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

Lankhorst, Nienke E; Middelkoop, Marienke van; Trier, Y. D. M. Van; Linschoten, Robbart van; Koes, Bart W.; Verhaar, Jan A N; Bierma-Zeinstra, Sita M A

doi:10.2519/jospt.2015.5583

Cited by 10 publications

(8 citation statements)

References 38 publications

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“…Six different specific treatments were investigated; foot orthoses,30 32 33 45–47 lumbopelvic manipulation,34 48 patellar taping,31 femoral nerve mobilisation,49 leg press exercise and stretching28 and exercise therapy (consisting of static and dynamic exercises for the quadriceps muscles, flexibility and balance exercises)50 (table 2). Twenty-two patient characteristics were reported to be associated with a successful outcome after a specific treatment.…”

Section: Resultsmentioning

confidence: 99%

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Can we predict the outcome for people with patellofemoral pain? A systematic review on prognostic factors and treatment effect modifiers

et al. 2016

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BackgroundPatellofemoral pain (PFP) is a multifactorial and often persistent knee condition. One strategy to enhance patient outcomes is using clinically assessable patient characteristics to predict the outcome and match a specific treatment to an individual.AimA systematic review was conducted to determine which baseline patient characteristics were (1) associated with patient outcome (prognosis); or (2) modified patient outcome from a specific treatment (treatment effect modifiers).Methods6 electronic databases were searched (July 2016) for studies evaluating the association between those with PFP, their characteristics and outcome. All studies were appraised using the Epidemiological Appraisal Instrument. Studies that aimed to identify treatment effect modifiers underwent a checklist for methodological quality.ResultsThe 24 included studies evaluated 180 participant characteristics. 12 studies investigated prognosis, and 12 studies investigated potential treatment effect modifiers. Important methodological limitations were identified. Some prognostic studies used a retrospective design. Studies aiming to identify treatment effect modifiers often analysed too many variables for the limiting sample size and typically failed to use a control or comparator treatment group. 16 factors were reported to be associated with a poor outcome, with longer duration of symptoms the most reported (>4 months). Preliminary evidence suggests increased midfoot mobility may predict those who have a successful outcome to foot orthoses.ConclusionsCurrent evidence can identify those with increased risk of a poor outcome, but methodological limitations make it difficult to predict the outcome after one specific treatment compared with another. Adequately designed randomised trials are needed to identify treatment effect modifiers.

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Section: Resultsmentioning

confidence: 99%

“…One study compared exercise therapy with usual care and found no significant predictors of a successful outcome to exercise therapy 50. One study evaluated a leg press training and lower limb muscle stretching exercise programme 28.…”

Section: Resultsmentioning

confidence: 99%

Can we predict the outcome for people with patellofemoral pain? A systematic review on prognostic factors and treatment effect modifiers

et al. 2016

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“…Treatment outcomes may be different on the basis of some characteristics (ie, effect modification). Lankhorst et al 53 suggested that sex and symptom duration may be effect modifiers in the relationship between exercise and function at 3 months, but no significant association was found. As there is no good evidence for any potential effect modifier, we did not include potential effect modifiers when planning the synthesis.…”

Section: Strengths and Weaknesses Of This Studymentioning

confidence: 99%

Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis

et al. 2020

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ObjectiveTo investigate the comparative effectiveness of all treatments for patellofemoral pain (PFP).DesignLiving systematic review with network meta-analysis (NMA).Data sourcesSensitive search in seven databases, three grey literature resources and four trial registers.Eligibility criteriaRandomised controlled trials evaluating any treatment for PFP with outcomes ‘any improvement’, and pain intensity.Data extractionTwo reviewers independently extracted data and assessed risk of bias with Risk of Bias Tool V.2. We used Grading of Recommendations, Assessment, Development and Evaluation to appraise the strength of the evidence.Primary outcome measure‘Any improvement’ measured with a Global Rating of Change Scale.ResultsTwenty-two trials (with forty-eight treatment arms) were included, of which approximately 10 (45%) were at high risk of bias for the primary outcome. Most comparisons had a low to very low strength of the evidence. All treatments were better than wait and see for any improvement at 3 months (education (OR 9.6, 95% credible interval (CrI): 2.2 to 48.8); exercise (OR 13.0, 95% CrI: 2.4 to 83.5); education+orthosis (OR 16.5, 95% CrI: 4.9 to 65.8); education+exercise+patellar taping/mobilisations (OR 25.2, 95% CrI: 5.7 to 130.3) and education+exercise+patellar taping/mobilisations+orthosis (OR 38.8, 95% CrI: 7.3 to 236.9)). Education+exercise+patellar taping/mobilisations, with (OR 4.0, 95% CrI: 1.5 to 11.8) or without orthosis (OR 2.6, 95% CrI: 1.7 to 4.2), were superior to education alone. At 12 months, education or education+any combination yielded similar improvement rates.Summary/conclusionEducation combined with a physical treatment (exercise, orthoses or patellar taping/mobilisation) is most likely to be effective at 3 months. At 12 months, education appears comparable to education with a physical treatment. There was insufficient evidence to recommend a specific type of physical treatment over another. All treatments in our NMA were superior to wait and see at 3 months, and we recommend avoiding a wait-and-see approach.PROSPERO registeration numberPROSPERO registration CRD42018079502.

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“…Several recent studies have established which patients are most likely to experience favourable outcomes with different conservative treatment approaches36,37,38 ) . A longer duration of symptoms (>4 months) will most likely result in a poor outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Other prognostic factors include older age, greater usual pain severity and lower baseline AKPS score38 ) . One study37 ) found that females respond better than males to exercise therapy. Kinematic differences may exist between genders.…”

Section: Discussionmentioning

confidence: 99%

The effect of an individualised functional retraining intervention on pain, function and biomechanics in participants with patellofemoral pain: a series of n of 1 trial

Leibbrandt

Louw

2019

J Phys Ther Sci

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[Purpose] To determine the effect of an individualised functional retraining intervention on pain, function, kinematics and self-reported recovery in participants with PFP. [Participants and Methods] Thirty-one participants with unilateral PFP between the ages of 14–40 were included. Data collection and treatment sessions were conducted at the Tygerberg 3D Motion Analysis Laboratory and Physiotherapy Clinic at the University of Stellenbosch Medical School in Cape Town, South Africa. Participants underwent motion analysis testing pre- and post-intervention and attended physiotherapy weekly for a 6-week individualised intervention. [Results] Thirty of the thirty-one participants (96.8%) demonstrated improved pain levels (NPRS) post intervention. Participants demonstrated a statistically significant improvement in function (AKPS) immediately post intervention and continued to improve with greater functional scores at 6-month follow up. Fifteen participants (48.4%) rated themselves as fully recovered on a 7-point Likert scale at 6-month follow up. Nineteen of the 31 participants (61.3%) demonstrated a clinically significant improvement in their priority kinematic outcome post intervention. [Conclusion] Individualised functional retraining may improve pain, function, kinematics and long-term recovery in participants with PFP presenting with kinematic contributing factors. Clinicians need to be educated on common biomechanical contributing factors and how to tailor treatment accordingly.

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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

Abstract: 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.

Cited by 10 publications

References 38 publications

Can we predict the outcome for people with patellofemoral pain? A systematic review on prognostic factors and treatment effect modifiers

Can we predict the outcome for people with patellofemoral pain? A systematic review on prognostic factors and treatment effect modifiers

Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis

The effect of an individualised functional retraining intervention on pain, function and biomechanics in participants with patellofemoral pain: a series of n of 1 trial

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