Management of Patellofemoral Pain Syndrome

NewsBot · Aug 9, 2020

Effects of Posterior X Taping on Movement Quality and Knee Pain Intensity during Forward-Step-Down in Patients with Patellofemoral Pain Syndrome
Eui-Hwan Lim et al
J Sports Sci Med. 2020 Feb 24;19(1):224-230

Excessive tibiofemoral rotation in weight-bearing position may be associated with patellofemoral pain syndrome (PFPS). A previous literature suggested that "posterior X taping" method is effective for correcting the reduction of hip adduction and tibiofemoral rotation in weight bearing position. The purpose of this study was to determine the effects of posterior X taping on the angles of hip adduction, tibiofemoral rotation, grades of the forward-step-down (FSD) performance test, and intensity of knee pain when descending stair in patients with PFPS. We recruited patients with PFPS. The knee pain intensity during FSD was measured using visual analogue scale system (100 mm) under both no-tape and tape conditions. A three-dimensional motion analysis system was used to assess the kinematics of lower limb joints during FSD. In addition, scoring system of FSD performance test was used to assess the movement deviation of the trunk and lower limb and one-leg balance. Participants with PFPS showed reduced pain intensity (p = 0.001) and improved scores on FSD performance test (p = 0.002) with posterior X taping compared to the no-tape condition during FSD. No significant alterations changes were noted in three dimensional angles of the hip, knee and ankle joints, especially hip adduction and tibiofemoral rotation between conditions. Posterior X taping decreases knee pain and improves the scores on FSD performance test for patients with PFPS.
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NewsBot · Aug 31, 2020

Effects of exercise combined with whole body vibration in patients with patellofemoral pain syndrome: a randomised-controlled clinical trial
Angel Yañez-Álvarez, Beatriz Bermúdez-Pulgarín, Sergio Hernández-Sánchez & Manuel Albornoz-Cabello
BMC Musculoskeletal Disorders volume 21, Article number: 582 (2020)

Background
Patellofemoral pain is a prevalent condition in the general population, especially in women, and produces functional impairment in patients. Therapeutic exercise is considered an essential part of the conservative management. The use of vibration platforms may help improve strength and function and reduce pain in patients with knee disorders. The aim of this investigation was to determine the effects of adding whole body vibration (vertical, vibration frequency of 40 Hz, with an amplitude from 2 to 4 mm) to an exercise protocol for pain and disability in adults with patellofemoral pain.

Methods
A randomised clinical trial was designed, where 50 subjects were randomly distributed into either an exercise group plus whole body vibration or a control group. Pain, knee function (self-reported questionnaire) and range of motion and lower limb functionality were assessed at baseline and at 4 weeks. The experimental group performed 12 supervised sessions of hip, knee and core strengthening exercises on a vibration platform 3 times per week during 4 weeks. The control group followed the same protocol but without vibration stimuli. Differences in outcome measures were explored using an analysis of the variance of 2 repeated measures. Effect sizes were estimated using Square Eta (η2). Significant level was set al P < 0.05.

Results
Statistically significant differences were found after intervention in favour of the experimental group in the between-groups comparison and in the interaction of the experimental group before and after treatment in terms of pain perception (P = 0.000; η2 = 0.63) and function outcomes scores (P = 0.000; η2 0.39 and 0.51 for lower limb functional scale and Kujala scores respectively).

Conclusion
A 4-week whole body vibration exercise programme reduces pain level intensity and improves lower limb functionality in patellofemoral pain patients and is more effective than exercise alone in improving pain and function in the short-term.
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NewsBot · Sep 12, 2020

Do exercises for patellofemoral pain reflect common injury mechanisms? A systematic review
Steven L. Dischiavi et al
JSMAS

Objectives
Current best evidence has reported that therapeutic exercise programs that are designed to treat patellofemoral pain (PFP) should include both hip and knee specific exercises. The purpose of this review was to (1) examine the quality/comprehensiveness of exercise reporting in this field; (2) quantify the extent to which individual exercises comprised task-specific elements (single limb stance; eccentric control of the hip; rotational z-axis control) most likely to address key pathomechanics associated with PFP.
Design
Systematic review: a systematic survey of RCTs.
Methods
PubMed, CINAHL, Medline, Physiotherapy Evidence Database (PEDro) and SPORT Discus databases were searched for randomized controlled trials that addressed PFP utilizing a proximal control hip focused rehabilitation paradigm. The therapeutic exercise programs were evaluated, and each individual exercise was extracted for analysis. Quality assessments included the PEDro Scale and the Consensus on Exercise Reporting Template (CERT) was utilized to score the reporting of the interventions.
Results
19 studies were included in the final analysis. 178 total exercises were extracted from the proximal hip and knee rehabilitation programs. The exercises were analyzed for the inclusion of elements that align with reported underlying biomechanical mechanisms.
Conclusions
The vast majority of the exercises were sagittal plane, concentric, non-weight bearing exercises, whereas multiplanar exercises, single limb weightbearing, and exercises where loading was directed around the longitudinal z-axis, were considerably under-represented. Current exercises for PFP utilize simplistic frameworks that lack progression into more task specific exercise, and are not reflective of the complex injury etiology.
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NewsBot · Oct 30, 2020

Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis
Marinus Winters et al
British Journal of Sports Medicine Published Online First: 26 October 2020

Objective To investigate the comparative effectiveness of all treatments for patellofemoral pain (PFP).

Design Living systematic review with network meta-analysis (NMA).

Data sources Sensitive search in seven databases, three grey literature resources and four trial registers.

Eligibility criteria Randomised controlled trials evaluating any treatment for PFP with outcomes ‘any improvement’, and pain intensity.

Data extraction Two reviewers independently extracted data and assessed risk of bias with Risk of Bias Tool V.2. We used Grading of Recommendations, Assessment, Development and Evaluation to appraise the strength of the evidence.

Primary outcome measure ‘Any improvement’ measured with a Global Rating of Change Scale.

Results Twenty-two trials (with forty-eight treatment arms) were included, of which approximately 10 (45%) were at high risk of bias for the primary outcome. Most comparisons had a low to very low strength of the evidence. All treatments were better than wait and see for any improvement at 3 months (education (OR 9.6, 95% credible interval (CrI): 2.2 to 48.8); exercise (OR 13.0, 95% CrI: 2.4 to 83.5); education+orthosis (OR 16.5, 95% CrI: 4.9 to 65.8); education+exercise+patellar taping/mobilisations (OR 25.2, 95% CrI: 5.7 to 130.3) and education+exercise+patellar taping/mobilisations+orthosis (OR 38.8, 95% CrI: 7.3 to 236.9)). Education+exercise+patellar taping/mobilisations, with (OR 4.0, 95% CrI: 1.5 to 11.8) or without orthosis (OR 2.6, 95% CrI: 1.7 to 4.2), were superior to education alone. At 12 months, education or education+any combination yielded similar improvement rates.

Summary/conclusion Education combined with a physical treatment (exercise, orthoses or patellar taping/mobilisation) is most likely to be effective at 3 months. At 12 months, education appears comparable to education with a physical treatment. There was insufficient evidence to recommend a specific type of physical treatment over another. All treatments in our NMA were superior to wait and see at 3 months, and we recommend avoiding a wait-and-see approach.
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NewsBot · Nov 6, 2020

Effects of kinesio taping on neuromuscular performance and pain of individuals affected by patellofemoral pain: A randomized controlled trial
Samara Alencar Melo et al
Physiother Theory Pract. 2020 Jun;36(6):709-719

Patellofemoral pain (PFP) is one of the most frequent musculoskeletal dysfunctions in the knee and its treatment is controversial. This study analyzed the effects of Kinesio Taping (KT) immediately and 72 hours after its application on the electromyographic (EMG) activity of the vastus medialis oblique (VMO) muscle, on the isokinetic performance of the quadriceps femoris and on the pain of subjects with PFP. Fifty-four participants were divided into three groups and performed one of the following protocols: (1) control group (CG)-remained at rest; (2) KT tension group (TG)-KT application with tension in the VMO region; and (3) KT without tension group (WTG)-KT application without tension in the same region. VMO and vastus lateralis (VL) EMG activity (RMS and onset), isokinetic performance and pain intensity were evaluated at three moments: before KT application, immediately after and 72 hours after. A mixed model ANOVA was used for statistical analysis with a significance level of 5% (p ≤ 0.05). No differences between the evaluated groups were found in relation to EMG variables and isokinetic performance. A reduction in pain intensity was found in the WTG in comparison to CG, after 72 hours. KT does not alter EMG parameters nor the isokinetic performance of subjects with PFP. However, we noticed reduced pain in the group submitted to the technique without tension 72 hours after its application.
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NewsBot · Dec 20, 2020

Osteopathic Manipulative Treatment Versus Exercise Program in Runners With Patellofemoral Pain Syndrome: A Randomized Controlled Trial
Julio Zago, Fellipe Amatuzzi, Tatiana Rondinel and João Paulo Matheus
Journal of Sport Rehabilitation

Context: The effects of an exercise program (EP) for the treatment of patellofemoral pain syndrome (PFPS) are well known. However, the effects of osteopathic manipulative treatment (OMT) are unclear. Objective: To evaluate the effects of OMT versus EP on knee pain, functionality, plantar pressure in middle foot (PPMF), posterior thigh flexibility (PTF), and range of motion of hip extension in runners with PFPS. Design : This is a randomized controlled trial. Setting: Human performance laboratory. Participants: A total of 82 runners with PFPS participated in this study. Interventions: The participants were randomized into 3 groups: OMT, EP, and control group. The OMT group received joint manipulation and myofascial release in the lumbar spine, hip, sacroiliac joint, knee, and ankle regions. The EP group performed specific exercises for lower limbs. The control group received no intervention. Main Outcome Measures: The main evaluations were pain through the visual analog scale, functionality through the Lysholm Knee Scoring Scale, dynamic knee valgus through the step-down test, PPMF through static baropodometry, PTF through the sit and reach test, and range of motion through fleximetry. The evaluations were performed before the interventions, after the 6 interventions, and at 30-day follow-up. Results: There was a significant pain decrease in the OMT and EP groups when compared with the control group. OMT group showed increased functionality, decreased PPMF, and increased PTF. The range of motion for hip extension increased only in the EP group. Conclusion: Both OMT and EP are effective in treating runners with PFPS.
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NewsBot · Jan 12, 2021

Effect of photobiomodulation in the patellofemoral pain syndrome; Randomized Clinical Trial in Young Women
Bruna Lehmkuhl Pocai et al
January 11, 2021

Objective
patellofemoral pain syndrome (PFPS) is one of the most frequent musculoskeletal disorders in the knee joint, affecting mainly physically active adolescents and young adults; its main symptom is pain. Physiotherapy has several therapeutic modalities aimed at pain relief, among which are photobiomodulation (PBM). The aim of the study was to analyze the effects of using PBM in cluster form (Laser+LED) in patients with PFPS.
Patients and Methods
This study is characterized as quantitative, experimental, randomized, composed of 30 women with PFPS, randomized into two groups: Control Group (CG) and PBM Group (PBMG). Both groups underwent three evaluations: pre-intervention, post-intervention, and after one month of follow-up. Participants of the PBMG were presented to the application of the cluster device, three times a week, for four weeks. The intensity of spontaneous pain and movement were evaluated, knee function tests and function questionnaires. The results showed a reduction in pain only for the landing of the jump. As for the other variables there was no interaction of factors; the questionnaires used showed larger effect sizes for PBMG when compared to CG. It is possible to conclude that the use of PBM showed benefit in reducing pain at the time of landing of the jump and functional assessment questionnaires.
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NewsBot · Jan 27, 2021

Selective Atrophy of the Vastus Medialis: Does It Exist in Women With Nontraumatic Patellofemoral Pain?
Kai-Yu Ho, PhD, PT, Yu-Jen Chen, PhD, PT, Shawn Farrokhi, PhD, DPT, ...
January 26, 2021

Background:
A commonly cited theory related to the pathomechanics of patellofemoral pain (PFP) states that atrophy of the vastus medialis (VM) muscle leads to lateral tracking of the patella. However, isolated atrophy of the VM or atrophy of the quadriceps muscle group as a whole, has not been consistently reported in this population.

Purpose:
To compare individual and total quadriceps muscle volumes between women with nontraumatic PFP and women without PFP as measured on magnetic resonance imaging scans.

Study Design:
Cross-sectional study; Level of evidence, 3.

Methods:
A total of 52 women with nontraumatic PFP and 64 women without PFP between the ages of 18 and 45 years participated. Magnetic resonance imaging scans of the thigh were obtained from the anterior inferior iliac spine to the tibial plateau. Individual quadriceps muscle cross-sectional area measurements were obtained from each image, and muscle volumes for the VM, vastus lateralis, vastus intermedius, and rectus femoris were calculated. Muscle volume measurements were expressed in absolute values and normalized to body mass. Separate 2-way mixed-factorial analysis of variance (group × muscle) were used to compare absolute and normalized individual muscle volumes between groups. Independent t tests were used to compare absolute and normalized total quadriceps volumes between groups.

Results:
There was no difference in absolute and normalized individual muscle volumes between individuals with and those without PFP. Additionally, absolute and normalized total muscle volumes did not differ between groups.

Conclusion:
Our findings do not support the concept of preferential atrophy of the VM or generalized quadriceps atrophy in women with nontraumatic PFP.
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NewsBot · Feb 22, 2021

Additional effects of core stability
exercises on pain and function of
patients with patellofemoral pain:
A randomized controlled trial
Behnaz Tazesh et al
Journal of Orthopaedics, Trauma and Rehabilitation XX(X)

Background/purpose: Recently, there is more emphasis on the role of core muscles in pathogenesis and rehabilitation
of patellofemoral pain (PFP). We aimed to investigate whether increased core muscle strength and endurance improve
clinical outcomes. Methods: In a randomized controlled trial, 60 patients (M/F: 25/35, age ¼ 32.28 (5.9) years) with PFP
were randomly allocated into two groups of routine exercise (control) and combined core plus routine exercise
(intervention). Home exercise was scheduled at least 5 times/week for 12 weeks. We assessed the outcomes of
pain (Visual analogue scale) and function (Anterior knee pain score) before and immediately after interventions.
Results: Significant improvements were reported in both groups (P < 0.001). There were significant between-group
differences in both outcomes in favor of the intervention (Pain: 12.4, CI 95%: 7.1–17.8, P < 0.001; Function: 6.4, CI 95%:
2.2–10.5, P ¼ 0.003). Conclusion: Outcome improvements were significantly greater in intervention group. Inclusion of
core stability exercises may lead to additional benefits.
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NewsBot · Mar 22, 2021

Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis
Marinus Winters et al
British Journal of Sports Medicine 2021;55:369-377.

Objective To investigate the comparative effectiveness of all treatments for patellofemoral pain (PFP).

Design Living systematic review with network meta-analysis (NMA).

Data sources Sensitive search in seven databases, three grey literature resources and four trial registers.

Eligibility criteria Randomised controlled trials evaluating any treatment for PFP with outcomes ‘any improvement’, and pain intensity.

Data extraction Two reviewers independently extracted data and assessed risk of bias with Risk of Bias Tool V.2. We used Grading of Recommendations, Assessment, Development and Evaluation to appraise the strength of the evidence.

Primary outcome measure ‘Any improvement’ measured with a Global Rating of Change Scale.

Results Twenty-two trials (with forty-eight treatment arms) were included, of which approximately 10 (45%) were at high risk of bias for the primary outcome. Most comparisons had a low to very low strength of the evidence. All treatments were better than wait and see for any improvement at 3 months (education (OR 9.6, 95% credible interval (CrI): 2.2 to 48.8); exercise (OR 13.0, 95% CrI: 2.4 to 83.5); education+orthosis (OR 16.5, 95% CrI: 4.9 to 65.8); education+exercise+patellar taping/mobilisations (OR 25.2, 95% CrI: 5.7 to 130.3) and education+exercise+patellar taping/mobilisations+orthosis (OR 38.8, 95% CrI: 7.3 to 236.9)). Education+exercise+patellar taping/mobilisations, with (OR 4.0, 95% CrI: 1.5 to 11.8) or without orthosis (OR 2.6, 95% CrI: 1.7 to 4.2), were superior to education alone. At 12 months, education or education+any combination yielded similar improvement rates.

Summary/conclusion Education combined with a physical treatment (exercise, orthoses or patellar taping/mobilisation) is most likely to be effective at 3 months. At 12 months, education appears comparable to education with a physical treatment. There was insufficient evidence to recommend a specific type of physical treatment over another. All treatments in our NMA were superior to wait and see at 3 months, and we recommend avoiding a wait-and-see approach.
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NewsBot · May 14, 2021

Treatment of Patellofemoral Pain Syndrome with Dielectric Radiofrequency Diathermy: A Preliminary Single-Group Study with Six-Month Follow-Up
Manuel Albornoz-Cabello et al.
Medicina (Kaunas). 2021 Apr 28;57(5):429

Background and Objectives: Notwithstanding patellofemoral pain syndrome (PFPS) being one of the most common causes of pain in the front of the knee in outpatients, few studies have shown the effects of radiofrequency on knee pain and function in this population. The aim of the present study was to determine whether outpatients diagnosed with PFPS obtained improvement in pain and function after treatment by dynamic application of monopolar dielectric diathermy by emission of radiofrequency (MDR). Materials and Methods: An experimental study was conducted with 27 subjects with PFPS. Subjects were treated with 10 sessions of MDR in dynamic application. The visual analogue scale (VAS), the Kujala scale, the DN4 questionnaire, the lower extremity function scale (LEFS), the range of movement (ROM) in knee flexion and extension and the daily drug intake were measured pre- and post-intervention and at the time of the follow-up (six months). Results: Statistically significant differences were found in pain perception (VAS: F1,26 = 92.43, p < 0.000, ŋ2 = 0.78 and DN4: F1.26 = 124.15, p < 0.000, ŋ2 = 0.82), as well as improvements in functionality (LEFS: F1.26 = 72.42, p < 0.000, ŋ2 = 0.74 and Kujala: F1.26 = 40.37, p < 0.000, ŋ2 = 0.61]) and in ROM (Flexion: F1.26 = 63.15, p < 0.000, ŋ2 = 0.71). No statistically significant changes in drug intake were found. Conclusions: The present study shows that the dynamic application of MDR seems effective in reducing pain and increasing functionality and knee flexion in patients with PFPS, after a follow-up of six months
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NewsBot · Jun 17, 2021

Effects of Hip and Hip Core Muscles Strengthening Versus Knee
Muscle Strengthening for the Management of Anterior Knee Pain
LUQMAN ALI et al
P J M H S Vol. 15, NO. 2, FEBRUARY 2021

Objective: To compare the effects of hip and hip core muscles strengthening versus knee muscles strengthening
to improve pain and functional ability in patients with anterior knee pain.
Methodology: A Quasi experimental trial was conducted in Physiotherapy department of Tehsil Head Quarter
Hospital, Ahmad Pur East after taking approval from ethical review board. A sample of 30 patients was taken.
Group A was given hip and hip core muscles strengthening while Group B was treated with knee muscles
strengthening exercises. The participants were completed Anterior Knee Pain Scale (AKPS), Visual Analogue
Scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) scale at baseline and after 6 weeks with
2 5 Sessions per week. Data was analyzed by using SPSS 21.
Results: Result showed that there were 26.7 % (n=4) males and 73.3% (n=11) females in hip and core muscle
strengthening group while 33.3% (n=5) males and 66.7 % (n=10) females in knee muscle strengthening. In
Across group comparison, Visual Analogue Scale showed significant difference for pain score at 6 weeks while
Anterior Knee Pain Scale showed no significant difference across the group comparison as P value greater than
0.05.
Conclusion: Hip and hip core muscle strengthening exercises are more effective than knee strengthening
exercises to manage anterior knee pain and function.
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NewsBot · Jun 29, 2021

REPORT-PFP: a consensus from the International Patellofemoral Research Network to improve REPORTing of quantitative PatelloFemoral Pain studies
Christian J Barton et al
British Journal of Sports Medicine Published Online First: 14 June 2021

Patellofemoral pain is a common and often debilitating musculoskeletal condition. Clinical translation and evidence synthesis of patellofemoral pain research are compromised by heterogenous and often inadequately reported study details. This consensus statement and associated checklist provides standards for REPORTing of quantitative PatelloFemoral Pain (REPORT-PFP) research to enhance clinical translation and evidence synthesis, and support clinician engagement with research and data collection. A three-stage Delphi process was initiated at the 2015 International Patellofemoral Research Network (iPFRN) retreat. An initial e-Delphi activity (n=24) generated topics and items, which were refined at the 2017 iPFRN retreat, and voted on prior to and following the 2019 iPFRN retreat (n=51 current and past retreat participants). Voting criteria included ‘strongly recommended’ (essential), ‘recommended’ (encouraged) and uncertain/unsure. An item was included in the checklist if ≥70% respondents voted ‘recommended’. Items receiving ≥70% votes for ‘strongly recommended’ were labelled as such. The final REPORT-PFP checklist includes 31 items (11 strongly recommended, 20 recommended), covering (i) demographics (n=2,4); (ii) baseline symptoms and previous treatments (n=3,7); (iii) outcome measures (2,4); (iv) outcomes measure description (n=1,2); (v) clinical trial methodology (0,3) and (vi) reporting study results (n=3,0). The REPORT-PFP checklist is ready to be used by researchers and clinicians. Strong stakeholder engagement from clinical academics during development means consistent application by the international patellofemoral pain research community is likely. Checklist adherence will improve research accessibility for clinicians and enhance future evidence synthesis.
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NewsBot · Jul 13, 2021

How effective is an evidence-based exercise intervention in individuals with patellofemoral pain?
HenrikeGreaves et al
Physical Therapy in Sport 13 July 2021

Highlights
•Individuals with PFP showed improved function, reduced kinesiophobia and reduced quadriceps muscle inhibition after the 6-week exercise intervention programme.
•Quadriceps strength did not improve in individuals with PFP in this study. The recruited participants with PFP in this study appeared to be stronger than described in previous literature. These findings indicate that stronger individuals with PFP might require an amended strength training.
•Individuals with PFP did not show differences in lower limb biomechanics during running after the 6-week exercise intervention programme.
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Objectives
Guidelines for a comprehensive rehabilitation programme for patellofemoral pain (PFP) have been developed by international experts. The aim of this study was to analyse the effect of such a rehabilitative exercise programme on pain, function, kinesiophobia, running biomechanics, quadriceps strength and quadriceps muscle inhibition in individuals with PFP.

Design
Observational study.

Setting
Clinical environment.

Participants
Twenty-seven participants with PFP.

Main outcome measures
Symptoms [numeric pain rating scale (NPRS)and the pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS)], function measured by using the KUJALA scale and KOOS, kinesiophobia measured by using the Tampa scale, three-dimensional biomechanical running data, quadriceps isometric, concentric and eccentric strength and arthrogenic muscle inhibition (AMI) were acquired before and after the six-week exercise programme.

Results
Although pain did not significantly improve all patients were pain-free after the six-week exercise programme (NPRS: p = 0.074). Function, kinesiophobia and quadriceps AMI improved significantly after the six-week exercise programme (KUJALA: p = 0.001, KOOS: p = 0.0001, Tampa: p = 0.017, AMI: p = 0.018). Running biomechanics during stance phase did not change after the exercise intervention. Quadriceps strength was not different after the six-week exercise programme (isometric: p = 0.992, concentric: p = 0.075, eccentric: p = 0.351).

Conclusion
The results of this study demonstrate that the current exercise recommendations can improve function and kinesiophobia and reduce pain and AMI in individuals with PFP. There is a need for reconsideration of the current exercise guidelines in stronger individuals with PFP.
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NewsBot · Dec 5, 2021

How Do Hip Exercises Improve Pain in Individuals With Patellofemoral Pain? Secondary Mediation Analysis of Strength and Psychological Factors as Mechanisms
Journal of Orthopaedic & Sports Physical Therapy November 30, 2021

Objective
To determine whether the effect of hip exercise on patellofemoral pain is mediated through changes in hip muscle strength or psychological factors.

Design
Secondary mediation analysis of a randomized clinical trial, in which 218 participants with patellofemoral pain were randomly assigned to receive foot orthoses or hip exercises.

Methods
Pain (Knee injury and Osteoarthritis Outcome Score pain subscale) and number of pain-free squats at 12 weeks were the outcomes for this mediation analysis, as they are pathognomonic of patellofemoral pain. Hip strength dynamometry (abduction, adduction, and external rotation) and psychological characteristics (pain catastrophizing, kinesiophobia, and anxiety) measured at 6 weeks were considered as potential mediators. We used mediation analysis to decompose the total effect of treatment on the outcome into (1) the “indirect effect” (ie, the portion acting through the mediator) and (2) the “direct effect.”

Results
The effect of hip exercise on pain and squats was not mediated by any of the strength or psychological mediators analyzed. All indirect effects were small and showed wide 95% confidence intervals (CIs) that contained zero (eg, for pain-free squats: abduction strength, −0.13; 95% CI: −0.49, 0.23; Tampa Scale of Kinesiophobia, −0.17; 95% CI: −0.64, 0.30).

Conclusion
Hip strength improved after hip exercise, yet strength did not mediate improvements in pain and pain-free squats, and alternative psychological mediators were not implicated.
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NewsBot · Dec 24, 2021

Assessing biomechanics and associated factors in individuals with patellofemoral pain in a clinical setting: A qualitative study based on interviews with expert clinicians
DominiqueLeibbrandtQuinetteLouw
The Knee Volume 34, January 2022, Pages 178-186

Objectives
To explore the perspectives of ten clinicians from different medical disciplines with experience in managing PFP on how to conduct biomechanical assessments in individuals with PFP in a clinical setting.

Methods
An explorative qualitative design was used to explore the perspectives of ten clinicians with at least five years of experience managing patients with patellofemoral pain. A series of semi-structured interviews were done over Zoom video chat. The participants were from six different medical disciplines (physiotherapy, biokinetics, podiatry, sport science, sports medicine, orthopaedic surgery). Data was analysed thematically.

Results
Four main themes emerged from the data. These were: 1) biomechanical contributing factors that clinicians routinely screen for in patients with PFP; 2) relevant functional activities for biomechanical screening in patients with PFP; 3) conducting gait analysis assessments in a clinical setting; and 4) challenges of biomechanical assessment in patients with PFP. The clinicians expressed conflicting opinions on the usefulness of clinical gait analysis. The clinicians questioned the clinical applicability of some of the biomechanical factors identified as important in the evidence.

Conclusions
It is important for clinicians to include the biomechanical assessment of functional activities linked to pain when managing patients with PFP. However, some of the biomechanical factors identified in the evidence are too difficult to observe without 3D movement analysis equipment and should not be considered clinically relevant. Expert clinical opinion is important to provide contextual information when addressing biomechanics in individuals with PFP.
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NewsBot · Feb 16, 2022

Talonavicular joint mobilization and foot core strengthening in patellofemoral pain syndrome: a single-blind, three-armed randomized controlled trial
Hyun-Joong Kim, Juchul Cho & Seungwon Lee
BMC Musculoskeletal Disorders volume 23, Article number: 150 (2022)

Background
Patellofemoral pain syndrome (PFPS) is defined as pain around the patella while performing activities such as squats, running, and climbing steps. One of the inherent risk factors for PFPS is an excessively pronated foot posture. The aim of this study was to investigate the effect of foot intervention, talonavicular joint mobilization (TJM) and foot core strengthening (FCS), on PFPS.

Methods
Forty-eight patients with PFPS (mean age, 21.96 ± 2.34 years; BMI, 22.77 ± 2.95 kg/m2) were enrolled in the study. Participants were randomly assigned in a 1:1:1 ratio to three groups, and received 12 sessions of TJM, FCS, and blended intervention at university laboratory for 4 weeks. The primary outcomes were pain while the secondary outcomes were lower extremity function, valgus knee, foot posture, and muscle activity ratio measured at baseline, after 12 sessions, and at the 4-week follow-up.

Results
The two-way repeated-measures ANOVA revealed significant interactions in all groups (p < 0.05). TJM reduced pain more than the FCS at post-test (mean difference, − 0.938; 95% Confidence interval [CI], − 1.664 to − 0.211; p < 0.05), and blended intervention improved lower extremity function (mean difference, 6.250; 95% CI, 1.265 to 11.235; p < 0.05) and valgus knee (mean difference, − 11.019; 95% CI, − 17.007 to − 5.031; p < 0.05) more than the TJM at 4 weeks follow-up. TJM was more effective in post-test (mean difference, − 1.250; 95% CI, − 2.195 to − 0.305; p < 0.05), and TJM (mean difference, − 1.563; 95% CI, − 2.640 to − 0.485; p < 0.05) and blended intervention (mean difference, − 1.500; 95% CI, − 2.578 to − 0.422; p < 0.05) were more effective in foot posture than the FCS in 4 weeks follow-up. Blended intervention displayed greater improvement in muscle activity than the TJM (mean difference, 0.284; 95% CI, 0.069 to 0.500; p < 0.05) and the FCS (mean difference, 0.265; 95% CI, 0.050 to 0.481; p < 0.05) at 4 weeks follow-up.

Conclusions
Our study is a novel approach to the potential impact of foot interventions on patellofemoral pain. Foot intervention including TJM and FCS is effective for pain control and function improvement in individuals with PFPS.
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NewsBot · Feb 21, 2022

Clinicians' experience of the diagnosis and management of patellofemoral pain: A qualitative exploration
Amy Jessica Curran et al
Musculoskelet Sci Pract. 2022 Feb 11

Background: Patellofemoral pain (PFP) is common and has a poor long-term prognosis. There is a lack of clarity about the clinical reasoning of recognised inter-disciplinary experts in the published literature.

Objectives: To help identify best practice by exploring the clinical reasoning of a range of inter-disciplinary experts that regularly diagnose and treat PFP.

Design: Qualitative study with semi-structured interviews.

Method: Recruitment resulted in a convenience sample for semi-structured interview, which were recorded and transcribed verbatim. Data were analysed until theoretical saturation, as determined by multiple investigators.

Findings: Interviews with 19 clinical experts (15 men, 4 women; mean experience 18.6 years ± 8.6) from four broad professions yielded four themes. Firstly, the assessment and diagnosis process should include a thorough history and examination to rule in PFP. Secondly, information provision should aim to increase patients' understanding, aid in controlling symptoms, and facilitate behaviour change. Thirdly, active rehabilitation, which was a salient theme and included advocacy of combined hip and knee exercise that is adapted to the individual. Finally, treatment adjuncts, which can be used selectively to modify symptoms, may include running retraining, taping, or foot orthoses.

Conclusions: PFP should be diagnosed clinically, and tailored treatment programmes should be prescribed for people with PFP. Exercise was considered the most effective treatment and underlying psychological factors should be addressed to improve prognosis.
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scotfoot · Mar 17, 2022

Increasingly weakness of the intrinsic foot muscles looks like being one of the key factors in causing PFP .

Three papers have been published recently on or around the subject .
One of these one found that foot strengthening could help alleviate the symptoms of PFP , another (a) found that people with PFP have smaller abductor hallucis muscles than those without ( p < 0.001 ), large effect size , and Taddei et al 2020, found that foot strengthening reduced running injuries by half ( mostly knee and hamstring injuries ) .

Who's job is it to identify foot muscle weaknesses and correct these weaknesses and any associated MSK problems ?

(a)https://pubmed.ncbi.nlm.nih.gov/35085911/#:~:text=PMID: 35085911-,DOI: 10.1016/j.ptsp.2022.01.002,-

NewsBot · Sep 24, 2022

Strategies to prevent and manage running-related knee injuries: a systematic review of randomised controlled trials
James L N Alexander et al
British Journal of Sports Medicine Published Online First: 23 September 2022

Objective To evaluate the effectiveness of interventions to prevent and manage knee injuries in runners.

Design Systematic review and meta-analysis.

Data sources MEDLINE, EMBASE, CINAHL, Web of Science and SPORTDiscus up to May 2022.

Eligibility criteria for selecting studies Randomised controlled trials (RCTs) with a primary aim of evaluating the effectiveness of intervention(s) to prevent or manage running-related knee injury.

Results Thirty RCTs (18 prevention, 12 management) analysed multiple interventions in novice and recreational running populations. Low-certainty evidence (one trial, 320 participants) indicated that running technique retraining (to land softer) reduced the risk of knee injury compared with control treadmill running (risk ratio (RR) 0.32, 95% CI 0.16 to 0.63). Very low-certainty to low-certainty evidence from 17 other prevention trials (participant range: 24 –3287) indicated that various footwear options, multicomponent exercise therapy, graduated running programmes and online and in person injury prevention education programmes did not influence knee injury risk (RR range: 0.55–1.06). In runners with patellofemoral pain, very low-certainty to low-certainty evidence indicated that running technique retraining strategies, medial-wedged foot orthoses, multicomponent exercise therapy and osteopathic manipulation can reduce knee pain in the short-term (standardised mean difference range: −4.96 to −0.90).

Conclusion There is low-certainty evidence that running technique retraining to land softer may reduce knee injury risk by two-thirds. Very low-certainty to low-certainty evidence suggests that running-related patellofemoral pain may be effectively managed through a variety of active (eg, running technique retraining, multicomponent exercise therapy) and passive interventions (eg, foot orthoses, osteopathic manipulation).
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NewsBot · Dec 12, 2022

Is Postural Control Affected in People with Patellofemoral Pain and Should it be Part of Rehabilitation? A Systematic Review with Meta-analysis
Guilherme S. Nunes, Diênifer Zilmer Rodrigues, Luiza Hörbe, Izabela Prates, Bruna M. Tessarin, Fábio V. Serrão & Marcos de Noronha
Sports Medicine - Open volume 8, Article number: 144 (2022)

Background
Growing evidence supports that exercise therapy is effective for patellofemoral pain (PFP) rehabilitation. Nevertheless, the improvements have been reported not to be sustained in the long term, suggesting that the current protocols may not comprehend all required functional factors to provide a consistent recovery. A potential neglected factor in treatment protocols for PFP is postural control. However, it is unclear whether this population presents balance impairments or the influence of postural control on pain and function during rehabilitation programmes.

Objective
To investigate whether (Q1) balance is impaired in people with PFP compared to controls, (Q2) conservative interventions are effective to improve balance in people with PFP, and (Q3) balance exercises are effective to improve pain and function in people with PFP.

Data sources
Medline, Embase, CINAHL, SPORTDiscus, Web of Science and Cochrane Library, supplemented by hand searching of reference lists, citations and relevant systematic reviews in the field.

Methods
A systematic review with meta-analysis was conducted according to the Cochrane recommendations and reported according to the PRISMA statement recommendations. We included cross-sectional studies comparing balance between people with and without PFP; and randomised controlled trials verifying the effect of conservative intervention on balance and the effect of balance intervention on pain and function in people with PFP. The risk of bias was assessed using the Epidemiological Appraisal Instrument for cross-sectional studies and the Physiotherapy Evidence Database scale for randomised controlled trials.

Results
From 15,436 records, 57 studies (Q1 = 28, Q2 = 23, Q3 = 14) met the eligibility criteria. Meta-analyses indicated that people with PFP have worse anteroposterior (very low grade evidence, standardised mean difference [SMD] = 1.03, 95% CI 0.40–1.66) and mediolateral (moderate grade evidence, SMD = 0.87, 95% CI 0.31–1.42) balance compared to controls. Moderate grade evidence indicated that overall balance is not affected in people with PFP (SMD = 0.38, 95% CI − 0.05–0.82). Low to very low grade evidence indicates that interventions are ineffective for mediolateral (SMD = 0.01, 95% CI − 0.51–0.53) and overall (SMD = 0.49, 95% CI − 0.14–1.11) balance improvements, and low grade evidence indicates that interventions are effective to improve anteroposterior balance (SMD = 0.64, 95% CI 0.04–1.23). Moderate to low grade evidence indicated that balance interventions are effective to reduce pain (SMD = 0.82, 95% CI 0.26–1.38) and improve function (SMD = 0.44, 95% CI 0.09–0.80) when measured using questionnaires; and very low grade evidence indicated no efficacy for function measured via functional tests (SMD = 0.73, 95% CI − 0.16–1.61).

Conclusion
People with PFP likely present balance deficits compared to asymptomatic people. There was insufficient evidence to support the efficacy of interventions to improve or modify balance in people with PFP. Also, there was insufficient evidence to support the efficacy of balance exercises to improve pain and function in people with PFP.
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NewsBot · Dec 12, 2022

Trunk Biomechanics in Individuals with Knee Disorders: A Systematic Review with Evidence Gap Map and Meta-analysis
Marina C. Waiteman, Lionel Chia, Matheus H. M. Ducatti, David M. Bazett-Jones, Evangelos Pappas, Fábio M. de Azevedo & Ronaldo V. Briani
Sports Medicine - Open volume 8, Article number: 145 (2022)

Background
The trunk is the foundation for transfer and dissipation of forces throughout the lower extremity kinetic chain. Individuals with knee disorders may employ trunk biomechanical adaptations to accommodate forces at the knee or compensate for muscle weakness. This systematic review aimed to synthesize the literature comparing trunk biomechanics between individuals with knee disorders and injury-free controls.

Methods
Five databases were searched from inception to January 2022. Observational studies comparing trunk kinematics or kinetics during weight-bearing tasks (e.g., stair negotiation, walking, running, landings) between individuals with knee disorders and controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and evidence gap maps were created.

Results
A total of 81 studies investigating trunk biomechanics across six different knee disorders were included (i.e., knee osteoarthritis [OA], total knee arthroplasty [TKA], patellofemoral pain [PFP], patellar tendinopathy [PT], anterior cruciate ligament deficiency [ACLD], and anterior cruciate ligament reconstruction [ACLR]). Individuals with knee OA presented greater trunk flexion during squatting (SMD 0.88, 95% CI 0.58–1.18) and stepping tasks (SMD 0.56, 95% CI 0.13–.99); ipsilateral and contralateral trunk lean during walking (SMD 1.36; 95% CI 0.60–2.11) and sit-to-stand (SMD 1.49; 95% CI 0.90–2.08), respectively. Greater trunk flexion during landing tasks in individuals with PFP (SMD 0.56; 95% CI 0.01–1.12) or ACLR (SMD 0.48; 95% CI 0.21–.75) and greater ipsilateral trunk lean during single-leg squat in individuals with PFP (SMD 1.01; 95% CI 0.33–1.70) were also identified. No alterations in trunk kinematics of individuals with TKA were identified. Evidence gap maps outlined the lack of investigations for individuals with PT or ACLD, as well as for trunk kinetics across knee disorders.

Conclusion
Individuals with knee OA, PFP, or ACLR present with altered trunk kinematics in the sagittal and frontal planes. The findings of this review support the assessment of trunk biomechanics in these individuals in order to identify possible targets for rehabilitation and avoidance strategies.
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NewsBot · Jul 8, 2024

Are adjunct treatments effective in improving pain and function when added to exercise therapy in people with patellofemoral pain? A systematic review with meta-analysis and appraisal of the quality of interventions
Larissa Rodrigues Souto et al
Br J Sports Med. 2024 Jul 1;58(14):792-804.

Objective: To compare the effectiveness of adjunct treatments combined with exercise to exercise alone in people with patellofemoral pain (PFP) and explore the quality of intervention descriptions in randomised controlled trials (RCTs).

Design: Systematic review.

Data sources: Seven databases were searched in November 2023.

Eligibility: RCTs that evaluated the effectiveness of any adjunct treatment combined with exercise to exercise alone on self-reported pain and function in people with PFP.

Results: We included 45 RCTs (2023 participants), with 25 RCTs (1050 participants) contributing to meta-analyses. Pooled analysis indicated very low-certainty evidence that neuromuscular electrical stimulation or monopolar dielectric diathermy combined with exercise leads to small and large improvements in self-reported pain when compared with exercise alone (standardised mean difference (95% CI)=-0.27 (-0.53 to -0.02) and -2.58 (-4.59 to -0.57), respectively) in the short-term. For self-reported pain and function, very low-certainty evidence indicates that knee taping, whole-body vibration, electromyographic biofeedback and knee brace combined with exercise do not differ from exercise alone. Interventions are poorly described in most RCTs, adjunct treatments scored on average 14/24 and exercise therapy 12/24 in the Template for Intervention Description and Replication checklist.

Conclusion: Neuromuscular electrical stimulation and monopolar dielectric diathermy combined with exercise seem to improve self-reported pain in people with PFP compared with exercise alone. Knee taping, whole-body vibration, electromyographic biofeedback and knee brace do not offer additional benefits to exercise alone. Most interventions are poorly described, which is detrimental to translating research knowledge into clinical practice.
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NewsBot · Oct 14, 2024

Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning
Bradley Stephen Neal et al
Source

Objective Define a best practice guide for managing people with patellofemoral pain (PFP).

Methods A mixed-methods convergent segregated synthesis of meta-analysed data with a thematic analysis of semistructured interviews and focus groups. Agreement between subproject results informed the strength of clinical recommendation for interventions eligible for best practice recommendation.

Data sources Medline, Web of Science, Scopus, reference lists and citation tracking; semistructured interviews of people with PFP; and semistructured interviews and focus groups with clinical experts.

Eligibility criteria High-quality (PEDro scale >7) randomised controlled trials (RCTs) were retained for efficacy estimation using meta-analysis. People with PFP were required to have experienced an episode of care in the past 6 months and clinical experts were required to have>5 years of clinical experience alongside direct involvement in research.

Results Data from 65 high-quality RCTs involving 3796 participants informed 11 meta-analyses of interventions. Interviews with 12 people with PFP led to 3 themes and interviews with 19 clinical experts led to 4 themes. These were further explored in three clinical expert focus groups. Best practice for PFP should first involve understanding a patient’s background risk factors, their reasons for seeking care, greatest symptoms, and physical impairments, to inform treatment selection. Synthesis led to six distinct interventions being recommended. Knee-targeted±hip-targeted exercise therapy underpinned by education should be delivered, with additional supporting interventions such as prefabricated foot orthoses, manual therapy, movement/running retraining, or taping decided on and tailored to a patient’s needs and preferences.

Conclusion A best practice guide based on a synthesis of three data streams recommends that exercise therapy and education be delivered as the primary intervention for people with PFP. Prescription of other supporting interventions should be aligned with the individual patient’s particular presentation following a thorough assessment.
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scotfoot · Oct 15, 2024

NewsBot said: ↑

Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning
Bradley Stephen Neal et al
Click to expand...

Effect of adding short foot exercise to hip and knee focused exercises in treatment of patients with patellofemoral pain syndrome: a randomized controlled trial

Abdallah Mohamed kamel,

Karim Ghuiba,

Dina S Abd Allah,

Nadia Abdelazem Fayaz &

Nasr Awad Abdelkader

Journal of Orthopaedic Surgery and Research volume 19, Article number: 207 (2024) Cite this article

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Abstract

Background

Patellofemoral pain syndrome is considered a common cause of anterior knee pain that could disturb function and limit daily activities. The purpose of the study was to investigate the effect of adding short foot exercise on pain, function, balance, and hip abductors, and quadriceps muscles strength in the treatment of patients with patellofemoral pain syndrome.
Methods

Twenty-eight male and female patients with patellofemoral pain syndrome with age ranged from 18 to 35 years old participated in this study. They were equally and randomly assigned into two groups; the study group which received short foot exercise in addition to hip and knee exercises (n = 14) and thecontrol group which received hip and knee exercises only (n = 14). Participants received their interventions during 6 consecutive weeks (12 sessions). Pain intensity, function, abductors quadriceps muscle strength, and balance were assessed using the Visual Analog Scale, anterior knee pain scale (AKPS), hand-held dynamometer, and the Biodex Balance System respectively. All measurements were taken before and after 6 weeks of intervention in both groups. Multivariate analysis of variance was performed to compare the within and between groups effects for measured variables.
Results

The within-group comparison showed significant improvement in pain severity, function, balance, and hip abductors, and quadriceps muscles strength in both groups post-treatment compared with pre-treatment. Between groups analysis, however, showed no significant statistical difference between both groups in all variables, except in pain, function, and mediolateral stability which showed better improvement compared to the control group.
Conclusions

Adding short foot exercise to hip and knee exercises improved pain, function, and mediolateral stability in patients with patellofemoral pain syndrome.

scotfoot · Oct 16, 2024

NewsBot said: ↑

Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning
Click to expand...

Randomized Controlled Trial
J Back Musculoskelet Rehabil. 2021;34(6):1093-1104.
doi: 10.3233/BMR-200255.
Short foot exercises have additional effects on knee pain, foot biomechanics, and lower extremity muscle strength in patients with patellofemoral pain

Pınar Kısacık 1, Volga Bayrakcı Tunay 1, Nilgün Bek 2, Özgür Ahmet Atay 3, James Selfe 4, Aynur Ayşe Karaduman 2
Affiliations Expand

PMID: 34024814

DOI: 10.3233/BMR-200255

Abstract

Background: Patellofemoral pain (PFP) is a common knee problem. The foot posture in a relaxed stance is reported as a distal factor of PFP. However, the effects of short foot exercise (SFE) on the knee and functional factors have not yet been investigated in patients with PFP.
Objective: This study aimed to investigate the additional effects of SFE on knee pain, foot biomechanics, and lower extremity muscle strength in patients with PFP following a standard exercise program.
Methods: Thirty patients with a 'weak and pronated' foot subgroup of PFP were randomized into a control group (ConG, n= 15) and a short foot exercise group (SFEG, n= 15) with concealed allocation and blinded to the group assignment. The program of ConG consisted of hip and knee strengthening and stretching exercises. SFEG program consisted of additional SFE. Both groups performed the supervised training protocol two times per week for 6 weeks. Assessment measures were pain visual analog scale (pVAS), Kujala Patellofemoral Score (KPS), navicular drop test (NDT), rearfoot angle (RA), foot posture index (FPI), and strength tests of the lower extremity muscles.
Results: Both groups displayed decreases in pVAS scores, but it was only significant in favor of SFEG. NDT, RA, and FPI scores decreased in SFEG whereas they increased in ConG. There was a significant group-by-time interaction effect in hip extensor strength and between-group difference was found to be significantly in favor of SFEG.
Conclusions: An intervention program consisting of additional SFE had positive effects on knee pain, navicular position, and rearfoot posture. An increase in the strength of the hip extensors may also be associated with improved stabilization by SFE.

scotfoot · Oct 17, 2024

NewsBot said: ↑

Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning
Bradley Stephen Neal et al
Click to expand...

PEDro score 8/10, which is an indication of high quality. But no mention of foot strengthening in final recommendations of study that I can see . I wonder what the experts problem was? ( I can only see the abstract of Neal et al )

Effect of adding short foot exercise to hip and knee focused exercises in treatment of patients with patellofemoral pain syndrome: a randomized controlled trial
Kamel AM, Ghuiba K, Abd Allah DS, Fayaz NA, Abdelkader NA
Journal of Orthopaedic Surgery and Research 2024 Apr 1;19(207):Epub
clinical trial
8/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: Yes; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*
BACKGROUND: Patellofemoral pain syndrome is considered a common cause of anterior knee pain that could disturb function and limit daily activities. The purpose of the study was to investigate the effect of adding short foot exercise on pain, function, balance, and hip abductors, and quadriceps muscles strength in the treatment of patients with patellofemoral pain syndrome. METHODS: Twenty-eight male and female patients with patellofemoral pain syndrome with age ranged from 18 to 35 years old participated in this study. They were equally and randomly assigned into two groups; the study group which received short foot exercise in addition to hip and knee exercises (n = 14) and thecontrol group which received hip and knee exercises only (n = 14). Participants received their interventions during 6 consecutive weeks (12 sessions). Pain intensity, function, abductors quadriceps muscle strength, and balance were assessed using the Visual Analog Scale, anterior knee pain scale (AKPS), hand-held dynamometer, and the Biodex Balance System respectively. All measurements were taken before and after 6 weeks of intervention in both groups. Multivariate analysis of variance was performed to compare the within and between groups effects for measured variables. RESULTS: The within-group comparison showed significant improvement in pain severity, function, balance, and hip abductors, and quadriceps muscles strength in both groups post-treatment compared with pre-treatment. Between groups analysis, however, showed no significant statistical difference between both groups in all variables, except in pain, function, and mediolateral stability which showed better improvement compared to the control group. CONCLUSIONS: Adding short foot exercise to hip and knee exercises improved pain, function, and mediolateral stability in patients with patellofemoral pain syndrome. TRIAL REGISTRATION: clinicaltrials.gov. NO: NCT05383781.

scotfoot · Oct 20, 2024

NewsBot said: ↑

Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning
Bradley Stephen Neal et al
Source
Click to expand...

Ah, Kamel et al was published after the authors stopped looking for evidence. I wouldn't be surprised if some of the experts involved in this study do now use foot strengthening exercise to help treat PFP in many of their patients.
Perhaps a new best practice guide in already warranted.

From Neal et al.

"We searched MEDLINE, Web of Science, and Scopus from inception to May 2022, with the English language and human participants as limitations and conducted a citing reference search in Google Scholar. We used the following eligibility criteria, again from Barton et al11: (1) randomised controlled trials (RCTs) involving participants with PFP and (2) RCTs investigating non-surgical interventions. Two independent authors (BSN and CB) applied the PEDro scale27 to all identified RCTs to determine methodological quality, with consensus scores of >7 reflecting high quality.28 These trials were retained for data synthesis."

NewsBot · Nov 11, 2024

Consensus methods in patellofemoral pain: how rigorous are they? A scoping review
Paul Blazey et al
Source

Objective Clinicians treating patients with patellofemoral pain (PFP) rely on consensus statements to make the best practice recommendations in the absence of definitive evidence on how to manage PFP. However, the methods used to generate and assess agreement for these recommendations have not been examined. Our objective was to map the methods used to generate consensus-based recommendations for PFP and apply four novel questions to assess the rigour of consensus development.

Design Scoping review.

Data sources We searched Medline, SPORTDiscus, CINAHL and Embase from inception to May 2022 to identify consensus-derived statements or practice guidelines on PFP. The Joanna Briggs Institute Manual for Evidence Synthesis was followed to map the existing evidence. We measured the consensus methods based on four sets of questions addressing the panel composition, application of the consensus method chosen, agreement process and the use of evidence mapping.

Eligibility criteria All consensus statements or clinical guidelines on PFP were considered.

Results Twenty-two PFP consensus statements were identified. Panel composition: 3 of the 22 (14%) consensus groups reported the panellists’ experience, 2 (9%) defined a desired level of expertise, 10 (45%) reported panellist sex and only 2 (9%) included a patient. Consensus method: 7 of 22 (32%) reported using an established method of consensus measurement/development. Agreement process: 10 of 22 (45%) reported their consensus threshold and 2 (9%) acknowledged dissenting opinions among the panel. Evidence mapping: 6 of 22 (27%) reported using systematic methods to identify relevant evidence gaps.

Conclusions PFP consensus panels have lacked diversity and excluded key partners including patients. Consensus statements on PFP frequently fail to use recognised consensus methods, rarely describe how ‘agreement’ was defined or measured and often neglect to use systematic methods to identify evidence gaps.
Click to expand...

scotfoot · Nov 12, 2024

From Blazey et al
"Conclusions PFP consensus panels have lacked diversity and excluded key partners including patients. Consensus statements on PFP frequently fail to use recognised consensus methods, rarely describe how ‘agreement’ was defined or measured and often neglect to use systematic methods to identify evidence gaps."

Yip, watch out for unintentional bias caused by groups of pals or like minded individuals getting together to produce consensus papers/reviews.
For example, lots of people associate with the same institution etc.

Management of Patellofemoral Pain Syndrome

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Pranic Healing for Diabetic Foot Ulcer Management

Laterally deviated foot types; 1st & 5th MPJ ulcerations - explanation & management

mHealth application for the management of people with diabetes and recently healed foot ulceration

Management of diabetic ulcers of the dorsum of the foot

Homoeopathic management for hyperhidrosis

Purified reconstituted bilayer matrix in the management of chronic diabetic foot ulcers

Healthy Footsteps - a supported self management programme

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