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Golubjatnikov M, Walker A. Endurance Sporting Events. Emerg Med Clin North Am 2024; 42:581-596. [PMID: 38925776 DOI: 10.1016/j.emc.2024.02.017] [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] [Indexed: 06/28/2024]
Abstract
Endurance sports encompass a broad range of events from marathons and triathlons to ultramarathons, long-distance cycling, skiing, and swimming. As these events have experienced a surge in popularity, we have a greater need to understand the associated medical risks. This article reviews the history of endurance races, reviews the most critical and common causes of cardiovascular, heat, electrolyte, and musculoskeletal injuries/illnesses, and discusses considerations for medical directors/personnel associated with such events.
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Affiliation(s)
- Matt Golubjatnikov
- St Joseph's Medical Center, 1800 N California Street, Stockton, CA 95204, USA
| | - Anne Walker
- St Joseph's Medical Center, 1800 N California Street, Stockton, CA 95204, USA.
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Albornoz-Cabello M, Ibáñez-Vera AJ, Barrios-Quinta CJ, Espejo-Antúnez L, Lara-Palomo IC, de los Ángeles Cardero-Durán M. Non-Invasive Radiofrequency Diathermy Neuromodulation Added to Supervised Therapeutic Exercise in Patellofemoral Pain Syndrome: A Single Blind Randomized Controlled Trial with Six Months of Follow-Up. Biomedicines 2024; 12:850. [PMID: 38672204 PMCID: PMC11048228 DOI: 10.3390/biomedicines12040850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The evidence-based treatment of patellofemoral pain (PFP) suggests that therapeutic exercise (TE) focused on improving muscle strength and motor control be the main conservative treatment. Recent research determined that the success of the TE approach gets improved in the short term by the addition of neuromodulation via radiofrequency diathermy (RFD). As there is no follow up data, the objective of this research is to assess the long-term effects of adding RFD to TE for the pain, function and quality of life of PFP patients. To this aim, a single-blind randomized controlled trial was conducted on 86 participants diagnosed of PFP. Participants who met the selection criteria were randomized and allocated into either a TE group or an RFD + TE group. TE consisted of a 20 min daily supervised exercise protocol for knee and hip muscle strengthening, while RFD consisted of the application of neuromodulation using a radiofrequency on the knee across 10 sessions. Sociodemographic data, knee pain and lower limb function outcomes were collected. The RFD + TE group obtained greater improvements in knee pain (p < 0.001) than the TE group. Knee function showed statistically significant improvements in Kujala (p < 0.05) and LEFS (p < 0.001) in the RFD + TE group in the short and long term. In conclusion, the addition of RFD to TE increases the beneficial effects of TE alone on PFP, effects that remain six months after treatment.
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Affiliation(s)
| | | | | | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapy, Universidad de Extremadura, 06006 Badajoz, Spain; (L.E.-A.)
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van Leeuwen GJ, de Schepper EIT, Bindels PJE, Bierma-Zeinstra SMA, van Middelkoop M. Patellofemoral pain in general practice: the incidence and management. Fam Pract 2023; 40:589-595. [PMID: 37669000 PMCID: PMC10667070 DOI: 10.1093/fampra/cmad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is a nontraumatic knee problem primarily observed in physically active adolescents. The objective of this study was to determine the incidence and management of PFP in children and adolescents in general practice. METHODS A retrospective cohort study was conducted using a regional primary care database containing full electronic health records of over 300,000 patients. Patients with a new PFP diagnosis between the years 2013 and 2019 were extracted using a search algorithm based on International Classification of Primary Health Care coding and search terms in free text. Data on the management of PFP were manually checked and analysed. In addition, a sub-analysis for chronic and nonchronic PFP patients was performed. RESULTS The mean incidence of PFP over the study period was 3.4 (95% CI 3.2-3.6) per 1,000 person years in the age group of 7-24 years. Girls had a higher incidence rate (4.6 [95% CI 4.3-5.0]) compared to boys (2.3 [95% CI 2.1-2.5]). Peak incidence was at age 13 years for both sexes. The most commonly applied management strategy was advice (55.1%), followed by referral to physiotherapy (28.2%), analgesics prescription (10.4%), and referral to the orthopaedic surgeon (8.9%). No differences were found in age, sex, and treatment between chronic and nonchronic PFP patients. CONCLUSIONS The average Dutch general practitioner sees approximately 1.4 new child or adolescent with PFP per year. Overall management strategies were in concordance with current Dutch general practice guideline on nontraumatic knee problems. More insight should be gained in the population with chronic complaints.
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Affiliation(s)
- Guido J van Leeuwen
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Evelien I T de Schepper
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Lack SD, Bartholomew C, North T, Miller SC, Neal BS. The effects of a two-week neuromuscular intervention on biopsychosocial variables in people with patellofemoral pain: an observational study. Front Sports Act Living 2023; 5:1087061. [PMID: 37255732 PMCID: PMC10225691 DOI: 10.3389/fspor.2023.1087061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/21/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Patellofemoral pain (PFP) is common and predominately affects active populations. Altered biomechanics and psychosocial variables have been reported in people with PFP, but the effects of neuromuscular exercise on these variables is unknown. We aimed to investigate changes in biopsychosocial measures following a two-week neuromuscular intervention in people with PFP. Materials and Methods We measured pain (visual analogue scale), function (Kujala), activity level (Tegner), psychological well-being (Orebro), lower-limb isometric strength (handheld dynamometry), three-dimensional (3D) lower limb kinematics, and surface electromyography (sEMG), in people with PFP. 3D lower-limb kinematics and sEMG were synchronously sampled during step-up, step-down, and overground running. All measures were repeated after participants had completed a two-week neuromuscular intervention consisting of three exercises completed once per day, five days per week. Results 18 participants completed pre/post testing (60% females, mean age 30.6 years ±7.0, height 173.4cm ±10.4, mass 70.2kg ±12.4, symptom duration 39.0 months ±58.8), with three of 21 participants lost to follow-up. Across all clinical measures (muscle onsets, muscle activation and kinematics), the 95% bootstrapped confidence intervals (CI) of the mean difference contained the null hypothesis following the two-week neuromuscular intervention, indicating no significant differences. Conclusion A two-week neuromuscular intervention did not change biomechanical or psychosocial measures in people with PFP. Interventions with a longer duration or greater load magnitude are required to fully evaluate the biopsychosocial mechanisms of effect for exercise in people with PFP.
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Affiliation(s)
- Simon David Lack
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
- Pure Sports Medicine, Point West Building, London, United Kingdom
| | - Clare Bartholomew
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
| | - Thomas North
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
| | - Stuart Charles Miller
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
| | - Bradley Stephen Neal
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
- School of Sport, Rehabilitation and Exercise Science, University of Essex, Colchester, Essex, United Kingdom
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Albornoz-Cabello M, Ibáñez-Vera AJ, Barrios-Quinta CJ, Lara-Palomo IC, Cardero-Durán MDLÁ, Espejo-Antúnez L. Effects of Radiofrequency Diathermy Plus Therapeutic Exercises on Pain and Functionality of Patients with Patellofemoral Pain Syndrome: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12062348. [PMID: 36983348 PMCID: PMC10051503 DOI: 10.3390/jcm12062348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Although consensus has been reached about the use of therapeutic exercise in patellofemoral pain syndrome, several techniques used worldwide such as radiofrequency diathermy could be useful as complementary therapy. The objective of this randomized controlled trial was to compare the effects of adding radiofrequency diathermy to therapeutic exercises in patients with patellofemoral pain syndrome. Fifty-six participants were randomly assigned either to radiofrequency diathermy plus therapeutic exercises group (n = 29) or therapeutic exercises group (n = 27). Both groups received the same therapeutic exercises, and the diathermy group additionally received monopolar dielectric diathermy for three weeks (5-3-2 weekly sessions). Data related to intensity of pain, probability of neuropathic pain, functionality, and range of movement of the knee were measured at baseline and three weeks after the intervention. Comparing pre-treatment and values obtained at the third week, significant improvements were found in intensity of pain, neuropathic pain, functionality, and range of motion in both groups (p < 0.05). The diathermy plus exercises group had significantly better intensity of pain than the control group at the end of the three weeks (p < 0.01). The addition of diathermy by emission of radiofrequency to the therapeutic knee exercise protocol is more effective than a therapeutic exercise protocol alone in the relief of intensity of pain in patients with patellofemoral pain in the immediate post-treatment follow-up compared with baseline scores.
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Affiliation(s)
| | | | | | | | | | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapy, Faculty of Medicine and Health Sciences, University of Extremadura, 06006 Badajoz, Spain
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Botta AFB, Waiteman MC, Ducatti MHM, Garcia CLG, Farinelli LALB, Bazett-Jones DM, Briani RV, de Azevedo FM. Patellofemoral pain over time: Protocol for a prospective, longitudinal study investigating physical and non-physical features. Front Sports Act Living 2023; 4:1081943. [PMID: 36713948 PMCID: PMC9875135 DOI: 10.3389/fspor.2022.1081943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
Background This is a protocol for a prospective longitudinal study that aims to investigate: (1) group-by-time changes over a minimum of 15 months follow-up in patellofemoral pain (PFP) symptoms, biomechanical, muscle function, pain processing, and psychological features; (2) the extent to which changes in biomechanical, muscle function, pain processing, and psychological features are associated with changes in self-reported pain, physical performance measures, self-reported function, health-related quality of life (HRQOL), and physical activity level. Methods Individuals with PFP (n = 144) and control individuals (n = 85) without PFP were assessed at baseline. Outcomes assessed included: 3D kinematics and kinetics during single leg squat, step-down and single leg hop; maximal torque and rate of torque development of hip abductors and knee extensors/flexors; force steadiness of hip abductors and knee extensors; anterior and lateral trunk endurance; pressure pain thresholds at the center of patella and contralateral shoulder; kinesiophobia (Tampa Scale for Kinesiophobia); pain catastrophizing (Pain Catastrophizing Scale); worst self-reported pain (Visual Analogue Scale); physical performance measures (Single Leg Hop Test and Forward Step-Down Test); self-reported function (Anterior Knee Pain Scale); HRQOL (Medical Outcome Short-Form 36), and physical activity level (Baecke's Questionnaire). Follow-up assessments will be identical to the baseline and will be performed after a minimum of 15 months. Generalized linear mixed model (GLMM) will be used to investigate group-by-time differences. Linear regression models will be used to determine the extent to which changes in biomechanical, muscle function, pain processing, and psychological features are associated with changes in self-reported pain, physical performance measures, self-reported function, HRQOL, and physical activity level. Discussion Physical and non-physical features have been previously associated with PFP. However, the present study will be the first to investigate their integrated evolution as part of the natural history of PFP and its progression. In doing so, we will be able to determine their behavior in the long-term, as well as how they prospectively associate with each other and with clinical outcomes. Ultimately, this will provide a greater understanding of predictors of long-term outcome and possible targets for interventions.
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Affiliation(s)
- Ana Flavia Balotari Botta
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil,Correspondence: Ana Flavia Balotari Botta
| | - Marina Cabral Waiteman
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | - Matheus Henrique Maiolini Ducatti
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | - Carmen Lúcia Gomes Garcia
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | - Lucca André Liporoni Bego Farinelli
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | | | - Ronaldo Valdir Briani
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | - Fábio Mícolis de Azevedo
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
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Are Physical Function and Fear of Movement Risk Factors for Patellofemoral Pain? A 2-Year Prospective Study. J Sport Rehabil 2023; 32:24-30. [PMID: 35894902 DOI: 10.1123/jsr.2021-0392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT To determine (1) whether physical function and fear of movement are prospectively associated with the risk of females developing patellofemoral pain (PFP) and (2) whether they change following development of PFP. DESIGN Prospective observational study. METHODS A total of 114 asymptomatic females (18-22 y old) completed assessment of physical function (forward step-down test and single-leg hop for distance) and fear of movement using the Tampa Scale for Kinesiophobia at baseline and 2-year follow-up. Presence of symptoms of PFP was monitored bimonthly. RESULTS Ninety participants (retention rate = 79%) completed the 2-year follow-up assessment, with 27 (24% of the cohort) developing PFP. Physical function, including forward step-down test (P = .659) and single-leg hop for distance (P = .825), and fear of movement (P = .479) were not associated with the risk of developing PFP. Females who developed PFP presented with reduced forward step-down repetitions (mean difference = 2.8; 95% confidence interval, 0.2 to 5.3) and single-leg hop for distance (10.2; 95% confidence interval, 2.7 to 17.7 cm) at 2-year follow-up. There was no statistically significant difference between those who did and did not develop PFP for fear of movement (-3.4; 95% confidence interval, -7.0 to 0.2). CONCLUSIONS Physical function and fear of movement were not associated with the risk of developing PFP in young females. However, the change over time in the step-down and single-leg hop for distance tests may suggest that, even in the early stages of PFP, young females present impaired physical function compared with females who did not develop symptoms. Fear of movement may develop due to persistent PFP, and does not appear to be a risk factor or key feature in females with PFP of short symptoms duration.
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Lally EM, Thorpe J, Ericksen H, Earl-Boehm J. Reliability and criterion validity of two-dimensional movement assessments in those with patellofemoral pain. Phys Ther Sport 2022; 58:134-140. [DOI: 10.1016/j.ptsp.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 10/31/2022]
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Xiong B, OuYang Y, Chang Y, Mao G, Du M, Liu B, Xu Y. A fused biometrics information graph convolutional neural network for effective classification of patellofemoral pain syndrome. Front Neurosci 2022; 16:976249. [PMID: 35968371 PMCID: PMC9372351 DOI: 10.3389/fnins.2022.976249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022] Open
Abstract
Patellofemoral pain syndrome (PFPS) is a common, yet misunderstood, knee pathology. Early accurate diagnosis can help avoid the deterioration of the disease. However, the existing intelligent auxiliary diagnosis methods of PFPS mainly focused on the biosignal of individuals but neglected the common biometrics of patients. In this paper, we propose a PFPS classification method based on the fused biometrics information Graph Convolution Neural Networks (FBI-GCN) which focuses on both the biosignal information of individuals and the common characteristics of patients. The method first constructs a graph which uses each subject as a node and fuses the biometrics information (demographics and gait biosignal) of different subjects as edges. Then, the graph and node information [biosignal information, including the joint kinematics and surface electromyography (sEMG)] are used as the inputs to the GCN for diagnosis and classification of PFPS. The method is tested on a public dataset which contain walking and running data from 26 PFPS patients and 15 pain-free controls. The results suggest that our method can classify PFPS and pain-free with higher accuracy (mean accuracy = 0.8531 ± 0.047) than other methods with the biosignal information of individuals as input (mean accuracy = 0.813 ± 0.048). After optimal selection of input variables, the highest classification accuracy (mean accuracy = 0.9245 ± 0.034) can be obtained, and a high accuracy can still be obtained with a 40% reduction in test variables (mean accuracy = 0.8802 ± 0.035). Accordingly, the method effectively reflects the association between subjects, provides a simple and effective aid for physicians to diagnose PFPS, and gives new ideas for studying and validating risk factors related to PFPS.
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Affiliation(s)
- Baoping Xiong
- School of Computer Science and Mathematics, Fujian University of Technology, Fuzhou, China
- Fujian Provincial Key Laboratory of Big Data Mining and Applications, Fujian University of Technology, Fuzhou, China
| | - Yaozong OuYang
- School of Computer Science and Mathematics, Fujian University of Technology, Fuzhou, China
- Fujian Provincial Key Laboratory of Big Data Mining and Applications, Fujian University of Technology, Fuzhou, China
| | - Yiran Chang
- School of Computer Science and Mathematics, Fujian University of Technology, Fuzhou, China
- Fujian Provincial Key Laboratory of Big Data Mining and Applications, Fujian University of Technology, Fuzhou, China
| | - Guoju Mao
- School of Computer Science and Mathematics, Fujian University of Technology, Fuzhou, China
- Fujian Provincial Key Laboratory of Big Data Mining and Applications, Fujian University of Technology, Fuzhou, China
- *Correspondence: Guoju Mao,
| | - Min Du
- Fujian Provincial Key Laboratory of Eco-Industrial Green Technology, Wuyi University, Wuyishan, China
| | - Bijing Liu
- State Grid Electric Power Research Institute, Beijing, China
- Bijing Liu,
| | - Yong Xu
- School of Computer Science and Mathematics, Fujian University of Technology, Fuzhou, China
- Fujian Provincial Key Laboratory of Big Data Mining and Applications, Fujian University of Technology, Fuzhou, China
- Yong Xu,
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Measurement Properties of Clinically Accessible Movement Assessment Tools for Analyzing Single-Leg Squats and Step-Downs: A Systematic Review. J Sport Rehabil 2022; 31:476-489. [PMID: 34996031 DOI: 10.1123/jsr.2021-0287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Poor lower-extremity biomechanics are predictive of increased risk of injury. Clinicians analyze the single-leg squat (SLS) and step-down (SD) with rubrics and 2D assessments to identify these poor lower-extremity biomechanics. However, evidence on measurement properties of movement assessment tools is not strongly outlined. Measurement properties must be established before movement assessment tools are recommended for clinical use. OBJECTIVE The purpose of this study was to systematically review the evidence on measurement properties of rubrics and 2D assessments used to analyze an SLS and SD. EVIDENCE ACQUISITION The search strategy was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The search was performed in PubMed, SPORTDiscus, and Web of Science databases. The COnsensus-based Standards for the selection of health Measurement INstruments multiphase procedure was used to extract relevant data, evaluate methodological quality of each study, score the results of each movement assessment, and synthesize the evidence. EVIDENCE SYNTHESIS A total of 44 studies were included after applying eligibility criteria. Reliability and construct validity of knee frontal plane projection angle was acceptable, but criterion validity was unacceptable. Reliability of the Chmielewski rubric was unacceptable. Content validity of the knee-medial-foot and pelvic drop rubrics was acceptable. The remaining rubrics and 2D measurements had inconclusive or conflicting results regarding reliability and validity. CONCLUSIONS Knee frontal plane projection angle is reliable for analyzing the SLS and SD; however, it does not serve as a substitute for 3D motion analysis. The Chmielewski rubric is not recommended for assessing the SLS or SD as it may be unreliable. Most movement assessment tools yield indeterminate results. Within the literature, standardized names, procedures, and reporting of movement assessment tool reliability and validity are inconsistent.
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Measurement Properties of Clinically Accessible Movement Assessment Tools for Analyzing Jump Landings: A Systematic Review. J Sport Rehabil 2022; 31:465-475. [PMID: 34996030 DOI: 10.1123/jsr.2021-0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Lower-extremity musculoskeletal injury is commonly associated with poor movement patterns at the trunk, hip, and knee. Efforts have been focused on identifying poor lower-extremity movement using clinically friendly movement assessments, such as rubrics and 2D measures. Assessments used clinically or for research should have acceptable measurement properties, such as reliability and validity. However, the literature on reliability and validity of movement assessments to analyze jump landings has not been summarized. OBJECTIVE To systematically review measurement properties of rubrics and 2D measurements that aim to classify movement quality during jump landings. EVIDENCE ACQUISITION The search strategy was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The search was performed in PubMed, SPORTDiscus, and Web of Science databases. The COnsensus-based Standards for the selection of health Measurement INstruments multiphase procedure was used to extract relevant data, evaluate methodological quality of each study, score the results of each movement assessment, and synthesize the evidence. EVIDENCE SYNTHESIS Twenty-two studies were included after applying eligibility criteria. Reliability and construct validity of the landing error scoring system were acceptable. Criterion validity of 2D knee flexion angle and medial knee displacement is acceptable. Reliability of 2D knee ankle separation ratio and knee frontal plane projection angle are acceptable. CONCLUSION The landing error scoring system is a valid way to determine poor movement quality and injury risk. Measures of 2D knee flexion angle and medial knee displacement are valid alternatives for 3D knee flexion angle and knee abduction moment, respectively. Knee ankle separation ratio and knee frontal plane projection angle are reliable but lack validity justifying their clinical use.
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Sigmund KJ, Bement MKH, Earl-Boehm JE. Exploring the Pain in Patellofemoral Pain: A Systematic Review and Meta-Analysis Examining Signs of Central Sensitization. J Athl Train 2021; 56:887-901. [PMID: 33238005 DOI: 10.4085/1062-6050-0190.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) has high recurrence rates and minimal long-term treatment success. Central sensitization refers to dysfunctional pain modulation that occurs when nociceptive neurons become hyperresponsive. Researchers in this area of PFP have been increasingly productive in the past decade. OBJECTIVE To determine whether evidence supports manifestations of central sensitization in individuals with PFP. DATA SOURCES We searched MeSH terms for quantitative sensory testing (QST) pressure pain thresholds (PPTs), conditioned pain modulation (CPM), temporal summation, sensitization, hyperalgesia, and anterior knee pain or PFP in PubMed, SPORTDiscus, CINAHL, Academic Search Complete, and EBSCOhost. STUDY SELECTION Peer-reviewed studies that were written in English and published between 2005 and 2020 and investigated QST or pain mapping in a sample with PFP were included in this review. DATA EXTRACTION The initial search yielded 140 articles. After duplicates were removed, 78 abstracts were reviewed. The full text of 21 studies was examined, and we included 15 studies in our evaluation: 6 in the meta-analysis, 4 in the systematic review, and 5 in both the meta-analysis and systematic review. DATA SYNTHESIS A random-effects meta-analysis was conducted for 4 QST variables (local PPTs, remote PPTs, CPM, temporal summation). Strong evidence supported lower local and remote PPTs, impaired CPM, and facilitated temporal summation in individuals with PFP compared with pain-free individuals. Evidence for heat and cold pain thresholds was conflicting. Pain mapping demonstrated expanding pain patterns associated with long duration of PFP symptoms. CONCLUSIONS Signs of central sensitization were present in individuals with PFP, indicating altered pain modulation. The etiologic and treatment models of PFP should reflect the current body of evidence regarding central sensitization. Signs of central sensitization should be monitored clinically, and treatments with central effects should be considered as part of a multimodal plan of care.
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Affiliation(s)
- Kemery J Sigmund
- Department of Rehabilitation Sciences, University of Wisconsin-Milwaukee.,Department of Health and Human Performance, Athletic Training Program, Concordia University Wisconsin, Mequon
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Albornoz-Cabello M, Barrios-Quinta CJ, Escobio-Prieto I, Sobrino-Sánchez R, Ibáñez-Vera AJ, Espejo-Antúnez L. Treatment of Patellofemoral Pain Syndrome with Dielectric Radiofrequency Diathermy: A Preliminary Single-Group Study with Six-Month Follow-Up. ACTA ACUST UNITED AC 2021; 57:medicina57050429. [PMID: 33925211 PMCID: PMC8145052 DOI: 10.3390/medicina57050429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Manuel Albornoz-Cabello
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain;
| | | | - Isabel Escobio-Prieto
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain;
- Correspondence:
| | | | | | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapy, Medicine Faculty, University of Extremadura, 06071 Badajoz, Spain;
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Albornoz-Cabello M, Barrios-Quinta CJ, Barrios-Quinta AM, Escobio-Prieto I, Cardero-Durán MDLA, Espejo-Antunez L. Effectiveness of Tele-Prescription of Therapeutic Physical Exercise in Patellofemoral Pain Syndrome during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031048. [PMID: 33504042 PMCID: PMC7908506 DOI: 10.3390/ijerph18031048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 01/09/2023]
Abstract
The health crisis caused by COVID-19 has had a huge impact on the provision of physiotherapists’ services during the pandemic. Patellofemoral pain syndrome (PFPS) is a major health problem and one of the most common causes of pain in the front of the knee in outpatients. The objective was to evaluate the effectiveness of a therapeutic physical exercise (TPE) program supervised by a physiotherapist using telematic channels in reducing pain and disability in a sample of 54 patients with PFPS in the Physiotherapy Service of the San José de la Rinconada Health Center (Seville). Subjects were evaluated pre- and post-intervention (4 weeks—12 treatment sessions). An analysis was made of perceived pain—using the visual analog scale (VAS) and the DN4 neuropathic pain questionnaire—and functional balance—through the Kujala Score test and the Lower Extremity Functional Scale. The supervised TPE program in patients with PFPS produced a reduction in pain: VAS F1, 52 = 8.68 (p = 0.005) η2 = 0.14 and DN4: F1, 52 = 69.94 (p = 0.000) η2 = 0.57; and in Lower Extremity Functional Scale (LEFS) disability: F1, 52 = 19.1 (p = 0.000) η2 = 0.27 and KUJALA: F1, 52 = 60.28 (p = 0.000) η2 = 0.54, which was statistically significant (p = 0.000 for p < 0.05). Hence, the TPE program presented was effective in reducing pain and disability in patients with PFPS.
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Affiliation(s)
- Manuel Albornoz-Cabello
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain;
| | | | | | - Isabel Escobio-Prieto
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain;
- Correspondence:
| | | | - Luis Espejo-Antunez
- Department of Medical-Surgical Therapy, Medicine Faculty, University of Extremadura, 06071 Badajoz, Spain; (M.d.l.A.C.-D.); (L.E.-A.)
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15
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Tung HY, Galloway J, Matcham F, Hotopf M, Norton S. High-frequency follow-up studies in musculoskeletal disorders: a scoping review. Rheumatology (Oxford) 2021; 60:48-59. [PMID: 33099639 DOI: 10.1093/rheumatology/keaa487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This scoping review identifies research in musculoskeletal disorders that uses high frequency follow-up of symptoms. The aim was to investigate whether symptom variability is investigated as a predictor of disease outcome and how intensive follow-up methods are used in musculoskeletal research. METHODS Embase, MEDLINE and PsycInfo were searched using OVID, and the Institute of Electrical and Electronic Engineers was also searched using the Institute of Electrical and Electronic Engineers Xplore search engine. Studies were systematically reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses, but no meta-analysis was done because the priority in this study is to identify gaps in available literature. RESULTS Twenty-one papers were included. There was a mean of 54 patients per study (s.d. of 27.7). Two-thirds of the papers looked at how a symptom influences another in the short-term (subsequent assessment in the same day or next day), but none looked at the long-term. Only one study considered symptom variability investigating how higher variability in pain (defined by the s.d.) is associated with higher average pain severity and lower average sleep quality. CONCLUSION The methodology of musculoskeletal disorder research has changed from completing paper booklets to using electronic data capture (smartphones). There has also been a trend of collecting more intensive longitudinal data, but very little research utilizes these data to look at how symptom variability affects symptom outcomes. This demonstrates a gap in research where furthering understanding of this will help clinicians decide on the most important symptom to address in future patients.
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Affiliation(s)
- Hsiu Yen Tung
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience
| | - James Galloway
- Centre for Rheumatic Diseases, Department of Inflammation Biology, Faculty of Life Sciences & Medicine
| | - Faith Matcham
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sam Norton
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience.,Centre for Rheumatic Diseases, Department of Inflammation Biology, Faculty of Life Sciences & Medicine
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Albornoz-Cabello M, Ibáñez-Vera AJ, Aguilar-Ferrándiz ME, Espejo-Antúnez L. Monopolar dielectric diathermy by emission of radiofrequency in Patellofemoral pain. A single-blind-randomized clinical trial. Electromagn Biol Med 2020; 39:282-289. [PMID: 32683992 DOI: 10.1080/15368378.2020.1793169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Despite the high incidence of patellofemoral pain syndrome (PFPS), few studies show the effects of radiofrequency on pain and functionality in these patients. For this reason, the aim of this study was to determine the efficacy of monopolar dielectric diathermy by emission of radiofrequency (MDR) in dynamic applications aimed at treating pain and improving function in patients with PFPS. For this purpose, a single-blind randomized clinical trial was conducted. Eighty-four participants with PFPS were evenly divided into an experimental group (EG) and a control group (CG). All subjects receive 10 min of daily home exercises along 3 weeks, and in addition, the subjects of the EG received 10 sessions based on the dynamic application of MDR. Variables measured included Visual Analogue Scale (VAS), DN4 questionnaire, Lower Extremity Functionality Scale (LEFS), Kujala scale, Range of Movement (ROM) in knee flexion and extension and drug intake. The EG showed a statistically significant reduction in pain (VAS = 4.8 [5.5-4.1] [p < .001]; DN4 = 3.8 [4.4-3.2] [p < .001]), and an increase in functionality (LEFS = 16 [19-13] [p < .001]; Kujala = 19 [23-14] [p < .001]) and in ROM (flexion 18º [21º-16º] [p < .001]). No statistically significant changes in drug intake were found. Based on this data, the dynamic application of MDR seems effective in reducing pain and increasing functionality and flexion in patients with PFPS. Diathermy by emission of radiofrequency could be recommended as complement or main therapy in the treatment of PFPS.
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Affiliation(s)
| | - A J Ibáñez-Vera
- Health Sciences Department, University of Jaen , Jaen, Spain
| | | | - L Espejo-Antúnez
- Department of Medical-Surgical Therapy, University of Extremadura , Badajoz, Spain
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Hott A, Brox JI, Pripp AH, Juel NG, Liavaag S. Predictors of Pain, Function, and Change in Patellofemoral Pain. Am J Sports Med 2020; 48:351-358. [PMID: 31821014 DOI: 10.1177/0363546519889623] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Identification of factors predictive of outcome and change is important to improve treatment for patellofemoral pain (PFP). Few studies have examined the predictive value of psychological factors in PFP, although they have been reported to be important predictors in other musculoskeletal pain conditions. PURPOSE To evaluate predictors of pain, function, and change 1 year after an exercise-based intervention in PFP. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS In sum, 112 patients were recruited to a randomized controlled trial; 98 attended 1-year follow-up. There were no between-group differences in the trial; thus, the material was analyzed as 1 cohort. Nine baseline factors-sex, bilateral pain, worst pain, pain duration, Anterior Knee Pain Scale (AKPS), kinesiophobia, anxiety and depression, self-efficacy, and number of pain sites throughout the body-were investigated for their predictive ability on outcome at 1 year (AKPS, worst pain) and for change at 1 year (global change score, change in AKPS, and change in worst pain). Multivariable linear regression models with stepwise backward removal method were used to find predictors of poor outcome. RESULTS Number of pain sites at baseline was a significant predictor of worse outcome for AKPS (B = -2.7; 95% CI, -4.0 to -1.3; P < .01), worst pain (B = 0.5; 95% CI, 0.2-0.8; P < .01), global change (B = -0.8; 95% CI, -1.2 to -0.5; P < .01), change in AKPS (B = -2.7; 95% CI, -4.0 to -1.3; P < .01), and change in worst pain (B = 0.5, 95% CI, 0.2-0.8; P < .01) at 1 year. Baseline scores for AKPS and worst pain predicted respective 1-year levels and change scores (P < .01). Lower self-efficacy and male sex predicted less global change (P < .01). Longer pain duration predicted final score and change score for worst pain (P < .01). The predictive models had reasonable fit with adjusted R2 from 0.22 to 0.35. CONCLUSION Higher number of pain sites throughout the body was a consistent predictor of poor outcome and less change at 1 year. Baseline levels for AKPS and worst pain predicted respective final scores and change scores. REGISTRATION NCT02114294 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Alexandra Hott
- Department of Physical Medicine and Rehabilitation, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Jens Ivar Brox
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Sigurd Liavaag
- Department of Orthopedic Surgery, Sørlandet Hospital Kristiansand, Kristiansand, Norway
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Association Between Self-reported Measures, Physical Examination, and Early Magnetic Resonance Imaging Signs of Osteoarthritis in Patients With Patellofemoral Pain. J Orthop Sports Phys Ther 2019; 49:634-639. [PMID: 31291559 DOI: 10.2519/jospt.2019.8889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Structural abnormalities associated with osteoarthritis (OA) are found in some patients with patellofemoral pain (PFP). OBJECTIVES To investigate the association between early signs of OA on magnetic resonance imaging (MRI) and characteristics from self-reported measures and physical examination in patients with PFP. METHODS This exploratory study included data from patients with PFP from a previously published cross-sectional case-control study (n = 64; 55% female; mean ± SD age, 23.4 ± 7.0 years). Structural OA features (osteophytes, bone marrow lesions, cartilage defects, Hoffa synovitis, patellar tendon abnormalities) and quantitative T2 measurements of cartilage composition were extracted from MRI. Associations between characteristics from self-reported measures (pain at rest, pain during stair walking, knee function, duration of complaints, hours of sports participation each week), physical examination (crepitus, quadriceps strength), and early MRI signs of OA were assessed. RESULTS Symptom duration was associated with bone marrow lesions in the patella (odds ratio [OR] = 1.1; 95% confidence interval [CI]: 1.0, 1.2). Sports participation (hours per week) was inversely associated with patellar tendon abnormalities on MRI (OR = 0.8; 95% CI: 0.6, 1.0). Crepitus and bilateral nature of the complaints were associated with minor patellar cartilage defects (OR = 12.0; 95% CI: 2.3, 63.6 and OR = 7.6; 95% CI: 1.1, 53.8, respectively). There were no significant associations between clinical characteristics and cartilage T2 relaxation time. CONCLUSION Presence of crepitus, bilateral complaints, a long PFP symptom duration, and reduced weekly sport participation were associated with early signs of OA in a young PFP population. LEVEL OF EVIDENCE Etiology, level 2c. J Orthop Sports Phys Ther 2019;49(9):634-639. Epub 10 Jul 2019. doi:10.2519/jospt.2019.8889.
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Bartholomew C, Edwards L, Lack S. Pressure pain thresholds in adults with patellofemoral pain and patellofemoral joint osteoarthritis: a case-control study. Scand J Pain 2019; 19:713-723. [PMID: 31199779 DOI: 10.1515/sjpain-2019-0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/25/2019] [Indexed: 12/24/2022]
Abstract
Abstract
Background and aims
Patellofemoral pain (PFP) and patellofemoral joint osteoarthritis (PFJOA) are common non-self-limiting conditions causing significant pain and disability. The underlying pain pathologies lack consensus with evidence suggesting reduced pressure pain thresholds (PPTs) in adolescent females with PFP and individuals with knee osteoarthritis. A paucity of evidence exists for mixed-sex adults with PFP and PFJOA in isolation. Exploring if pain sensitisation is a dominant feature of PFP and PFJOA may have important implications for the delivery of a patient centred management approach. The primary aim was to measure local and remote PPTs in PFP and PFJOA patients compared to matched controls. Secondary aims were to evaluate the relationship between PPTs and (1) condition severity and (2) knee function.
Methods
13 PFP patients plus 20 matched controls and 15 PFJOA patients plus 34 matched controls were recruited from a UK mixed-sex adult population. Controls were matched on age, sex and activity level. Demographic details, Tegner activity level score, symptom duration, condition severity (Kujala and KOOS-PF scores for PFP and PFJOA, respectively) and knee function (Modified Whatman score rating of five single leg squats) were recorded. PPTs were measured at six sites: five local around the knee, one remote on the contralateral leg. Between-group differences were tested using a two-way mixed model analysis of variance with repeated measures. Strength of association between PPTs and condition severity and knee function were tested using Spearman’s rank order correlation.
Results
No statistically significant difference in PPTs were observed between the PFP patients [F(1,31) = 0.687, p = 0.413, η2 = 0.022] or PFJOA patients [F(1,47) = 0.237, p = 0.629, η2 = 0.005] and controls. Furthermore, no correlation was found between PPTs and condition severity or knee function in PFP or PFJOA (p > 0.05).
Conclusions
Results suggest mechanical pain sensitisation is not a dominant feature of UK mixed-sex adults with PFP or PFJOA.
Implications
PFP and PFJOA remain persistent pain complaints which may not be well explained by objective measures of sensitivity such as PPTs. The findings suggest that peripheral pain processing changes leading to pain sensitisation is not a key feature in PFP or PFJOA. Instead the underlying pain pathway is likely to remain primary nociceptive, possibly with a subgroup of patients who experience pain sensitisation and might benefit from a more targeted management approach.
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Affiliation(s)
- Clare Bartholomew
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Laura Edwards
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Simon Lack
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Pure Sports Medicine, London, UK
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20
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Earl-Boehm JE, Bolgla LA, Emory C, Hamstra-Wright KL, Tarima S, Ferber R. Treatment Success of Hip and Core or Knee Strengthening for Patellofemoral Pain: Development of Clinical Prediction Rules. J Athl Train 2018; 53:545-552. [PMID: 29893604 DOI: 10.4085/1062-6050-510-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Patellofemoral pain (PFP) is a common injury that interferes with quality of life and physical activity. Clinical subgroups of patients may exist, one of which is caused by proximal muscle dysfunction. OBJECTIVES To develop clinical prediction rules that predict a positive outcome after either a hip and core- or knee-focused strengthening program for individuals with PFP. DESIGN Secondary analysis of data from a randomized control trial. SETTING Four university laboratories. PATIENTS OR OTHER PARTICIPANTS A total of 199 participants with PFP. INTERVENTION(S) Participants were randomly allocated to either a hip and core-focused (n = 111) or knee-focused (n = 88) rehabilitation group for a 6-week program. MAIN OUTCOME MEASURE(S) Demographics, self-reported knee pain (visual analog scale) and function (Anterior Knee Pain Scale), hip strength, abdominal muscle endurance, and hip range of motion were evaluated at baseline. Treatment success was defined as a decrease in visual analog scale score by ≥2 cm or an increase in the Anterior Knee Pain Scale score by ≥8 points or both. Bivariate relationships between the outcome (treatment success) and the predictor variables were explored, followed by a forward stepwise logistic regression to predict a successful outcome. RESULTS Patients with more pain, better function, greater lateral core endurance, and less anterior core endurance were more likely to have a successful outcome after hip and core strengthening (88% sensitivity and 54% specificity). Patients with lower weight, weaker hip internal rotation, stronger hip extension, and greater trunk-extension endurance were more likely to have success after knee strengthening (82% sensitivity and 58% specificity). CONCLUSION The patients with PFP who have more baseline pain and yet maintain a high level of function may experience additional benefit from hip and core strengthening. The clinical prediction rules from this study remain in the developmental phase and should be applied with caution until externally validated.
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Affiliation(s)
| | - Lori A Bolgla
- Department of Physical Therapy, Augusta University, GA
| | - Carolyn Emory
- Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | | | - Sergey Tarima
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee
| | - Reed Ferber
- Faculty of Kinesiology, University of Calgary, Alberta, Canada
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Lack S, Neal B, De Oliveira Silva D, Barton C. How to manage patellofemoral pain - Understanding the multifactorial nature and treatment options. Phys Ther Sport 2018; 32:155-166. [PMID: 29793124 DOI: 10.1016/j.ptsp.2018.04.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 12/18/2022]
Abstract
Patellofemoral pain (PFP) is one of the most prevalent conditions within sports medicine, orthopaedic and general practice settings. Long-term treatment outcomes are poor, with estimates that more than 50% of people with the condition will report symptoms beyond 5 years following diagnosis. Additionally, emerging evidence indicates that PFP may be on a continuum with patellofemoral osteoarthritis. Consensus of world leading clinicians and academics highlights the potential benefit of delivering tailored interventions, specific to an individual's needs, to improve patient outcome. This clinical masterclass aims to develop the reader's understanding of PFP aetiology, inform clinical assessment and increase knowledge regarding individually tailored treatment approaches. It offers practical application guidance, and additional resources, that can positively impact clinical practice.
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Affiliation(s)
- Simon Lack
- Sports and Exercise Medicine, William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom; Pure Sports Medicine, London, United Kingdom.
| | - Bradley Neal
- Sports and Exercise Medicine, William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom; Pure Sports Medicine, London, United Kingdom
| | - Danilo De Oliveira Silva
- Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia; Laboratory of Biomechanics and Motor Control, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Christian Barton
- Sports and Exercise Medicine, William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom; Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
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Saad MC, Vasconcelos RAD, Mancinelli LVDO, Munno MSDB, Liporaci RF, Grossi DB. Is hip strengthening the best treatment option for females with patellofemoral pain? A randomized controlled trial of three different types of exercises. Braz J Phys Ther 2018; 22:408-416. [PMID: 29661570 DOI: 10.1016/j.bjpt.2018.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/14/2018] [Accepted: 03/22/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the effect of three types of exercise intervention in patients with patellofemoral pain and to verify the contributions of each intervention to pain control, function, and lower extremity kinematics. METHODS A randomized controlled, single-blinded trial was conducted. Forty women with patellofemoral pain were randomly allocated into four groups: hip exercises, quadriceps exercises, stretching exercises and a control group (no intervention). Pain (using a visual analog scale), function (using the Anterior Knee Pain Scale), hip and quadriceps strength (using a handheld isometric dynamometer) and measuring lower limb kinematics during step up and down activities were evaluated at baseline and 8 weeks post intervention. RESULTS All treatment groups showed significant improvements on pain and Anterior Knee Pain Scale after intervention with no statistically significant differences between groups except when compared to the control group. Only hip and quadriceps groups demonstrated improvements in muscle strength and knee valgus angle during the step activities. CONCLUSION Hip strengthening exercises were not more effective for pain relief and function compared to quadriceps or stretching exercises in females with patellofemoral pain. Only hip and quadriceps groups were able to decrease the incidence of dynamic valgus during step-down activity. This study was approved by Brazilian Clinical Trials Registry registration number: RBR-6tc7mj (http://www.ensaiosclinicos.gov.br/rg/RBR-6tc7mj/).
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Affiliation(s)
- Marcelo Camargo Saad
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil; Programa de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
| | | | | | - Matheus Soares de Barros Munno
- Curso de Fisioterapia,Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Rogério Ferreira Liporaci
- Programa de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Débora Bevilaqua Grossi
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
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Mehta BY, Bass AR, Goto R, Russell LA, Parks ML, Figgie MP, Goodman SM. Disparities in Outcomes for Blacks versus Whites Undergoing Total Hip Arthroplasty: A Systematic Literature Review. J Rheumatol 2018; 45:717-722. [DOI: 10.3899/jrheum.170855] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 01/13/2023]
Abstract
Objective.Total hip replacement (THA) surgery is a successful procedure, yet blacks in the United States undergo THA less often and reflect poorer outcomes than whites. The purpose of this study is to systematically review the literature on health-related quality of life after THA, comparing blacks and whites.Methods.A librarian-assisted search was performed in Medline through PubMed, Embase, and Cochrane Library on February 27, 2017. Original cohort studies examining pain, function, and satisfaction in blacks and whites 1 year after elective THA were included. Using the Patient/Population–Intervention–Comparison/Comparator–Outcome (PICO) process format, our population of interest was US black adults, our intervention was elective THA, our comparator was white adults, and our outcomes of interest were pain, function, and satisfaction after elective THA. The protocol was registered under the PROSPERO international register, and the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed.Results.Of the articles, 4739 were screened by title, 180 by abstract, 25 by full text, and 4 remained for analysis. The studies represented 1588 THA patients, of whom 240 (15%) were black. All studies noted more pain and worse function for blacks; although differences were statistically significant, they were not clinically significant. One study sought and identified less satisfaction for blacks after THA, and 1 study showed worse fear and anxiety scores in blacks.Conclusion.When measured, there are small differences in THA outcomes between blacks and whites, but most studies do not analyze/collect race. Future studies should address the effect of race and socioeconomic factors on healthcare disparities.
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Smith BE, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Smith TO, Logan P. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PLoS One 2018; 13:e0190892. [PMID: 29324820 PMCID: PMC5764329 DOI: 10.1371/journal.pone.0190892] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/21/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patellofemoral pain is considered one of the most common forms of knee pain, affecting adults, adolescents, and physically active populations. Inconsistencies in reported incidence and prevalence exist and in relation to the allocation of healthcare and research funding, there is a clear need to accurately understand the epidemiology of patellofemoral pain. METHODS An electronic database search was conducted, as well as grey literature databases, from inception to June 2017. Two authors independently selected studies, extracted data and appraised methodological quality. If heterogeneous, data were analysed descriptively. Where studies were homogeneous, data were pooled through a meta-analysis. RESULTS 23 studies were included. Annual prevalence for patellofemoral pain in the general population was reported as 22.7%, and adolescents as 28.9%. Incidence rates in military recruits ranged from 9.7-571.4/1,000 person-years, amateur runners in the general population at 1080.5/1,000 person-years and adolescents amateur athletes 5.1%-14.9% over 1 season. One study reported point prevalence within military populations as 13.5%. The pooled estimate for point prevalence in adolescents was 7.2% (95% Confidence Interval: 6.3%-8.3%), and in female only adolescent athletes was 22.7% (95% Confidence Interval 17.4%-28.0%). CONCLUSION This review demonstrates high incidence and prevalence levels for patellofemoral pain. Within the context of this, and poor long term prognosis and high disability levels, PFP should be an urgent research priority. PROSPERO REGISTRATION CRD42016038870.
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Affiliation(s)
- Benjamin E Smith
- Derby Teaching Hospitals NHS Foundation Trust, London Road Community Hospital, Derby, United Kingdom
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Damian Thacker
- PhysioWorks (Sheffield), Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, United Kingdom
| | - Marcus Bateman
- Derby Teaching Hospitals NHS Foundation Trust, London Road Community Hospital, Derby, United Kingdom
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, United Kingdom
| | - 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
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Mølgaard CM, Rathleff MS, Andreasen J, Christensen M, Lundbye-Christensen S, Simonsen O, Kaalund S. Foot exercises and foot orthoses are more effective than knee focused exercises in individuals with patellofemoral pain. J Sci Med Sport 2017; 21:10-15. [PMID: 28844333 DOI: 10.1016/j.jsams.2017.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 04/10/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To examine the effect of knee targeted exercises compared to knee targeted exercises combined with foot targeted exercises and foot orthoses in patients with patellofemoral pain. DESIGN Forty adult individuals (28 women, 12 men) diagnosed with patellofemoral pain and screened for excessive calcaneal eversion were randomized to knee targeted exercises or knee targeted exercises combined with foot targeted exercise and orthoses. METHODS The knee targeted exercises were prescribed during three supervised consultations. Individuals were instructed to perform the exercises 3 times per week during a 12-week period. The foot targeted exercises were prescribed for 2 times per week for 12 weeks with one session per week being supervised by a physiotherapist. The primary outcome was the subscale "pain" in the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 4 months. RESULTS Individuals randomized to knee targeted exercises combined with foot targeted exercises and foot orthoses had 8.9 points (95%CI: 0.4; 17.4) - NNT=3 (2-16) larger improvement in KOOS pain at the primary endpoint. CONCLUSIONS The addition of foot targeted exercises and foot orthoses for 12 weeks was more effective than knee targeted exercises alone in individuals with patellofemoral pain. The effect was apparent after 4 months, but not significantly different after 12 months.
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Affiliation(s)
- Carsten M Mølgaard
- Department of Occupational therapy and Physiotherapy, Aalborg University Hospital, Denmark; Orthopaedic Surgery Research Unit, Aalborg University Hospital, Denmark.
| | - Michael Skovdal Rathleff
- Department of Occupational therapy and Physiotherapy, Aalborg University Hospital, Denmark; Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Denmark
| | - Jane Andreasen
- Department of Occupational therapy and Physiotherapy, Aalborg University Hospital, Denmark
| | - Marianne Christensen
- Department of Occupational therapy and Physiotherapy, Aalborg University Hospital, Denmark
| | | | - Ole Simonsen
- Orthopaedic Surgery Research Unit, Aalborg University Hospital, Denmark
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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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de Oliveira Silva D, Magalhães FH, Faria NC, Ferrari D, Pazzinatto MF, Pappas E, de Azevedo FM. Vastus Medialis Hoffmann Reflex Excitability Is Associated With Pain Level, Self-Reported Function, and Chronicity in Women With Patellofemoral Pain. Arch Phys Med Rehabil 2017; 98:114-119. [DOI: 10.1016/j.apmr.2016.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 06/19/2016] [Accepted: 06/20/2016] [Indexed: 01/25/2023]
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Culvenor A, Boeth H, Diederichs G, Wirth W, Duda G, Eckstein F. Longitudinal bone, muscle and adipose tissue changes in physically active subjects - sex differences during adolescence and maturity. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2016; 16:237-46. [PMID: 27609038 PMCID: PMC5114346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 10/29/2022]
Abstract
OBJECTIVES To explore changes in bone, muscle and adipose tissue composition in athletes with high physical activity levels at different stages of life. METHODS Thigh MRIs were acquired at baseline and 2-year follow-up for 20 young (16±1 years) and 20 mature (46±5 years) athletes (10 males, 10 females, respectively). Longitudinal changes in cross-sectional areas (CSAs) of femoral bone, quadriceps muscle, and thigh subcutaneous (SCF) and intermuscular (IMF) adipose tissue were evaluated. RESULTS Adolescent males displayed significant muscle (+5.0%, 95%CI: 0.8, 9.2) and bone growth (+2.9%, 95%CI: 1.3, 4.5), whereas adolescent females did not (muscle: +0.8%, 95%CI: -2.2, 3.8; bone: +1.9%, 95%CI: -2.1, 5.6). Adolescent and mature females showed significant SCF increases (+11.0%, 95%CI: 0.9, 21.1 and +6.0%, 95%CI: 0.6, 11.4, respectively), whereas adolescent and mature males did not (+7.2%, 95%CI: -8.0, 22.5 and +1.5%, 95%CI: -9.7, 11.8, respectively). Muscle and bone changes were highly correlated in adolescent males (r=0.66), mature males (r=0.75) and mature females (r=0.68) but not in adolescent females (r=-0.11). CONCLUSIONS The results suggest sex-specific patterns of age-related change in bone, muscle and adipose tissue, and tight coupling of bone and muscle growth. Sex-specific bone-muscle-adipose tissue relationships may have implications for understanding sex differences in fracture risk.
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Affiliation(s)
- A.G. Culvenor
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremburg, Salzburg, Austria
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - H. Boeth
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Centre for Sports Science and Sports Medicine Berlin, Germany
| | - G. Diederichs
- Department of Radiology, Charité-Universitätsmedizin Berlin, Germany
| | - W. Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremburg, Salzburg, Austria
- Chondrometrics GmbH, Ainring, Germany
| | - G. Duda
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Centre for Sports Science and Sports Medicine Berlin, Germany
| | - F. Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremburg, Salzburg, Austria
- Chondrometrics GmbH, Ainring, Germany
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Woznowski-Vu A, Da Costa C, Turgeon-Provost F, Dagenais K, Roy-Mathie B, Aggban M, Preuss R. Factors Affecting Length of Stay in Adult Outpatient Physical Rehabilitation: A Scoping Review of the Literature. Physiother Can 2016; 67:329-40. [PMID: 27504032 DOI: 10.3138/ptc.2014-75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To identify factors affecting length of stay (LOS) for adults participating in outpatient physical or occupational therapy programmes. METHOD A scoping review of the literature was conducted using the Ovid MEDLINE, EMBASE, CINAHL, AMED, and Cochrane Library databases. RESULTS A total of 19 articles were retained from the search, and 2 additional articles were retrieved from grey literature (i.e., non-published sources). Personal factors affecting LOS are age and sex, both of which had inconsistent effects on LOS, and communication, language, physical, and cognitive difficulties, for which higher levels of function were generally associated with shorter LOS. Institutional factors affecting LOS were location, interdisciplinary communication, number of disciplines involved, and type of rehabilitation setting. Finally, two clinician-related factors-fewer treatment goals and a selection of evidence-informed treatment techniques-were associated with shorter LOS. CONCLUSIONS Research on factors affecting adult outpatient rehabilitation LOS is limited and inconsistent. A preliminary list of LOS factors was produced, but this topic should be further explored with the collaboration of researchers and clinical institutions.
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Affiliation(s)
| | | | | | | | | | - Martina Aggban
- School of Physical and Occupational Therapy, McGill University
| | - Richard Preuss
- School of Physical and Occupational Therapy, McGill University; Constance Lethbridge Rehabilitation Centre, Centre de recherche interdisciplinaire en réadaptation, Montreal
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Pazzinatto MF, de Oliveira Silva D, Barton C, Rathleff MS, Briani RV, de Azevedo FM. Female Adults with Patellofemoral Pain Are Characterized by Widespread Hyperalgesia, Which Is Not Affected Immediately by Patellofemoral Joint Loading. PAIN MEDICINE 2016; 17:1953-1961. [DOI: 10.1093/pm/pnw068] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Myer GD, Barber Foss KD, Gupta R, Hewett TE, Ittenbach RF. Analysis of patient-reported anterior knee pain scale: implications for scale development in children and adolescents. Knee Surg Sports Traumatol Arthrosc 2016; 24:653-60. [PMID: 24781273 PMCID: PMC4214896 DOI: 10.1007/s00167-014-3004-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 04/09/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this investigation was to estimate and document the reliability and validity of the Anterior Knee Pain Scale (AKPS) and to estimate its relative prediction accuracy of anterior knee pain in young females. METHODS Data from a prospective, epidemiologic study to diagnose patellofemoral knee pain among female athletes (n = 499) using the Anterior Knee Pain Scale (AKPS). Data were treated in 4 phases (descriptive phase, reliability phase, scale refinement phase) and a final validation stage that was focused on an effort to test and document the validation of the AKPS short form and perform head-to-head comparisons of the 6-item short form with the original, 13-item form. RESULTS The AKPS was reduced from 13 items (αCoeff = 0.77, σSEM = 0.004) to 6 items (αCoeff = 0.78, σSEM = 0.004). Point-biserial correlations with patellofemoral pain diagnosis were comparable: r [498] = 0.70 (R(2) = 0.49, short form) and r [498] = 0.71 (R(2) = 0.51, long form), as was sensitivity: 84% (short form) and 80% (long form), and specificity: 89% (short form) and 90% (long form; AUC = 0.94 both). CONCLUSION The current analyses indicate that a subset of measures from the AKPS is responsive to patellofemoral pain symptoms and may support screening for related diagnoses. A simpler and quicker scale optimized for diagnostic accuracy could reduce the demand on patients, clinicians and research teams focused on the identification and management of patellofemoral pain. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gregory D. Myer
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue; MLC 10001, Cincinnati, OH 45229, USA,Department of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH, USA,Sports Medicine Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA,Micheli Center for Sports Injury Prevention, Boston, MA, USA
| | - Kim D. Barber Foss
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue; MLC 10001, Cincinnati, OH 45229, USA,Division of Health Sciences, Department of Athletic Training, College of Mount St. Joseph, Cincinnati, OH, USA
| | - Resmi Gupta
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Timothy E. Hewett
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue; MLC 10001, Cincinnati, OH 45229, USA,Department of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH, USA,Sports Medicine Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA,Department of Physiology and Cell Biology, The Ohio State University, Columbus, OH, USA,Department Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA,Department Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Richard F. Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Rathleff MS, Petersen KK, Arendt-Nielsen L, Thorborg K, Graven-Nielsen T. Impaired Conditioned Pain Modulation in Young Female Adults with Long-Standing Patellofemoral Pain: A Single Blinded Cross-Sectional Study. PAIN MEDICINE 2015; 17:980-8. [DOI: 10.1093/pm/pnv017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 09/05/2015] [Indexed: 12/21/2022]
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Green A, Liles C, Rushton A, Kyte DG. Reply to Selfe (2014) letter to the editor on: measurement properties of patient-reported outcome measures (PROMS) in patellofemoral pain syndrome: a systematic review. MANUAL THERAPY 2015; 20:e7. [PMID: 25487345 DOI: 10.1016/j.math.2014.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 10/28/2014] [Indexed: 06/04/2023]
Affiliation(s)
- Andrew Green
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK.
| | - Clive Liles
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Derek G Kyte
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Can we predict which patients with patellofemoral pain are more likely to benefit from exercise therapy? A secondary exploratory analysis of a randomized controlled trial. J Orthop Sports Phys Ther 2015; 45:183-9. [PMID: 25627152 DOI: 10.2519/jospt.2015.5583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Secondary exploratory analysis of a randomized controlled trial comparing supervised exercise therapy to usual care in patients with patellofemoral pain (PFP). OBJECTIVE To explore which patients with PFP are more likely to benefit from exercise therapy. BACKGROUND Patellofemoral pain is a common condition for which exercise therapy is effective in reducing pain and improving function. However, not all patients benefit from exercise therapy. METHODS The present study explored patient characteristics that might interact with treatment effects of PFP in 131 patients treated with usual care or exercise therapy. These characteristics were tested for interaction with treatment in a regression analysis. The primary outcomes were function and pain on activity at a 3-month follow-up. RESULTS None of the tested variables had a significant interaction with treatment. A positive trend was seen for females with PFP: they were more likely to report higher function scores with exercise therapy than with usual care compared to males with PFP (β = 12.1; 95% confidence interval: 0.23, 24.0; P = .05). A positive trend was seen for patients with a longer duration of complaints (greater than 6 months); they were more likely to report higher function scores and to have less pain on activity with exercise therapy than with usual care compared to those with a shorter duration of complaints (β = 12.3; 95% confidence interval: -0.08, 24.7; P = .05 and β = -1.74; 95% confidence interval: -3.90, 0.43; P = .12, respectively). CONCLUSION Two factors, sex and duration of complaints, may have a predictive value for response to exercise therapy at 3-month follow-up. Due to the exploratory design of the study, future research should confirm this tendency.
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Briani RV, Silva DDO, Pazzinatto MF, Albuquerque CED, Ferrari D, Aragão FA, Azevedo FMD. Comparison of frequency and time domain electromyography parameters in women with patellofemoral pain. Clin Biomech (Bristol, Avon) 2015; 30:302-7. [PMID: 25583618 DOI: 10.1016/j.clinbiomech.2014.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite its high incidence, patellofemoral pain etiology remains unclear. No prior study has compared surface electromyography frequency domain parameters and surface electromyography time domain variables, which have been used as a classic analysis of patellofemoral pain. METHODS Thirty one women with patellofemoral pain and twenty eight pain-free women were recruited. Each participant was asked to descend a seven step staircase and data from five successful trials were collected. During the task, the vastus medialis and vastus lateralis muscle activities were monitored by surface electromyography. The data were processed and analyzed in four variables of the frequency domain (median frequency, low, medium and high frequency bands) and three time domain variables (Automatic, Cross-correlation and Visual Onset between the vastus medialis and vastus lateralis muscles). Reliability, Receiver Operating Characteristic curves and regression models were performed. FINDINGS The medium frequency band was the most reliable variable and different between the groups for both muscles, also demonstrated the best values of sensitivity and sensibility, 72% and 69% for the vastus medialis and 68% and 62% for the vastus lateralis, respectively. The frequency variables predicted the pain of individuals with patellofemoral pain, 26% for the vastus medialis and 20% for the vastus lateralis, being better than the time variables, which achieved only 7%. INTERPRETATION The frequency domain parameters presented greater reliability, diagnostic accuracy and capacity to predict pain than the time domain variables during stair descent and might be a useful tool to diagnose individuals with patellofemoral pain.
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Affiliation(s)
- Ronaldo Valdir Briani
- Department of Physical Therapy, State University of West Parana, Research Laboratory of Human Movement, Cascavel, PR, Brazil; Department of Physical Therapy, University of São Paulo State, School of Science and Technology, Laboratory of Biomechanics and Motor Control, Presidente Prudente, SP, Brazil
| | - Danilo de Oliveira Silva
- Department of Physical Therapy, University of São Paulo State, School of Science and Technology, Laboratory of Biomechanics and Motor Control, Presidente Prudente, SP, Brazil
| | - Marcella Ferraz Pazzinatto
- Department of Physical Therapy, University of São Paulo State, School of Science and Technology, Laboratory of Biomechanics and Motor Control, Presidente Prudente, SP, Brazil
| | - Carlos Eduardo de Albuquerque
- Department of Physical Therapy, State University of West Parana, Research Laboratory of Human Movement, Cascavel, PR, Brazil
| | - Deisi Ferrari
- University of São Paulo, Post-graduation Program Interunits Bioengineering, EESC/FMRP/IQSC-USP, São Carlos, Brazil
| | - Fernando Amâncio Aragão
- Department of Physical Therapy, State University of West Parana, Research Laboratory of Human Movement, Cascavel, PR, Brazil
| | - Fábio Mícolis de Azevedo
- Department of Physical Therapy, University of São Paulo State, School of Science and Technology, Laboratory of Biomechanics and Motor Control, Presidente Prudente, SP, Brazil.
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Huang BY, Shih YF, Chen WY, Ma HL. Predictors for identifying patients with patellofemoral pain syndrome responding to femoral nerve mobilization. Arch Phys Med Rehabil 2015; 96:920-7. [PMID: 25576086 DOI: 10.1016/j.apmr.2015.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/19/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify the predictors for successful neurodynamic management in patients with patellofemoral pain syndrome. DESIGN Prospective cohort, prediction rule study. SETTING Hospital. PARTICIPANTS Patients with patellofemoral pain syndrome (N=51) underwent clinical examination and measurement of physical parameters, including femoral slump test, lower-extremity alignment, flexibility and muscle strength, and functional level. INTERVENTION Patients received 6 treatment sessions of femoral nerve mobilization within 2 weeks. MAIN OUTCOME MEASURES Pain level during functional testing was assessed before and after the first and sixth session of treatment. Patients were then grouped into responder and nonresponder groups. Criteria for the responder group was a pain score decrease ≥50% or Global Rating Scale score ≥4. Chi-square and independent t tests were used to identify potential variables with a significance level of .10, and stepwise logistic regression was used to find predictors with a significance level of .05. RESULTS Twenty-five patients responded to the initial treatment (immediate effect), and 28 patients responded after 6 sessions (longer-term effect). A positive femoral slump test was identified as the predictor for the immediate treatment effect. The prediction factors for the longer-term effect included responding to femoral nerve mobilization the first time and a bilateral difference in hip extension angles. Application of the clinical predictors improved the success rate to 90% for 1 treatment session and 93% for 6 treatment sessions. CONCLUSIONS Clinicians could use the positive femoral slump test and a bilateral difference in hip extension angles during the femoral slump test to determine whether or not patients with patellofemoral pain syndrome might benefit from femoral nerve mobilization.
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Affiliation(s)
- Bing-Yao Huang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan; Department of Rehabilitation, Daqian General Hospital, Miaoli, Taiwan
| | - Yi-Fen Shih
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
| | - Wen-Yin Chen
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Li Ma
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan
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J. Khadavi M, Chen YT, Fredericson M. A Novel Knee Orthosis in the Treatment of Patellofemoral Pain Syndrome. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojtr.2015.32008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rathleff CR, Cavallius C, Jensen HP, Simonsen OH, Rasmussen S, Kaalund S, Østgaard SE. Successful conservative treatment of patients with MRI-verified meniscal lesions. Knee Surg Sports Traumatol Arthrosc 2015; 23:178-83. [PMID: 23575649 DOI: 10.1007/s00167-013-2494-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 04/03/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE To follow a prospective cohort of consecutive patients with MRI-verified meniscal lesions to identify pre-treatment prognostic factors for long-term results following arthroscopic or conservative treatment. METHODS In the course of 1 year, 291 patients with knee pain and clinically suspected of meniscal lesion were referred to the regional orthopaedic division and subjected to MRI and clinical examination by an experienced surgeon. Patients with MRI-verified meniscal lesions were treated according to an arthroscopy restrictive strategy meaning that treatment was initiated by conservative treatment. Arthroscopy was only performed if satisfying pain relief was not obtained. The Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were obtained at baseline and after 12-24 months. A multiple linear regression model was used to investigate which pre-treatment prognostic factors were associated with improvement in the KOOS subscale pain from baseline to follow-up. RESULTS An MRI-verified meniscal lesion was found in 185 patients (64%). Among these, 58% were treated successfully by conservative treatment. A high KOOS subscale pain score at baseline was associated with less improvement from baseline to follow-up. Bucket-handle lesions were associated with larger improvement from baseline to follow-up compared to flap-tear lesions. CONCLUSION MRI findings and clinical status measured by KOOS subscale pain are prognostic for improvement among patients treated for MRI-verified meniscal lesions. Good results were observed for both operative and conservative treatment. The success rate for conservative treatment was 58%. LEVEL OF EVIDENCE Prospective cohort study, Level II.
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Affiliation(s)
- Camilla Rams Rathleff
- Orthopaedic Surgery Research Unit, Research and Innovation Center, Aalborg University Hospital, 15 Soendre Skovvej, 9000, Aalborg, Denmark ,
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Kastelein M, Luijsterburg PAJ, Heintjes EM, van Middelkoop M, Verhaar JAN, Koes BW, Bierma-Zeinstra SMA. The 6-year trajectory of non-traumatic knee symptoms (including patellofemoral pain) in adolescents and young adults in general practice: a study of clinical predictors. Br J Sports Med 2014; 49:400-5. [DOI: 10.1136/bjsports-2014-093557] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rathleff MS, Roos EM, Olesen JL, Rasmussen S. Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofemoral pain: a cluster randomised trial. Br J Sports Med 2014; 49:406-12. [DOI: 10.1136/bjsports-2014-093929] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Scattone Silva R, Serrão FV. Sex differences in trunk, pelvis, hip and knee kinematics and eccentric hip torque in adolescents. Clin Biomech (Bristol, Avon) 2014; 29:1063-9. [PMID: 25190109 DOI: 10.1016/j.clinbiomech.2014.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adolescents have a high incidence of knee joint dysfunctions, with up to 28% of adolescents reporting knee pain. Although adolescent females have a greater incidence of knee injuries in comparison to males, few studies conducted biomechanical evaluations in this population aiming to identify sex differences. If trunk and/or lower limb biomechanical impairments are identified in female adolescents, the implementation of early interventions for injury prevention will be better justified. The purpose of this study was to compare the trunk, pelvis, hip and knee kinematics during a single-leg squat task, as well as the isokinetic eccentric hip torque, between male and female healthy adolescents. METHODS Forty-four healthy adolescents were divided into two groups, group of males (n=22) and group of females (n=22). Kinematics during single-leg squat were assessed using a electromagnetic tracking system. For the evaluation of eccentric hip torque in the three planes an isokinetic dynamometer was used. Group differences were assessed using a one-way multivariate analysis of variance. FINDINGS Results showed that adolescent females presented greater hip adduction, hip external rotation and knee abduction, as well as smaller trunk flexion during single-leg squat in comparison to males. Additionally, adolescent females showed smaller isokinetic eccentric hip torque normalized by body mass in all planes in comparison to males. INTERPRETATION These sex differences in terms of trunk/lower limb kinematics and eccentric hip torque generation might play an important role in the greater incidence of overuse knee injuries observed in adolescent females.
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Affiliation(s)
- Rodrigo Scattone Silva
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, SP, Brazil
| | - Fábio Viadanna Serrão
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, SP, Brazil.
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Outcome Predictors for Conservative Patellofemoral Pain Management: A Systematic Review and Meta-Analysis. Sports Med 2014; 44:1703-16. [DOI: 10.1007/s40279-014-0231-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Green A, Liles C, Rushton A, Kyte DG. Measurement properties of patient-reported outcome measures (PROMS) in Patellofemoral Pain Syndrome: a systematic review. ACTA ACUST UNITED AC 2014; 19:517-26. [PMID: 24997774 DOI: 10.1016/j.math.2014.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/14/2014] [Accepted: 05/21/2014] [Indexed: 02/03/2023]
Abstract
This systematic review investigated the measurement properties of disease-specific patient-reported outcome measures used in Patellofemoral Pain Syndrome. Two independent reviewers conducted a systematic search of key databases (MEDLINE, EMBASE, AMED, CINHAL+ and the Cochrane Library from inception to August 2013) to identify relevant studies. A third reviewer mediated in the event of disagreement. Methodological quality was evaluated using the validated COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) tool. Data synthesis across studies determined the level of evidence for each patient-reported outcome measure. The search strategy returned 2177 citations. Following the eligibility review phase, seven studies, evaluating twelve different patient-reported outcome measures, met inclusion criteria. A 'moderate' level of evidence supported the structural validity of several measures: the Flandry Questionnaire, Anterior Knee Pain Scale, Functional Index Questionnaire, Eng and Pierrynowski Questionnaire and Visual Analogue Scales for 'usual' and 'worst' pain. In addition, there was a 'Limited' level of evidence supporting the test-retest reliability and validity (cross-cultural, hypothesis testing) of the Persian version of the Anterior Knee Pain Scale. Other measurement properties were evaluated with poor methodological quality, and many properties were not evaluated in any of the included papers. Current disease-specific outcome measures for Patellofemoral Pain Syndrome require further investigation. Future studies should evaluate all important measurement properties, utilising an appropriate framework such as COSMIN to guide study design, to facilitate optimal methodological quality.
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Affiliation(s)
- Andrew Green
- The Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK.
| | - Clive Liles
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Derek G Kyte
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Simon CB, Stryker SE, George SZ. Assessing the influence of treating therapist and patient prognostic factors on recovery from axial pain. J Man Manip Ther 2014; 21:187-95. [PMID: 24421631 DOI: 10.1179/2042618613y.0000000035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Limited research exists regarding the influence of a treating physical therapist on patient recovery (deemed therapist effects). Recent randomized clinical trials data provide an indication of small therapist effects for manual therapy; however, the extent to which therapist effects exist in the average outpatient facility is not clear. Moreover, patient-related prognostic factors, like fear-avoidance or pain duration, are important to consider since these may also influence the extent of therapist effects. OBJECTIVE To assess therapist effects and the influence of patient prognostic factors on recovery from axial pain in an outpatient orthopedic physical therapy facility. METHODS Clinical data were collected from consecutive patients with musculoskeletal neck and low back pain. Patient outcomes included pain intensity (visual analog scale) and functional measure (CareConnections functional outcomes index) scores. Therapist effects estimates and the influence of intake fear-avoidance (fear-avoidance beliefs questionnaire) and pain duration (days) were examined using multilevel linear or regression modeling. RESULTS A total of 258 patients (160 females; mean age 46.4±14.9 years) completed physical therapy and the required outcome measures. Five physical therapists (1-13 years of experience, mean 5.8 years) provided treatment. Therapists effects did not exist for discharge pain intensity or function after accounting for intake scores (P > 0.05). Further, therapist experience did not influence patient outcomes. Patient prognostic factors of fear-avoidance and pain duration did not influence therapists effects on the same patient outcome measures (P > 0.05). DISCUSSION Preliminary findings suggest that there are no major differences in patient outcome based on either the individual therapist (therapist effect) or therapist experience in this type of PT setting. Established prognostic factors had no influence on therapist effects for this cohort. Future analyses should consider intrinsic therapist factors (beliefs, equipoise), specific treatment parameters (dosage, type), and other patient prognostic factors (psychological, age, expectation, satisfaction) to further elucidate the influence of therapist effects.
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Affiliation(s)
- Corey B Simon
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | | | - Steven Z George
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA ; Center for Pain Research and Behavioral Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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Rathleff MS, Roos EM, Olesen JL, Rasmussen S. High prevalence of daily and multi-site pain--a cross-sectional population-based study among 3000 Danish adolescents. BMC Pediatr 2013; 13:191. [PMID: 24252440 PMCID: PMC3840664 DOI: 10.1186/1471-2431-13-191] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 11/15/2013] [Indexed: 12/15/2022] Open
Abstract
Background Daily pain and multi-site pain are both associated with reduction in work ability and health-related quality of life (HRQoL) among adults. However, no population-based studies have yet investigated the prevalence of daily and multi-site pain among adolescents and how these are associated with respondent characteristics. The purpose of this study was to investigate the prevalence of self-reported daily and multi-site pain among adolescents aged 12–19 years and associations of almost daily pain and multi-site pain with respondent characteristics (sex, age, body mass index, HRQoL and sports participation). Methods A population-based cross-sectional study was conducted among 4,007 adolescents aged 12–19 years in Denmark. Adolescents answered an online questionnaire during physical education lessons. The questionnaire contained a mannequin divided into 12 regions on which the respondents indicated their current pain sites and pain frequency (rarely, monthly, weekly, more than once per week, almost daily pain), characteristics, sports participation and HRQoL measured by the EuroQoL 5D. Multivariate regression was used to calculate the odds ratio for the association between almost daily pain, multi-site pain and respondent characteristics. Results The response rate was 73.7%. A total of 2,953 adolescents (62% females) answered the questionnaire. 33.3% reported multi-site pain (pain in >1 region) while 19.8% reported almost daily pain. 61% reported current pain in at least one region with knee and back pain being the most common sites. Female sex (OR: 1.35-1.44) and a high level of sports participation (OR: 1.51-2.09) were associated with increased odds of having almost daily pain and multi-site pain. Better EQ-5D score was associated with decreased odds of having almost daily pain or multi-site pain (OR: 0.92-0.94). Conclusion In this population-based cohort of school-attending Danish adolescents, nearly two out of three reported current pain and, on average, one out of three reported pain in more than one body region. Female sex, and high level of sports participation were associated with increased odds of having almost daily pain and multi-site pain. The study highlights an important health issue that calls for investigations to improve our understanding of adolescent pain and our capacity to prevent and treat this condition.
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Affiliation(s)
- Michael S Rathleff
- HEALTH, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark.
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Karstens S, Hermann K, Froböse I, Weiler SW. Predictors for patients with knee complaints receiving physiotherapy. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013. [DOI: 10.3109/21679169.2013.852241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Lower mechanical pressure pain thresholds in female adolescents with patellofemoral pain syndrome. J Orthop Sports Phys Ther 2013; 43:414-21. [PMID: 23508216 DOI: 10.2519/jospt.2013.4383] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To compare pressure pain thresholds (PPTs) between adolescent females diagnosed with patellofemoral pain syndrome (PFPS) and gender- and age-matched controls without musculoskeletal pain. BACKGROUND PFPS is prevalent among adolescents and may be associated with reduced PPT both locally and remotely from the site of reported pain. This may indicate altered central processing of nociceptive information. However, this has never been investigated in adolescents with PFPS. METHODS Adolescents with PFPS and a comparison group without musculoskeletal pain were recruited from a population-based cohort of students from 4 upper secondary schools, aged 15 to 19 years. All 2846 students within that age range were invited to answer an online questionnaire regarding musculoskeletal pain. The students who reported knee pain were contacted by telephone and offered a clinical examination by an experienced rheumatologist, who made a diagnosis. PPTs were measured at 4 sites around the knee and 1 site on the tibialis anterior in the 57 female adolescents diagnosed with PFPS and in 22 female adolescents without musculoskeletal pain. RESULTS Adolescents with PFPS, compared to controls, had significantly lower PPTs (26%-37% [100-178 kPa]) at each of the 4 sites around the knee, suggesting localized hyperalgesia. On the tibialis anterior, adolescents with PFPS had a 33% (159 kPa) lower PPT (distal hyperalgesia) compared with controls. CONCLUSION These findings suggest that adolescent females with PFPS have localized and distal hyperalgesia. These findings may have implications for treating PFPS, as both peripheral and central mechanisms may be driving the pain. Registered at clinicaltrials.gov (NCT01438762).
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Myer GD, Faigenbaum AD, Foss KB, Xu Y, Khoury J, Dolan LM, McCambridge TM, Hewett TE. Injury initiates unfavourable weight gain and obesity markers in youth. Br J Sports Med 2013; 48:1477-81. [PMID: 23673521 DOI: 10.1136/bjsports-2012-091988] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the association of knee injuries with subsequent changes in body mass index and body composition during maturation in young females. METHODS A prospective longitudinal study design was employed to evaluate young females active in soccer or basketball (N=862). Participants who completed at least 1-year follow-up to provide consecutive annual measures of BMIZ and %fat were included in the study analysis to determine the effect of knee injuries on the trajectory of these obesity markers in youth. RESULTS Of the 71 reported knee injuries, 12 (17%) occurred in athletes at the prepubertal stage, 24 (34%) in athletes at the pubertal stage, and 35 (49%) in postpubertal athletes. Controlling for the effects of maturation, female athletes who reported knee injury demonstrated a greater yearly increase in BMIZ (LS means and 95% CI for the injured group=0.039 (-0.012 to 0.089), for the non-injured group=-0.019 (-0.066 to 0.029), and group difference=0.057 (0.005 to 0.11), p=0.03) and in %body fat (LS means and 95% CI for the injured group=1.05 (0.45 to 1.65), for the non-injured group=0.22 (-0.21 to 0.064), and group difference=0.83 (0.21 to 1.45), p=0.009), compared to those without knee injuries. This indicates that the athletes with knee injuries will increase their body mass index percentile by up to 5 units more than someone of the same age without an injury, and in body fat by up to 1.5%, compared to their non-injured peers. CONCLUSIONS The present findings indicate that knee injury during the growing years may be associated with unfavourable changes in body composition.
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Affiliation(s)
- Gregory D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Athletic Training Division, School of Allied Medical Professions, Ohio State University, Columbus, Ohio, USA
| | - Avery D Faigenbaum
- Department of Health and Exercise Science, The College of New Jersey, Ewing, New Jersey, USA
| | - Kim Barber Foss
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Health Sciences, Department of Athletic Training, College of Mount St. Joseph, Cincinnati, Ohio, USA
| | - Yingying Xu
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jane Khoury
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lawrence M Dolan
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Teri M McCambridge
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Timothy E Hewett
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Departments of Physiology and Cell Biology, Family Medicine and of Orthopaedic Surgery and Biomedical Engineering, The Ohio State University, Columbus, Ohio and University of Cincinnati, Cincinnati, Ohio, USA
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Pattyn E, Mahieu N, Selfe J, Verdonk P, Steyaert A, Witvrouw E. What predicts functional outcome after treatment for patellofemoral pain? Med Sci Sports Exerc 2013; 44:1827-33. [PMID: 22617398 DOI: 10.1249/mss.0b013e31825d56e3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Although physical therapy is known to be effective in treating patellofemoral pain (PFP), there is considerable individual variation in the treatment response. It is unclear why some patients benefit from a specific treatment while others do not experience improvement. This study, using a prospective study design, aims to identify factors that could predict the short-term functional outcome and account for the variation frequently seen in the outcome after conservative treatment of PFP. METHODS Thirty-six patients (20 female and 16 male with a mean age of 23.8 ± 6.7 yr) followed a physical therapy rehabilitation program of 7 wk. Before this treatment, all patients were evaluated on subjective symptoms (pain on visual analog scales in millimeters) and functional performance (step test expressed as highest level, single-legged hop test in centimeters, and triple-hop test in centimeters). The concentric and eccentric knee extensor strength at 60°.s(-1) and 240°.s(-1) (N.m) were measured as well as the quadriceps muscle size by calculating the cross-sectional area (cm(2)) with magnetic resonance imaging. The success of the treatment was evaluated by the functional Kujala anterior knee pain scale. A linear regression model was used to identify predisposing factors for the functional outcome. RESULTS The total quadriceps cross-sectional area (P = 0.010), the eccentric average peak torque at 60°.s(-1) (P = 0.015), and the frequency of pain at baseline (P = 0.012) have been indicated as predisposing variables in the short-term functional outcome after a physical therapy rehabilitation program for PFP (adjusted R(2) = 0.46). CONCLUSION Patients with a greater quadriceps muscle size, lower eccentric knee strength, and less pain have a better short-term functional outcome after conservative treatment for PFP.
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Affiliation(s)
- Els Pattyn
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3B3, Ghent, Belgium.
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