Treatment of Patients With Patellofemoral Pain ...

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or peripatellar pain. - crepitation & the giving-way phenomenon. Davis et al., Journal of Orthopaedic and Sports Physical Therapy 2010. METHODS. RESULTS.
Treatment of Patients With Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis Ron Clijsen1,2,3 , Janine Fuchs, 2 Jan Taeymans3,4 1 Rehabilitation

Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart, Switzerland 2 THIM University of Applied Sciences, Landquart , Switzerland 3 Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium 4 Health Department, Bern University of Applied Sciences, Berne, Switzerland

INTRODUCTION

METHODS

RESULTS

DISCUSSION

CONCLUSION

• Patellofemoral pain syndrome (PFPS) is a common musculoskeletal disorder in physically active individuals aged 15 to 30 years. Rathleff et al., PLoS One. 2013 Boling et al., J Med Sci Sports. 2010

• Incidence PFPS: highly active populations general population

22 new cases per 1000 pers./year 5- 6 new cases per 1000 pers./year

Boling et al., J Med Sci Sports. 2010 Van der Linden et al., NIVEL/ RIVM, 2004.

• Young ♀ more affected than young ♂ Witvrouw et al., Am J Sports Med. 2000

INTRODUCTION

METHODS

RESULTS

DISCUSSION

CONCLUSION

Symptoms of PFPS - retropatellar pain - or peripatellar pain - crepitation & the giving-way phenomenon Davis et al., Journal of Orthopaedic and Sports Physical Therapy 2010

Etiology of PFPS • Multifactorial

still unclear

• Causative factors relating to misalignment of lower extremity kinematics: - force imbalance M. quadriceps resulting PFJ stress on the lat. facet - biomechanical disorders in foot – ankle and hip – pelvis and trunk Powers et al., J Orthop Sports Phys Ther. 2003

INTRODUCTION

METHODS

RESULTS

DISCUSSION

CONCLUSION

Treatment strategy - Conservative treatment method

first line treatment

Cutbill et al., Clin J Sport Med. 1997 Thomee et al., Sports Med. 1999 Juhn et al., Am Fam Physician. 1999

- No consensus on the most appropriate conservative treatment - Exercise therapy Thomee et al., Sports Med. 1999 Clark et al., Ann Rheum Dis. 2000 Boling et al., Arch Phys Med Rehabil. 2006

- Different variation the quadriceps muscle strengthening Powers et al., J Orthop Sports Phys Ther. 2003

INTRODUCTION

METHODS

RESULTS

DISCUSSION

CONCLUSION

Aim of the study

Determine whether exercise therapy is an effective intervention to: - reduce pain (VAS)

- reduce patient reported measures of activity limitations and participation restrictions (PRMALP) functional improvement (WHO) Short-term Long-term

(≤ 12 weeks) (≥ 26 weeks)

INTRODUCTION

Methods CTION

METHODS

Systematic literature Review

Databases:

RESULTS

DISCUSSION

CONCLUSION

(PRISMA) statement

- MEDLINE (pubmed) - Cochrane database of systematic reviews - Physiotherapy Evidence Database (PEDro) - International Clinical Trial Registry Platform

• Studies included in quantitative analysis and meta-analysis (n = 16) • Methodological quality was rated using the PEDro scale

INTRODUCTION CTION

METHODS

Meta-analysis • Outcome measure • Secondary outcome measure

RESULTS

DISCUSSION

CONCLUSION

Pain (VAS) PRMALP

- Kujala patellofemoral score - Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) - Lysholm scale - Functional Index Questionnaire (FIQ) - Lower Extremity Functional Scale •

A random-effects model (specified a priori) was used



Effect sizes of the RCTs included were expressed as Hedges’ g (to correct for small size studies, effect of overestimating true effect size)

INTRODUCTION

METHODS

RESULTS

DISCUSSION

CONCLUSION

Forest plot of 7 studies evaluating the short-term effects of exercise therapy versus no exercise on pain in the treatment of PFPS Study name

Hedges‘ g

p-Value

Clark, 2000

-0.279

0.392

Fukuda, 2010

-0.713

0.007

Herrington, 2007

-2.269

0.000

Khayambashi, 2012

-3.159

0.000

Osteras, 2011

-0.750

0.020

Song, 2009

-0.914

0.001

van Linschoten, 2009

-0.410

0.020

Summary estimate

-1.106