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Eckenrode BJ, Kietrys DM, Brown A, Parrott JS, Noehren B. Effects of high frequency strengthening on pain sensitivity and function in female runners with chronic patellofemoral pain. Phys Ther Sport 2024; 67:31-40. [PMID: 38471409 DOI: 10.1016/j.ptsp.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To investigate the effects of a high frequency strengthening program on function, pain, and pain sensitization in female runners with chronic patellofemoral pain (PFP). DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Thirty female runners (mean age 32 ± 8.1 years) with chronic PFP completed an 8-week home strengthening program. MAIN OUTCOME MEASURES Variables assessed at baseline, 8-weeks, and 12 weeks included single leg step down test (SLSD), pain, Anterior Knee Pain Scale (AKPS), University of Wisconsin Running Injury and Recovery Index (UWRI), and quantitative sensory testing. RESULTS There was large and statistically significant improvement at 8 and 12 weeks for average knee pain (ηp2 = 0.334, p < 0.001), worst knee pain (ηp2 = 0.351, p < 0.001), SLSD (ηp2 = 0.161, p = 0.001), AKPS (ηp2 = 0.463, p < 0.001), and UWRI (ηp2 = 0.366, p < 0.001). A medium to large effect and statistically significant improvement in pressure pain threshold testing was found for all local and remote structures (ηp2 range, 0.110 to 0.293, range p < 0.001 to p = 0.009) at 8 and 12 weeks. CONCLUSIONS There was a significant decrease in local and remote hyperalgesia via mechanical and thermal pain sensitivity testing in female runners with chronic PFP. There was a large effect and significant improvement in self-reported pain and function.
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Affiliation(s)
- Brian J Eckenrode
- Arcadia University, Department of Physical Therapy, Glenside, PA, 19038, USA.
| | - David M Kietrys
- Rutgers School of Health Professions, Department of Rehabilitation and Movement Sciences, Blackwood, NJ, 08012, USA
| | - Allison Brown
- Rutgers School of Health Professions, Department of Rehabilitation and Movement Sciences Newark, NJ, 07101, USA
| | - J Scott Parrott
- Rutgers School of Health Professions, Department of Interdisciplinary Studies, Blackwood, NJ, 08012, USA
| | - Brian Noehren
- University of Kentucky, Department of Physical Therapy, Lexington, KY, 40536, USA
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Hong QM, Wang HN, Liu XH, Zhou WQ, Zhang X, Luo XB. Home-based exercise program and Health education in patients with patellofemoral pain: a randomized controlled trial. BMC Musculoskelet Disord 2023; 24:896. [PMID: 37980477 PMCID: PMC10657019 DOI: 10.1186/s12891-023-07027-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is one of the most common disorders of the knee joint. Home-based exercise is an effective intervention to achieve self-management for chronic diseases. This study evaluated the effects of home-based exercise and health education in patients with PFP. METHODS Patients who had PFP were randomly allocated to an intervention group (IG) or control group (CG). Patients in the IG received a 6-week tailored home-based exercise program with health education via remote support, while patients in the CG group only received health education. Clinical outcomes were compared using the Anterior Knee Pain Scale (AKPS) to measure function and the Visual Analog Scale (VAS) to measure "worst pain" and "pain with daily activity". Muscle strength was measured according to the peak torque of the knee muscles using an isokinetic system. RESULTS Among a total of 112 participants screened for eligibility, 38 were randomized and analyzed, including 19 participants in the intervention group and 19 participants in the control group. There were no significant differences in baseline characteristics between the groups. At 6-week follow-up, the intervention group showed a greater worst pain reduction (between-group difference, -19.3 [95%CI, -23.2 to -15.5]; P < 0.01) and pain with daily activity (between-group difference, -22.9 [95%CI, -28.3 to -17.4]; P < 0.01) than the control group. Similarly, the intervention group had better improvements in AKPS (between-group difference, 9.0 [95%CI, 4.1 to 13.9]; P < 0.01) and knee extensor strength (between-group difference, 20.1 [95%CI, 14.5 to 25.8]; P < 0.01), compared to the control group. No adverse events were reported. CONCLUSION Home-based exercise and health education resulted in less pain, better function, and higher knee muscle strength compared with no exercise in patients with PFP. A large randomized controlled trial with long-term follow-up is required to confirm these findings. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2200056224 ( https://www.chictr.org.cn/showproj.aspx?proj=135506 ). Registered on February 1, 2022.
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Affiliation(s)
- Qiao-Mei Hong
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Hao-Nan Wang
- Faculty of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Xi-Hui Liu
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Wen-Qi Zhou
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Xiao Zhang
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Xiao-Bing Luo
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China.
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ØSTERÅS H, PAULSBERG F. The acute hypoalgesic effect of bicycling on pain for patients with knee osteoarthritis: a cohort study. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.20.04366-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zeinalzadeh A, Nazary-Moghadam S, Sayyed Hoseinian SH, Ebrahimzadeh MH, Imani E, Karimpour S. Intra- and Inter-Session Reliability of Methods for Measuring Reaction Time in Participants with and without Patellofemoral Pain Syndrome. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:102-109. [PMID: 33778122 DOI: 10.22038/abjs.2020.46213.2270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To evaluate the relative and absolute reliability of reaction time measuring methods during different conditions in participants with and without patellofemoral pain syndrome (PFPS). Methods 30 patients with PFPS and 30 healthy controls were recruited in the present study. The upper extremity reaction time, upper extremity error rate, involved and non-involved lower extremity braking reaction times, and involved and non-involved knee extension reaction times were measured. Each condition was repeated three times, 2 sessions with a 5-7 days interval. The intra-session reliability was evaluated in three-trial (A), second- and third-trial (B) modes. In addition, the inter-session reliability was evaluated in mode A, mode B, and best score (C) mode. Results The result of inter-session reliability of mode A showed that all measurements except upper extremity reaction time in PFPS group showed high to very high relative reliability (ICC: 0.74-0.94). In mode B, all measurements except non-involved knee extension reaction time in PFPS group showed high to very high relative reliability (ICC: 0.71-0.93). In mode C, all measurements showed high to very high relative reliability (ICC: 0.70-0.94) except upper extremity error rate and non-involved knee extension reaction time in PFPS group. The result of intra-session reliability showed that all measurements had high to very high relative reliability (ICC: 0.78-0.94) in mode A. In mode B, all measurements showed high to very high relative reliability (0.78-0.94). Conclusion The braking time seems more reliable than other reaction time tasks. In addition, the results showed that mode A is more reliable than other modes. The newly designed package is a reliable tool to measure the knee extension reaction time in patients with knee musculoskeletal disorders.
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Affiliation(s)
- Afsaneh Zeinalzadeh
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Salman Nazary-Moghadam
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Esmaeel Imani
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Karimpour
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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Price J, Rushton A, Tyros I, Tyros V, Heneghan NR. Effectiveness and optimal dosage of exercise training for chronic non-specific neck pain: A systematic review with a narrative synthesis. PLoS One 2020; 15:e0234511. [PMID: 32520970 PMCID: PMC7286530 DOI: 10.1371/journal.pone.0234511] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Clinical guidelines make vague recommendations as to exercise training (ET) type and dosage to manage chronic non-specific neck pain (CNSNP). OBJECTIVE To synthesise evidence on the effectiveness of different ET programmes to reduce CNSNP and associated disability, and whether dosage affects outcomes. METHODS A systematic review and data synthesis was conducted according to a published registered protocol (PROSPERO CRD42018096187). A sensitive topic-based search was conducted of CINAHL, MEDLINE, EMBASE, PEDro, grey literature sources and key journals from inception to 6th January 2020 for randomised controlled trials, investigating ET for CNSNP or disability. Two reviewers independently completed eligibility screening, data extraction, risk of bias assessment (Cochrane Risk of Bias Tool) and rated the overall strength of evidence using Grading of Recommendations Assessment, Development and Evaluation. Data was tabulated for narrative synthesis and grouped by intervention, outcome and time point to compare across studies. RESULTS Twenty-six trials from 3990 citations (n = 2288 participants) investigated fifteen ET programmes. High RoB and low sample sizes reduced evidence quality. Clinical heterogeneity prevented meta-analyses. A range of ET programmes reduce pain/disability in the short term (low to moderate evidence). Pillar exercises reduce pain/disability in the intermediate term (low level evidence). Moderate to very large pain reduction is found with ET packages that include motor control + segmental exercises (low to moderate evidence). No high-quality trials investigated long term outcomes. Increased frequency of motor control exercises and progressively increased load of pillar exercise may improve effectiveness. CONCLUSIONS Motor control + segmental exercises are the most effective ET to reduce short term pain/disability, but long-term outcomes have not been investigated. Optimal motor control + segmental exercise variables and dosage is unknown and requires clarification. An adequately powered, low RoB trial is needed to evaluate the effectiveness and optimal dosage of motor control + segmental on long term outcomes. TRIAL REGISTRATION PROSPERO CRD42018096187.
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Affiliation(s)
- Jonathan Price
- Musculoskeletal Physiotherapy Services, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, England, United Kingdom
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine) School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine) School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Isaak Tyros
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine) School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Edgbaston Physiotherapy Clinic, Birmingham, England, United Kingdom
| | - Vasileios Tyros
- Edgbaston Physiotherapy Clinic, Birmingham, England, United Kingdom
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine) School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, England, United Kingdom
- * E-mail:
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Nielsen TG, Miller LL, Mygind-Klavsen B, Lind M. A simple rehabilitation regime improves functional outcome in patients with patellafemoral pain after 12 month. J Exp Orthop 2020; 7:5. [PMID: 32034562 PMCID: PMC7007455 DOI: 10.1186/s40634-020-00223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/03/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The purpose of the present study was to investigate the effects of a 3-month multimodal intervention including patient education, a simple hip exercise program, footwear adjustment, and foot orthoses to reduce symptoms in patients with patellafemoral pain (PFP). METHODS Patients were diagnosed based on a physical examination, patient symptoms and ruled out intra-articular knee pathologies by MRI. Patients were educated on PFP and participated in a 3-month exercise program; shoes with solid heel-caps were recommended, and custom made orthoses with arch support were recommended to patients with foot pronation. The Anterior Knee Pain Scale (AKPS) and the pain numeric rating scale (NRS) were used to evaluate the outcomes of the intervention and collected at baseline, 3 and 12-months follow-ups. RESULTS Sixty-five patients (age 18 years (9-32)) were included in a consecutive prospective cohort. The AKPS score improved from 71 ± 24 to 89 ± 9 (p < 0.01) at 12 months follow up. The NRS-rest and NRS-activity improved from 3 to 0 (p < 0.01) and 7 to 3 (p < 0.01) respectively. 78% of the patients clinically improved (i.e., demonstrated a > 10-point improvement (minimal clinically important difference (MCID))) considering the AKPS; and 76% and 73% clinically improved (i.e., demonstrated (MCID) a ≥ 2-point improvement) in their NRS-rest and NRS-activity, respectively. No patients experienced a decrease in their AKPS score or an increase in their NRS-rest and NRS-activity scores at 12-months. CONCLUSION A 3-month PFP multimodal treatment strategy focusing on patient education, footwear adjustment, orthoses, and simple hip muscle exercises significantly improved functional outcomes and reduced pain at a 12 month follow-up.
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Affiliation(s)
- Torsten Grønbech Nielsen
- Orthopedic Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Lene Lindberg Miller
- Orthopedic Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Bjarne Mygind-Klavsen
- Orthopedic Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Martin Lind
- Orthopedic Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Abstract
Patellofemoral pain (PFP) is a common musculoskeletal-related condition that is characterized by insidious onset of poorly defined pain, localized to the anterior retropatellar and/or peripatellar region of the knee. The onset of symptoms can be slow or acutely develop with a worsening of pain accompanying lower-limb loading activities (eg, squatting, prolonged sitting, ascending/descending stairs, jumping, or running). Symptoms can restrict participation in physical activity, sports, and work, as well as recur and persist for years. This clinical practice guideline will allow physical therapists and other rehabilitation specialists to stay up to date with evolving PFP knowledge and practices, and help them to make evidence-based treatment decisions. J Orthop Sports Phys Ther. 2019;49(9):CPG1-CPG95. doi:10.2519/jospt.2019.0302.
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Bolgla LA, Boling MC, Mace KL, DiStefano MJ, Fithian DC, Powers CM. National Athletic Trainers' Association Position Statement: Management of Individuals With Patellofemoral Pain. J Athl Train 2018; 53:820-836. [PMID: 30372640 DOI: 10.4085/1062-6050-231-15] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE: To present recommendations for athletic trainers and other health care providers regarding the identification of risk factors for and management of individuals with patellofemoral pain (PFP). BACKGROUND: Patellofemoral pain is one of the most common knee diagnoses; however, this condition continues to be one of the most challenging to manage. Recent evidence has suggested that certain risk factors may contribute to the development of PFP. Early identification of risk factors may allow clinicians to develop and implement programs aimed at reducing the incidence of this condition. To date, clinicians have used various treatment strategies that have not necessarily benefitted all patients. Suboptimal outcomes may reflect the need to integrate clinical practice with scientific evidence to facilitate clinical decision making. RECOMMENDATIONS: The recommendations are based on the best available evidence. They are intended to give athletic trainers and other health care professionals a framework for identifying risk factors for and managing patients with PFP.
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Affiliation(s)
- Lori A Bolgla
- Department of Physical Therapy, Augusta University, GA
| | - Michelle C Boling
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville
| | | | | | | | - Christopher M Powers
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles
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Torstensen TA, Grooten WJA, Østerås H, Heijne A, Harms-Ringdahl K, Äng BO. How does exercise dose affect patients with long-term osteoarthritis of the knee? A study protocol of a randomised controlled trial in Sweden and Norway: the SWENOR Study. BMJ Open 2018; 8:e018471. [PMID: 29730615 PMCID: PMC5942416 DOI: 10.1136/bmjopen-2017-018471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Osteoarthritis (OA) of the knee is characterised by knee pain, disability and degenerative changes, and places a burden on societies all over the world. Exercise therapy is an often-used modality, but there is little evidence of what type of exercise dose is the most effective, indicating a need for controlled studies of the effect of different dosages. Thus, the aim of the study described in this protocol is to evaluate the effects of high-dose versus low-dose medical exercise therapy (MET) in patients with knee OA. METHODS AND ANALYSIS This is a multicentre prospective randomised two-arm trial with blinded assessment and data analysis. We are planning to include 200 patients aged 45-85 years with symptomatic (pain and decreased functioning) and X-ray verified diagnosis of knee OA. Those eligible for participation will be randomly allocated to either high-dose (n=100) or low-dose (n=100) MET. All patients receive three supervised treatments each week for 12 weeks, giving a total of 36 MET sessions. The high-dose group exercises for 70-90 min compared with 20-30 min for the low-dose group. The high-dose group exercises for a longer time, and receives a greater number of exercises with more repetitions and sets. Background and outcome variables are recorded at inclusion, and outcome measures are collected after every sixth treatment, at the end of treatment, and at 6-month and 12-month follow-ups. Primary outcome is self-rated knee functioning and pain using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The primary end point is at the end of treatment after 3 months, and secondary end points are at 6 months and 12 months after the end of treatment. ETHICS AND DISSEMINATION This project has been approved by the Regional Research Ethics Committees in Stockholm, Sweden, and in Norway. Our results will be submitted to peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT02024126; Pre-results.
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Affiliation(s)
- Tom Arild Torstensen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Wilhelmus J A Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Allied Health Professionals Function, Functional area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Håvard Østerås
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Annette Heijne
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Allied Health Professionals Function, Functional area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Harms-Ringdahl
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Allied Health Professionals Function, Functional area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Olov Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- School of Education, Health and Social Sciences, Dalarna University, Falun, Sweden
- Center for Clinical Research Dalarna, Falun, Sweden
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Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, Selfe J, Logan P. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med 2017; 51:1679-1687. [PMID: 28596288 PMCID: PMC5739826 DOI: 10.1136/bjsports-2016-097383] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic musculoskeletal disorders are a prevalent and costly global health issue. A new form of exercise therapy focused on loading and resistance programmes that temporarily aggravates a patient's pain has been proposed. The object of this review was to compare the effect of exercises where pain is allowed/encouraged compared with non-painful exercises on pain, function or disability in patients with chronic musculoskeletal pain within randomised controlled trials. METHODS Two authors independently selected studies and appraised risk of bias. Methodological quality was evaluated using the Cochrane risk of bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence. RESULTS The literature search identified 9081 potentially eligible studies. Nine papers (from seven trials) with 385 participants met the inclusion criteria. There was short- term significant difference in pain, with moderate quality evidence for a small effect size of -0.27 (-0.54 to -0.05) in favour of painful exercises. For pain in the medium and long term, and function and disability in the short, medium and long term, there was no significant difference. CONCLUSION Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence. In the medium and long term there is no clear superiority of one treatment over another. Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes. Further research is warranted to fully evaluate the effectiveness of loading and resistance programmes into pain for chronic musculoskeletal disorders. PROSPERO REGISTRATION CRD42016038882.
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Affiliation(s)
- Benjamin E Smith
- Department of Physiotherapy, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | | | - Marcus Bateman
- Department of Physiotherapy, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Michael S Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine at Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - James Selfe
- Manchester Metropolitan University, Manchester, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Smith BE, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Selfe J, Smith TO, Logan P. Study protocol: a mixed methods feasibility study for a loaded self-managed exercise programme for patellofemoral pain. Pilot Feasibility Stud 2017; 4:24. [PMID: 28748107 PMCID: PMC5520346 DOI: 10.1186/s40814-017-0167-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022] Open
Abstract
Background Patellofemoral pain (PFP) is one of the most common forms of knee pain in adults under the age of 40, with a prevalence of 23% in the general population. The long-term prognosis is poor, with only one third of people pain-free 1 year after diagnosis. The biomedical model of pain in relation to persistent PFP has recently been called into question. It has been suggested that interventions for chronic musculoskeletal conditions should consider alternative mechanisms of action, beyond muscles and joints. Modern treatment therapies should consider desensitising strategies, with exercises that target movements and activities patients find fearful and painful. High-quality research on exercise prescription in relation to pain mechanisms, not directed at specific tissue pathology, and dose response clearly warrants further investigation. Our primary aim is to establish the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with patellofemoral pain. Method This is a single-centred, multiphase, sequential, mixed-methods trial that will evaluate the feasibility of running a definitive large-scale randomised controlled trial of a loaded self-managed exercise programme versus usual physiotherapy. Initially, 8–10 participants with a minimum 3-month history of PFP will be recruited from an NHS physiotherapy waiting list and interviewed. Participants will be invited to discuss perceived barriers and facilitators to exercise engagement, and the meaning and impact of PFP. Then, 60 participants will be recruited in the same manner for the main phase of the feasibility trial. A web-based service will randomise patients to a loaded self-managed exercise programme or usual physiotherapy. The loaded self-managed exercise programme is aimed at addressing lower limb knee and hip weakness and is positioned within a framework of reducing fear/avoidance with an emphasis on self-management. Baseline assessment will include demographic data, average pain within the last week (VAS), fear avoidance behaviours, catastrophising, self-efficacy, sport and leisure activity participation, and general quality of life. Follow-up will be 3 and 6 months. The analysis will focus on descriptive statistics and confidence intervals. The qualitative components will follow a thematic analysis approach. Discussion This study will evaluate the feasibility of running a definitive large-scale trial on patients with patellofemoral pain, within the NHS in the UK. We will identify strengths and weaknesses of the proposed protocol and the utility and characteristics of the outcome measures. The results from this study will inform the design of a multicentre trial. Trial registration ISRCTN35272486.
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Affiliation(s)
- Benjamin E Smith
- Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department (Level 3), London Road Community Hospital, Derby, DE1 2QY UK.,Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Marcus Bateman
- Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department (Level 3), London Road Community Hospital, Derby, DE1 2QY UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine at Aalborg University, Aalborg, Denmark.,Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Smith BE, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Selfe J, Smith TO, Logan P. Current management strategies for patellofemoral pain: an online survey of 99 practising UK physiotherapists. BMC Musculoskelet Disord 2017; 18:181. [PMID: 28482879 PMCID: PMC5422884 DOI: 10.1186/s12891-017-1539-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/27/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is considered one of the commonest forms of knee pain. This study aimed to identify how physiotherapists in the United Kingdom (UK) currently manage patellofemoral pain (PFP), particularly in relation to exercise prescription, and response to pain. METHODS An anonymous survey was designed with reference to previous surveys and recent systematic reviews. Practising UK physiotherapists who treat patients with PFP were invited to take part via an invitation email sent through professional networks, the 'interactive Chartered Society of Physiotherapy (iCSP)' message board, and social media (Twitter). Descriptive statistics were used to analyse the data. RESULTS A total of 99 surveys were completed. Responders reported a wide range of management strategies, including a broad selection of type and dose of exercise prescription. The five most common management strategies chosen were: closed chain strengthening exercises (98%); education and advice (96%); open chain strengthening exercises (76%); taping (70%) and stretches (65%). Physiotherapists with a special interest in treating PFP were statistically more likely to manage patients with orthotics (P = 0.02) and bracing (P = 0.01) compared to physiotherapists without a special interest. Approximately 55% would not prescribe an exercise if it was painful. Thirty-one percent of physiotherapists would advise patients not to continue with leisure and/or sporting activity if they experienced any pain. CONCLUSION Current UK practice in the management strategies of PFP is variable. Further high quality research on which to inform physiotherapy practice is warranted for this troublesome musculoskeletal condition.
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Affiliation(s)
- Benjamin E. Smith
- Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department (Level 3), London Road Community Hospital, Derby, DE1 2QY UK
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Marcus Bateman
- Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department (Level 3), London Road Community Hospital, Derby, DE1 2QY UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg and Department of Clinical Medicine at Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - James Selfe
- Manchester Metropolitan University, Manchester, UK
| | | | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Alshehri A, Lohman E, Daher NS, Bahijri K, Alghamdi A, Altorairi N, Arnons A, Matar A. Cross-Cultural Adaptation and Psychometric Properties Testing of the Arabic Anterior Knee Pain Scale. Med Sci Monit 2017; 23:1559-1582. [PMID: 28364114 PMCID: PMC5386430 DOI: 10.12659/msm.901264] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background PFPS is one of the most frequently occurring overuse injuries affecting the lower limbs. A variety of functional and self-reported outcome measures have been used to assess clinical outcomes of patients with PFPS, however, only the Anterior Knee Pain Scale (AKPS) has been designed for PFPS patients. Material/Methods We followed international recommendations to perform a cross-cultural adaptation of the AKPS. The Arabic AKPS and the Arabic RAND 36-item Health Survey were administered to 40 patients who were diagnosed with PFPS. Participants were assessed at baseline and after 2 to 3 days assessed with the Arabic AKPS only. The measurements tested were reliability, validity, and feasibility. Results The Arabic AKPS showed high reliability for both temporal stability, internal consistency (Cronbach’s alpha was 0.81 for the first assessment and 0.75 for the second), excellent test-retest reliability (Intraclass Correlation Coefficients ICC=0.96; 95% confidence interval (CI): 0.93, 0.98) and good agreement (standard error of measurement SEM=1.8%). The Arabic AKPS was significantly correlated with physical components of the RAND 36-Item Health Survey (Spearman’s rho=0.69: p<0.001). No ceiling or floor effects were observed. Conclusions The Arabic AKPS is a valid and reliable tool and is comparable to the original English version and other translated versions.
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Affiliation(s)
- Abdullah Alshehri
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Everett Lohman
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Noha S Daher
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Khalid Bahijri
- Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Abdulmohsen Alghamdi
- Department of Physical Therapy, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Nezar Altorairi
- Department of Physical Therapy, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Arin Arnons
- Department of Physical Therapy, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Matar
- Department of Physical Therapy, Prince Faisal Bin Fahad Hospital for Sports Medicine, Riyadh, Saudi Arabia
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Østerås B. Similar benefits from Tai Chi and supervised physiotherapy for knee osteoarthritis [commentary]. J Physiother 2017; 63:116. [PMID: 28314648 DOI: 10.1016/j.jphys.2017.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/08/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Berit Østerås
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
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Clijsen R, Fuchs J, Taeymans J. Effectiveness of exercise therapy in treatment of patients with patellofemoral pain syndrome: systematic review and meta-analysis. Phys Ther. 2014;94:1697-1708. Phys Ther 2015; 95:944. [PMID: 26031469 DOI: 10.2522/ptj.20130310.cx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Lorås H, Østerås B, Torstensen TA, Østerås H. Medical Exercise Therapy for Treating Musculoskeletal Pain: A Narrative Review of Results from Randomized Controlled Trials with a Theoretical Perspective. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2015; 20:182-90. [DOI: 10.1002/pri.1632] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 10/09/2014] [Accepted: 04/10/2015] [Indexed: 02/01/2023]
Affiliation(s)
- H. Lorås
- Faculty of Health Education and Social Work, Division Physiotherapy; Sør-Trøndelag University College; Trondheim Norway
| | - B. Østerås
- Faculty of Health Education and Social Work, Division Physiotherapy; Sør-Trøndelag University College; Trondheim Norway
| | - T. A. Torstensen
- Holten Institute; Lidingö Sweden
- Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - H. Østerås
- Faculty of Health Education and Social Work, Division Physiotherapy; Sør-Trøndelag University College; Trondheim Norway
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van der Heijden RA, Lankhorst NE, van Linschoten R, Bierma‐Zeinstra SMA, van Middelkoop M. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev 2015; 1:CD010387. [PMID: 25603546 PMCID: PMC10898323 DOI: 10.1002/14651858.cd010387.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patellofemoral pain syndrome (PFPS) is a common knee problem, which particularly affects adolescents and young adults. PFPS, which is characterised by retropatellar (behind the kneecap) or peripatellar (around the kneecap) pain, is often referred to as anterior knee pain. The pain mostly occurs when load is put on the knee extensor mechanism when climbing stairs, squatting, running, cycling or sitting with flexed knees. Exercise therapy is often prescribed for this condition. OBJECTIVES To assess the effects (benefits and harms) of exercise therapy aimed at reducing knee pain and improving knee function for people with patellofemoral pain syndrome. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2014), the Cochrane Central Register of Controlled Trials (2014, Issue 4), MEDLINE (1946 to May 2014), EMBASE (1980 to 2014 Week 20), PEDro (to June 2014), CINAHL (1982 to May 2014) and AMED (1985 to May 2014), trial registers (to June 2014) and conference abstracts. SELECTION CRITERIA Randomised and quasi-randomised trials evaluating the effect of exercise therapy on pain, function and recovery in adolescents and adults with patellofemoral pain syndrome. We included comparisons of exercise therapy versus control (e.g. no treatment) or versus another non-surgical therapy; or of different exercises or exercise programmes. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. Where appropriate, we pooled data using either fixed-effect or random-effects methods. We selected the following seven outcomes for summarising the available evidence: pain during activity (short-term: ≤ 3 months); usual pain (short-term); pain during activity (long-term: > 3 months); usual pain (long-term); functional ability (short-term); functional ability (long-term); and recovery (long-term). MAIN RESULTS In total, 31 heterogeneous trials including 1690 participants with patellofemoral pain are included in this review. There was considerable between-study variation in patient characteristics (e.g. activity level) and diagnostic criteria for study inclusion (e.g. minimum duration of symptoms) and exercise therapy. Eight trials, six of which were quasi-randomised, were at high risk of selection bias. We assessed most trials as being at high risk of performance bias and detection bias, which resulted from lack of blinding.The included studies, some of which contributed to more than one comparison, provided evidence for the following comparisons: exercise therapy versus control (10 trials); exercise therapy versus other conservative interventions (e.g. taping; eight trials evaluating different interventions); and different exercises or exercise programmes. The latter group comprised: supervised versus home exercises (two trials); closed kinetic chain (KC) versus open KC exercises (four trials); variants of closed KC exercises (two trials making different comparisons); other comparisons of other types of KC or miscellaneous exercises (five trials evaluating different interventions); hip and knee versus knee exercises (seven trials); hip versus knee exercises (two studies); and high- versus low-intensity exercises (one study). There were no trials testing exercise medium (land versus water) or duration of exercises. Where available, the evidence for each of seven main outcomes for all comparisons was of very low quality, generally due to serious flaws in design and small numbers of participants. This means that we are very unsure about the estimates. The evidence for the two largest comparisons is summarised here. Exercise versus control. Pooled data from five studies (375 participants) for pain during activity (short-term) favoured exercise therapy: mean difference (MD) -1.46, 95% confidence interval (CI) -2.39 to -0.54. The CI included the minimal clinically important difference (MCID) of 1.3 (scale 0 to 10), indicating the possibility of a clinically important reduction in pain. The same finding applied for usual pain (short-term; two studies, 41 participants), pain during activity (long-term; two studies, 180 participants) and usual pain (long-term; one study, 94 participants). Pooled data from seven studies (483 participants) for functional ability (short-term) also favoured exercise therapy; standardised mean difference (SMD) 1.10, 95% CI 0.58 to 1.63. Re-expressed in terms of the Anterior Knee Pain Score (AKPS; 0 to 100), this result (estimated MD 12.21 higher, 95% CI 6.44 to 18.09 higher) included the MCID of 10.0, indicating the possibility of a clinically important improvement in function. The same finding applied for functional ability (long-term; three studies, 274 participants). Pooled data (two studies, 166 participants) indicated that, based on the 'recovery' of 250 per 1000 in the control group, 88 more (95% CI 2 fewer to 210 more) participants per 1000 recovered in the long term (12 months) as a result of exercise therapy. Hip plus knee versus knee exercises. Pooled data from three studies (104 participants) for pain during activity (short-term) favoured hip and knee exercise: MD -2.20, 95% CI -3.80 to -0.60; the CI included a clinically important effect. The same applied for usual pain (short-term; two studies, 46 participants). One study (49 participants) found a clinically important reduction in pain during activity (long-term) for hip and knee exercise. Although tending to favour hip and knee exercises, the evidence for functional ability (short-term; four studies, 174 participants; and long-term; two studies, 78 participants) and recovery (one study, 29 participants) did not show that either approach was superior. AUTHORS' CONCLUSIONS This review has found very low quality but consistent evidence that exercise therapy for PFPS may result in clinically important reduction in pain and improvement in functional ability, as well as enhancing long-term recovery. However, there is insufficient evidence to determine the best form of exercise therapy and it is unknown whether this result would apply to all people with PFPS. There is some very low quality evidence that hip plus knee exercises may be more effective in reducing pain than knee exercise alone.Further randomised trials are warranted but in order to optimise research effort and engender the large multicentre randomised trials that are required to inform practice, these should be preceded by research that aims to identify priority questions and attain agreement and, where practical, standardisation regarding diagnostic criteria and measurement of outcome.
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Affiliation(s)
- Rianne A van der Heijden
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | - Nienke E Lankhorst
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | - Robbart van Linschoten
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | - Sita MA Bierma‐Zeinstra
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | - Marienke van Middelkoop
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
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