Digital Public Defence: Alexandra Hott

MD Alexandra Hott at Institute of Clinical Medicine will be defending the thesis Patellofemoral pain. Treatment, outcome measures and prognostic factors for the degree of PhD (Philosophiae Doctor).

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The public defence will be held as a video conference over Zoom.

The defence will follow regular procedure as far as possible, hence it will be open to the public and the audience can ask ex auditorio questions when invited to do so.

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Due to copyright reasons, an electronic copy of the thesis must be ordered from the faculty. In order for the faculty to have time to process the order, it must be received by the faculty no later than 2 days prior to the public defence. Orders received later than 2 days before the defence will not be processed. Inquiries regarding the thesis after the public defence must be addressed to the candidate.


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Adjudication committee

  • First opponent: Professor Ewa M. Roos, University of Southern Denmark, Odense
  • Second opponent: Associate Professor Laurie A. Hiemstra, University of Calgary, Canada
  • Third member and chair of the evaluation committee: Professor Erik Lønnmark Werner, Institute of Heath and Society, University of Oslo

Chair of the Defence

Professor II John-Anker Zwart, Institute of Clinical Medicine, University of Oslo

Principal Supervisor

Senior consultant in Orthopedic Surgery Sigurd Liavaag, Sørlandet Hospital, Kristiansand


Patellofemoral pain (PFP) is a common cause of knee pain in the general population, including young active people. 

Exercise is a mainstay in the treatment of PFP, and traditionally targets the quadriceps muscles. More recently, exercises targeting the hip muscles have gained attention and have shown promising results in treating PFP.

The aims of the thesis were to compare the effectiveness of isolated hip exercises to traditional quadriceps-based exercises or free physical activity on pain and function in PFP in a randomized controlled trial with follow-up at 3 and 12 months. All patients received the same patient education. Predictors of one-year outcomes were examined using multivariable analysis. The primary outcome measure was the patient-reported Anterior Knee Pain Scale. It was translated to Norwegian and its reliability, validity and responsiveness were evaluated.
All groups improved significantly during the course of the study.  There was no difference in pain and function between isolated hip exercise, traditional quadriceps-based exercises or free physical activity in the short or long term. Clinical improvements at 3 months were maintained or further improved at 12 months. Structured hip or quadriceps exercises led to larger gains in muscle strength compared to free physical activity, but this did not translate to superior clinical outcomes.  

The most consistent predictor of poorer outcome at 12 months was the number of painful body areas at baseline. Longer pain duration, lower self-efficacy and male gender were also predictive of poorer outcomes.

The Norwegian Anterior Knee Pain Scale was found to have comparable measurement properties to the original version. It had acceptable reliability and validity, and moderate responsiveness.

Overall, the findings question the importance of exercise specificity in PFP and suggest patient education and advice for self-directed physical activity as an effective treatment strategy for PFP.

Additional information

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Published Feb. 8, 2021 1:38 PM - Last modified Feb. 23, 2021 11:46 AM