications and the addition of new items from experts.
Conclusion: Our study establishes an evidence-based, region-specific framework for self-managing PFPS among recreational cyclists.
Clinical implications: The proposed programme is designed to enhance adherence, reduce the risk of injury and improve cycling performance. Future research should evaluate the effectiveness of this approach, its scalability, outcomes and integration into national sports and rehabilitation strategies.