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
