1
|
Blazey P, Scott A, Ardern CL, Davis JC, Whittaker JL, Losciale JM, Khan KM. Consensus methods in patellofemoral pain: how rigorous are they? A scoping review. Br J Sports Med 2024; 58:733-744. [PMID: 38777386 PMCID: PMC11228197 DOI: 10.1136/bjsports-2023-107552] [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] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Clinicians treating patients with patellofemoral pain (PFP) rely on consensus statements to make the best practice recommendations in the absence of definitive evidence on how to manage PFP. However, the methods used to generate and assess agreement for these recommendations have not been examined. Our objective was to map the methods used to generate consensus-based recommendations for PFP and apply four novel questions to assess the rigour of consensus development. DESIGN Scoping review. DATA SOURCES We searched Medline, SPORTDiscus, CINAHL and Embase from inception to May 2022 to identify consensus-derived statements or practice guidelines on PFP. The Joanna Briggs Institute Manual for Evidence Synthesis was followed to map the existing evidence. We measured the consensus methods based on four sets of questions addressing the panel composition, application of the consensus method chosen, agreement process and the use of evidence mapping. ELIGIBILITY CRITERIA All consensus statements or clinical guidelines on PFP were considered. RESULTS Twenty-two PFP consensus statements were identified. Panel composition: 3 of the 22 (14%) consensus groups reported the panellists' experience, 2 (9%) defined a desired level of expertise, 10 (45%) reported panellist sex and only 2 (9%) included a patient. Consensus method: 7 of 22 (32%) reported using an established method of consensus measurement/development. Agreement process: 10 of 22 (45%) reported their consensus threshold and 2 (9%) acknowledged dissenting opinions among the panel. Evidence mapping: 6 of 22 (27%) reported using systematic methods to identify relevant evidence gaps. CONCLUSIONS PFP consensus panels have lacked diversity and excluded key partners including patients. Consensus statements on PFP frequently fail to use recognised consensus methods, rarely describe how 'agreement' was defined or measured and often neglect to use systematic methods to identify evidence gaps.
Collapse
Affiliation(s)
- Paul Blazey
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Alex Scott
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Clare L Ardern
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Jennifer C Davis
- Applied Health Economics Laboratory, Faculty of Management, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Karim M Khan
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
Mohamadi M, Meftahi N, Javidi-Alsaadi P. Comparison of tactile acuity between patients with chronic patellofemoral pain with central sensitization and healthy persons: A cross-sectional study. Physiother Theory Pract 2024:1-7. [PMID: 38165123 DOI: 10.1080/09593985.2023.2300040] [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: 06/26/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a common multifactorial condition in young and physically active people. OBJECTIVE The occurrence of central sensitization may play an important role in sensory disturbance. This study was designed to investigate, in patients with chronic PFP, the presence of disturbances in tactile acuity with central sensitization. METHODS Thirty patients with chronic PFP and 30 matched healthy controls entered this cross-sectional study. Graphesthesia (numerical score), two-point discrimination (mm), and point-to-point sensation (mm) were assessed in all participants. RESULTS The results of between-group comparisons showed that there were significant differences between the involved knee in patients with chronic PFP and healthy participants in graphesthesia (median = 13 [case], 19 [control]; p < .001), two-point discrimination (median = 25.8 [case], 20.3 [control]; p < .001), and point-to-point sensation (median = 14.5 [case], 6.2 [control]; p < .001). There was also a significant difference in graphesthesia between the non-involved knee in patients with chronic PFP and healthy participants (median = 17 [case], 19 [control]; p = .003). The results of within-group comparisons revealed a significant difference in graphesthesia, two-point discrimination, and point-to-point sensation between the involved and non-involved knee in patients with chronic PFP (p < .001). Moreover, there was a positive correlation between two-point discrimination and pain in patients with chronic PFP (r = 0.446, p = .014). CONCLUSION The findings of this study reveal that there is a sensory deficit in patients with chronic PFP. Because sensory information is necessary for motor control and pain perception, we can assume that clinical symptoms in these patients are related to sensory deficits.
Collapse
Affiliation(s)
- Marzieh Mohamadi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Narges Meftahi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Pouria Javidi-Alsaadi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| |
Collapse
|
3
|
Holden S, Lee H, van Middelkoop M, Rathleff MS. Exploring the pain and disability continuum in adolescents with non-traumatic anterior knee pain: a mediation analysis using individual participant data of prospective studies. Br J Sports Med 2023; 57:1388-1394. [PMID: 37699655 DOI: 10.1136/bjsports-2023-107177] [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] [Accepted: 08/09/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE To use individual patient data (IPD) to investigate if the effect of pain on sports-related disability is mediated through physical (lower extremity isometric strength) or psychological (depression/anxiety and knee confidence) factors in adolescents with non-traumatic anterior knee pain. METHODS This study included four datasets from a previously harmonised IPD dataset. Prior to analysis, the protocol and analysis approach were predefined and published on Open Science Framework. Potential mediators were pre-sepcified as isometric knee and hip strengths, self-reported anxiety/depression and confidence in the knee, allmeasured at 12 weeks after baseline evaluation. Mediation analyses were undertaken using the CMAVerse package in RStudio using the regression-based approach to decompose the total effect of the exposure (pain at baseline evaluation) on the outcome (sports-related disability at 6 months) into the 'indirect effect' (the portion of the total effect acting through the mediators) and the 'direct effect'. RESULTS Two-hundred and seventy-nine adolescents with non-traumatic knee pain were included in the analysis. Median age was 13 (range 10-19), and 72% were women. Baseline pain was associated with sports-related disability at 6 months. There was no evidence of the association being mediated by any of the proposed mediators (total natural indirect effect for strength 0.01 (-1.14 to 1.80) and psychological factors 0.00 (-0.66 to 2.02)). CONCLUSION We found an effect of pain on sports-related disability at 6 months which appears to be independent of lower extremity muscle strength, or depression/anxiety and knee confidence in adolescents with non-traumatic anterior knee pain.
Collapse
Affiliation(s)
- Sinead Holden
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hopin Lee
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Michael Skovdal Rathleff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
4
|
Selhorst M, Hoehn J, Schmitt L, Benedict J, Fernandez-Fernandez A. The Effect of a Psychologically Informed Video Series to Treat Adolescents With Patellofemoral Pain: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2023; 53:634–642. [PMID: 37706686 DOI: 10.2519/jospt.2023.12041] [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: 09/15/2023]
Abstract
OBJECTIVE: To test whether a series of brief, psychologically informed educational videos added to physical therapy improved function among adolescents with patellofemoral pain. The secondary aims were to assess pain and psychological beliefs. DESIGN: A double-blinded randomized controlled trial. METHODS: Sixty-eight adolescents with patellofemoral pain were randomly assigned to view brief, psychologically informed videos (n = 34) or control videos (n = 34) in addition to usual care physical therapy. The psychologically informed videos targeted fear-avoidance beliefs, kinesiophobia, and pain catastrophizing. The control videos conveyed basic anatomy, biomedical factors, and lower extremity mechanics. Outcomes were assessed at baseline, 3 weeks, 6 weeks (primary end point), and 3 months. The primary outcome was change in the Anterior Knee Pain Scale. Secondary outcomes were changes in Numeric Pain-Rating Scale and psychological beliefs (Modified Fear-Avoidance Beliefs Questionnaire-Physical Activity, Tampa Kinesiophobia Scale-11, and Pain Catastrophizing Scale-Child). RESULTS: Adolescents in the psychologically informed group experienced significantly greater improvements in function (Anterior Knee Pain Scale mean difference = 8 points; 95% CI: 2.2, 13.2; P = .01) and pain (Numeric Pain-Rating Scale mean difference = 1.2 points; 95% CI: 0.1, 2.4; P = .04) at 6 weeks compared to the control group. The psychologically informed group had significantly greater reductions in psychological beliefs over time than the control group (P≤.001; partial η2 = 0.32). CONCLUSION: Incorporating psychologically informed education into physical therapy care improved function, pain, and psychological beliefs to a greater extent than the control group. J Orthop Sports Phys Ther 2023;53(10):1-9. Epub: 14 September 2023. doi:10.2519/jospt.2023.12041.
Collapse
|
5
|
Hansen R, Brushøj C, Rathleff MS, Magnusson SP, Henriksen M. Quadriceps or hip exercises for patellofemoral pain? A randomised controlled equivalence trial. Br J Sports Med 2023; 57:1287-1294. [PMID: 37137673 DOI: 10.1136/bjsports-2022-106197] [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] [Accepted: 04/16/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To assess effectiveness equivalence between two commonly prescribed 12-week exercise programmes targeting either the quadriceps or the hip muscles in patients with patellofemoral pain (PFP). METHODS This randomised controlled equivalence trial included patients with a clinical diagnosis of PFP. Participants were randomly assigned to either a 12-week quadriceps-focused exercise (QE) or a hip-focused exercise (HE) programme. The primary outcome was the change in Anterior Knee Pain Scale (AKPS) (0-100) from baseline to 12-week follow-up. Prespecified equivalence margins of ±8 points on the AKPS were chosen to demonstrate comparable effectiveness. Key secondary outcomes were the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire pain, physical function and knee-related quality of life subscales. RESULTS 200 participants underwent randomisation; 100 assigned to QE and 100 to HE (mean age 27.2 years (SD 6.4); 69% women). The least squares mean changes in AKPS (primary outcome) were 7.6 for QE and 7.0 for HE (difference 0.6 points, 95% CI -2.0 to 3.2; test for equivalence p<0.0001), although neither programme surpassed the minimal clinically important change threshold. None of the group differences in key secondary outcomes exceeded predefined equivalence margins. CONCLUSION The 12-week QE and HE protocols provided equivalent improvements in symptoms and function for patients with PFP. TRIAL REGISTRATION NUMBER NCT03069547.
Collapse
Affiliation(s)
- Rudi Hansen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christoffer Brushøj
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice, Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| |
Collapse
|
6
|
Rethman KK, Mansfield CJ, Moeller J, De Oliveira Silva D, Stephens JA, Di Stasi S, Briggs MS. Kinesiophobia Is Associated With Poor Function and Modifiable Through Interventions in People With Patellofemoral Pain: A Systematic Review With Individual Participant Data Correlation Meta-Analysis. Phys Ther 2023; 103:pzad074. [PMID: 37354454 PMCID: PMC10517194 DOI: 10.1093/ptj/pzad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 02/27/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE The aim of this systematic review and correlation meta-analysis was to identify factors associated with kinesiophobia in individuals with patellofemoral pain (PFP) and to identify interventions that may reduce kinesiophobia in individuals with PFP. METHODS Seven databases were searched for articles including clinical factors associated with kinesiophobia or interventions that may reduce kinesiophobia in individuals with PFP. Two reviewers screened articles for inclusion, assessed risk of bias and quality, and extracted data from each study. A mixed-effects model was used to calculate correlations of function and pain with kinesiophobia using individual participant data. Meta-analyses were performed on interventional articles; Grading of Recommendations, Assessment, Development, and Evaluation was used to evaluate certainty of evidence. Results were reported narratively when pooling was not possible. RESULTS Forty-one articles involving 2712 individuals were included. Correlation meta-analyses using individual participant data indicated a moderate association between self-reported function and kinesiophobia (n = 499; r = -0.440) and a weak association between pain and kinesiophobia (n = 644; r = 0.162). Low-certainty evidence from 2 articles indicated that passive treatment techniques were more effective than minimal intervention in reducing kinesiophobia (standardized mean difference = 1.11; 95% CI = 0.72 to 1.49). Very low-certainty evidence from 5 articles indicated that interventions to target kinesiophobia (psychobehavioral interventions, education, and self-managed exercise) were better in reducing kinesiophobia than physical therapist treatment approaches not specifically targeting kinesiophobia (standardized mean difference = 1.64; 95% CI = 0.14 to 3.15). CONCLUSION Higher levels of kinesiophobia were moderately associated with poorer function and weakly associated with higher pain in individuals with PFP. Taping and bracing may reduce kinesiophobia immediately after use, and specific kinesiophobia-targeted interventions may reduce kinesiophobia following the full intervention; however, the certainty of evidence is very low. IMPACT Assessment of kinesiophobia in clinical practice is recommended, on the basis of the relationships identified between kinesiophobia and other important factors that predict outcomes in individuals with PFP.
Collapse
Affiliation(s)
- Katherine K Rethman
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, USA
- Ohio State University Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cody J Mansfield
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, USA
- Ohio State University Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Josh Moeller
- Department of Biology, The Ohio State University, Columbus, Ohio, USA
| | - Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Julie A Stephens
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, USA
- Division of Physical Therapy, School of Health & Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Matthew S Briggs
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, USA
- Ohio State University Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
7
|
Pontillo M, Gunterstockman BM, Mauntel TC, Farrokhi S. The association between kinesiophobia and functional limitations in service members with knee pain. Musculoskelet Sci Pract 2023; 65:102766. [PMID: 37207505 DOI: 10.1016/j.msksp.2023.102766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/17/2023] [Accepted: 04/19/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Knee diagnoses account for more than 50% of lower extremity musculoskeletal conditions in non-deployed US Service members. However, there is limited information regarding kinesiophobia in Service members with non-operative knee diagnoses. HYPOTHESES The objectives of this study were to determine the prevalence of high levels of kinesiophobia in US military Service members with knee pain across different knee diagnoses, and to determine the relationships between kinesiophobia and lower extremity function and/or specific functional limitations in Service members with knee pain. It was hypothesized Service members with knee pain would exhibit high levels of kinesiophobia across all knee diagnoses examined, and higher levels of both kinesiophobia and pain would be associated with worse self-reported function in this population. It was also hypothesized higher levels of kinesiophobia would be associated with functional activities with high knee loading. DESIGN Retrospective cohort study. LEVEL OF EVIDENCE IV. METHODS Sixty-five US Service members presenting to an outpatient physical therapy clinic were included in this study (20 females; age = 30.8 ± 7.7 years; height = 1.74 ± 0.9 m; mass = 80.7 ± 16.2 kg). Inclusion criterion was the presence of knee pain (duration = 50 ± 59 months); exclusion criterion was knee pain as a sequela of knee surgery. Data regarding demographic, pain chronicity, pain by Numeric Rating Scale (NRS), Tampa Scale of Kinesiophobia (TSK), and Lower Extremity Functional Scale (LEFS) were retrospectively obtained from patients' medical records. A high level of kinesiophobia was defined as a TSK score of greater than 37 points. Patient diagnoses included: osteoarthritis (n = 16); patellofemoral pain syndrome (n = 23); and other non-operative knee diagnoses (n = 26). Commonality analysis was utilized to determine the effects of age, height, mass, NRS, and TSK on LEFS score. Predictor values were interpreted as <1% = negligible, >1% = small; >9% = moderate, >25% = large. Additionally, exploratory item-specific analyses examined the strength of the relationships between kinesiophobia and LEFS item responses. Binary logistic regression determined if difficulty with an individual LEFS item could be predicted from either NRS or TSK score. Statistical significance was set at P < 0.05. RESULTS High levels of kinesiophobia were identified in 43 individuals (66%). NRS and TSK explained 19.4% and 8.6% of the unique variance in LEFS, and 38.5% and 20.5% of total variance, respectively. Age, height, and mass explained negligible to small proportions of the unique variance in LEFS. TSK and NRS were independent predictors for 13/20 individual LEFS items, with odds ratios ranging from 1.12 to 3.05 (P < 0.05). CONCLUSION The majority of US Service members in this study exhibited high levels of kinesiophobia. Kinesiophobia was significantly related to self-reported functional scores and performance on individual functional tasks in Service members with knee pain. CLINICAL RELEVANCE Treatment strategies addressing both fear of movement and pain reduction in patients with knee pain may help optimize functional outcomes.
Collapse
Affiliation(s)
- Marisa Pontillo
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, 7700 Arlington Blvd, Falls Church, VA, USA; Department of Physical and Occupational Therapy, Chiropractic Services, and Sports Medicine, Naval Medical Center San Diego, San Diego, CA, USA.
| | | | - Timothy C Mauntel
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, 7700 Arlington Blvd, Falls Church, VA, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, NC, USA
| | - Shawn Farrokhi
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, 7700 Arlington Blvd, Falls Church, VA, USA; Department of Physical and Occupational Therapy, Chiropractic Services, and Sports Medicine, Naval Medical Center San Diego, San Diego, CA, USA; Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD, USA
| |
Collapse
|
8
|
Bazett-Jones DM, Neal BS, Legg C, Hart HF, Collins NJ, Barton CJ. Kinematic and Kinetic Gait Characteristics in People with Patellofemoral Pain: A Systematic Review and Meta-analysis. Sports Med 2023; 53:519-547. [PMID: 36334239 DOI: 10.1007/s40279-022-01781-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent knee condition with many proposed biomechanically orientated etiological factors and treatments. OBJECTIVE We aimed to systematically review and synthesize the evidence for biomechanical variables (spatiotemporal, kinematic, kinetic) during walking and running in people with PFP compared with pain-free controls, and determine if biomechanical variables contribute to the development of PFP. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched Medline, CINAHL, SPORTDiscus, Embase, and Web of Science from inception to October 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES All study designs (prospective, case-control [± interventional component, provided pre-intervention data were reported for both groups], cross-sectional) comparing spatiotemporal, kinematic, and/or kinetic variables during walking and/or running between people with and without PFP. RESULTS We identified 55 studies involving 1300 people with PFP and 1393 pain-free controls. Overall pooled analysis identified that people with PFP had slower gait velocity [moderate evidence, standardized mean difference (SMD) - 0.50, 95% confidence interval (CI) - 0.72, - 0.27], lower cadence (limited evidence, SMD - 0.43, 95% CI - 0.74, - 0.12), and shorter stride length (limited evidence, SMD - 0.46, 95% CI - 0.80, - 0.12). People with PFP also had greater peak contralateral pelvic drop (moderate evidence, SMD - 0.46, 95% CI - 0.90, - 0.03), smaller peak knee flexion angles (moderate evidence, SMD - 0.30, 95% CI - 0.52, - 0.08), and smaller peak knee extension moments (limited evidence, SMD - 0.41, 95% CI - 0.75, - 0.07) compared with controls. Females with PFP had greater peak hip flexion (moderate evidence, SMD 0.83, 95% CI 0.30, 1.36) and rearfoot eversion (limited evidence, SMD 0.59, 95% CI 0.03, 1.14) angles compared to pain-free females. No significant between-group differences were identified for all other biomechanical variables. Data pooling was not possible for prospective studies. CONCLUSION A limited number of biomechanical differences exist when comparing people with and without PFP, mostly characterized by small-to-moderate effect sizes. People with PFP ambulate slower, with lower cadence and a shortened stride length, greater contralateral pelvic drop, and lower knee flexion angles and knee extension moments. It is unclear whether these features are present prior to PFP onset or occur as pain-compensatory movement strategies given the lack of prospective data. TRIAL REGISTRATION PROSPERO # CRD42019080241.
Collapse
Affiliation(s)
- David M Bazett-Jones
- Department of Exercise and Rehabilitation Sciences, The University of Toledo, Toledo, OH, USA.
| | - Bradley S Neal
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, Essex, UK.,Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Christopher Legg
- Physiotherapy Department, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Harvi F Hart
- School of Physical Therapy and Bone and Joint Institute, Western University, London, ON, Canada
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, VIC, Australia.,Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
| |
Collapse
|
9
|
Esculier JF, Bouyer LJ, Roy JS. Running gait modifications can lead to immediate reductions in patellofemoral pain. Front Sports Act Living 2023; 4:1048655. [PMID: 36726397 PMCID: PMC9884822 DOI: 10.3389/fspor.2022.1048655] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
Gait modifications are commonly advocated to decrease knee forces and pain in runners with patellofemoral pain (PFP). However, it remains unknown if clinicians can expect immediate effects on symptoms. Our objectives were (1) to compare the immediate effects of gait modifications on pain and kinetics of runners with PFP; (2) to compare kinetic changes in responders and non-responders; and (3) to compare the effects between rearfoot strikers (RFS) and non-RFS. Sixty-eight runners with PFP (42 women, 26 men) ran normally on a treadmill before testing six modifications: 1- increase step rate by 10%; 2- 180 steps per minute; 3- decrease step rate by 10%; 4- forefoot striking; 5- heel striking; 6- running softer. Overall, there were more responders (pain decreased ≥1/10 compared with normal gait) during forefoot striking and increasing step rate by 10% (both 35%). Responders showed greater reductions in peak patellofemoral joint force than non-responders during all conditions except heel striking. When compared with non-RFS, RFS reduced peak patellofemoral joint force in a significant manner (P < 0.001) during forefoot striking (partial η 2 = 0.452) and running softer (partial η 2 = 0.302). Increasing step rate by 10% reduced peak patellofemoral joint force in both RFS and non-RFS. Forty-two percent of symptomatic runners reported immediate reductions in pain during ≥1 modification, and 28% had reduced pain during ≥3 modifications. Gait modifications leading to decreased patellofemoral joint forces may be associated with immediate pain reductions in runners with PFP. Other mechanisms may be involved, given that some runners reported decreased symptoms regardless of kinetic changes.
Collapse
Affiliation(s)
- Jean-Francois Esculier
- The Running Clinic, Lac beauport, QC, Canada,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada,MoveMed Physiotherapy, Kelowna, BC, Canada,Correspondence: Jean-Francois Esculier
| | - Laurent J. Bouyer
- Faculty of Medicine, Université Laval, Quebec, QC, Canada,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, QC, Canada
| | - Jean-Sébastien Roy
- Faculty of Medicine, Université Laval, Quebec, QC, Canada,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, QC, Canada
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
|