{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T13:40:47Z","timestamp":1793108447329,"version":"4.5.0"},"reference-count":68,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000776","name":"Orthopaedic Research UK","doi-asserted-by":"publisher","award":["ORUK Ref: 574"],"award-info":[{"award-number":["ORUK Ref: 574"]}],"id":[{"id":"10.13039\/501100000776","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,1,28]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Patellar tendinopathy (PT) rehabilitation programmes frequently incorporate eccentric exercise (EE), where participants have limited control over the range of motion, speed, force production and load. Newly developed training protocols that employ visual feedback with specialised devices offer controlled management of loads, speeds and forces across the full range of motion, potentially providing greater benefits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This protocol outlines a randomised controlled trial designed to compare the effects of a visuomotor torque feedback (TF) protocol with a traditional EE protocol on the rehabilitation of PT over a 6-week period. Our primary objective is to evaluate whether the TF protocol reduces pain and disability more effectively than the EE protocol in individuals with PT. Secondary objectives include analysing structural and architectural changes in the patellar tendon and quadriceps femoris muscles, as well as examining motor unit discharge dynamics in response to EE and TF training. Lastly, we aim to compare these dynamics and structural changes between healthy controls and individuals with PT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty two individuals with PT and twenty six healthy controls will be recruited. The PT group will be subdivided into an EE group, and a TF group, with both groups undergoing a 6-week training programme. The EE group will perform their exercises two times per day, while the TF group will do so 2\u20133 times a week. In individuals with PT, the primary outcomes will be the Victorian Institute of Sport-Patella (VISA-P) questionnaire to measure disability\/physical function, and pain with a Numerical Rating Scale (NRS). To gain insights on mechanisms of action for potential improvements, motor unit discharge characteristics of the quadriceps femoris muscles will be assessed with high-density surface electromyography. Additionally, we will measure structural\/architectural changes to the patellar tendon and quadriceps femoris muscles using B-mode ultrasonography and shear-wave elastography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study was approved by the Science, Technology, Engineering and Mathematics Ethical Review Committee from the University of Birmingham (ERN_2257-Jun2024). The results of this study will be disseminated in peer-reviewed journals and at international conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN15821610\">ISRCTN15821610<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-092104","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T08:50:53Z","timestamp":1739177453000},"page":"e092104","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Torque visuomotor feedback training versus standard eccentric exercise for the management of patellar tendinopathy: protocol for a randomised controlled trial"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"isrctn15821610","registry":"10.18810\/isrctn"},{"clinical-trial-number":"isrctn15821610","registry":"10.18810\/isrctn"}],"author":[{"given":"Ragul","family":"Selvamoorthy","sequence":"first","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michail","family":"Arvanitidis","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK"},{"name":"Centre for precision rehabilitation of spinal pain, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Negro","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, Universit\u00e0 degli Studi di Brescia, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricio","family":"Pincheira","sequence":"additional","affiliation":[{"name":"School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Evans","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5790-7514","authenticated-orcid":false,"given":"Eduardo","family":"Martinez-Valdes","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"2026102705550841000_15.2.e092104.1","doi-asserted-by":"crossref","DOI":"10.1177\/23259671231173659","article-title":"Epidemiology of Patellar Tendinopathy in Athletes and the General Population: A Systematic Review and Meta-analysis","volume":"11","author":"Nutarelli","year":"2023","journal-title":"Orthop J Sports Med"},{"key":"2026102705550841000_15.2.e092104.2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-020-00234-1"},{"key":"2026102705550841000_15.2.e092104.3","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-092275"},{"key":"2026102705550841000_15.2.e092104.4","doi-asserted-by":"crossref","first-page":"953","DOI":"10.4085\/1062-6050-70-18","article-title":"Prevalence of Patellar Tendinopathy and Patellar Tendon Abnormality in Male Collegiate Basketball Players: A Cross-Sectional Study","volume":"54","author":"Hutchison","year":"2019","journal-title":"J Athl Train"},{"key":"2026102705550841000_15.2.e092104.5","doi-asserted-by":"crossref","first-page":"887","DOI":"10.2519\/jospt.2015.5987","article-title":"Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations","volume":"45","author":"Malliaras","year":"2015","journal-title":"J Orthop Sports Phys Ther"},{"key":"2026102705550841000_15.2.e092104.6","doi-asserted-by":"publisher","DOI":"10.1002\/jor.20415"},{"key":"2026102705550841000_15.2.e092104.7","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2020-103403"},{"key":"2026102705550841000_15.2.e092104.8","unstructured":"Bourke D . 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