Dose–response effects of medical exercise therapy in patients with patellofemoral pain syndrome: a randomised controlled clinical trial

Østerås, Berit; Østerås, Håvard; Torstensen, Tom Arild; Vasseljen, Ottar

doi:10.1016/j.physio.2012.05.009

Cited by 57 publications

(39 citation statements)

References 33 publications

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“…The results of the review indicated that pain need not be a barrier to successful outcomes, and protocols using painful exercises typically have higher loads and dose of exercise. These results have been supported in a PFP study in Norway ( n = 42) investigating different dosages of exercise intervention; a high dose regime versus a low dose regime [36]. The results demonstrated significant benefit of the high dose in terms of pain and function at 12 weeks.…”

Section: Discussionmentioning

confidence: 58%

“…The results demonstrated significant benefit of the high dose in terms of pain and function at 12 weeks. This difference was even greater at 1 year follow-up, as the high dose group continued to improve in terms of pain and function, while the low dose group had relapsed [36, 37]. Pain and dose response as an aspect of exercise prescription clearly warrants further investigation.…”

Section: Discussionmentioning

confidence: 99%

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Current management strategies for patellofemoral pain: an online survey of 99 practising UK physiotherapists

Smith

Hendrick

Bateman

et al. 2017

BMC Musculoskelet Disord

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BackgroundPatellofemoral 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.MethodsAn 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.ResultsA 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.ConclusionCurrent 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1539-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Current management strategies for patellofemoral pain: an online survey of 99 practising UK physiotherapists

Smith

Hendrick

Bateman

et al. 2017

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…Interestingly, this common recommendation is contrary to findings by a recent study investigating the dose–response effects of exercise for PFP 44. Specifically, high-dose rehabilitation involving seven exercises and taking approximately 60 min to complete was found to produce superior outcomes compared to low dose involving five exercises and taking approximately 20 min to complete 44. Establishing the optimal time needed per exercise session to enhance patient outcomes, while maintaining compliance should be a research priority.…”

Section: Discussionmentioning

confidence: 76%

The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning

et al. 2015

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ImportancePatellofemoral pain (PFP) is both chronic and prevalent; it has complex aetiology and many conservative treatment options.ObjectiveDevelop a comprehensive contemporary guide to conservative management of PFP outlining key considerations for clinicians to follow.DesignMixed methods.MethodsWe synthesised the findings from sixhigh-qualitysystematic reviews to September 2013 with the opinions of 17 experts obtained via semistructured interviews. Experts had at least 5 years clinical experience with PFP as a specialist focus, were actively involved in PFP research and contributed to specialist international meetings. The interviews covered clinical reasoning, perception of current evidence and research priorities.ResultsMultimodal intervention including exercise to strengthen the gluteal and quadriceps musculature, manual therapy and taping possessed the strongest evidence. Evidence also supports use of foot orthoses and acupuncture. Interview transcript analysis identified 23 themes and 58 subthemes. Four key over-arching principles to ensure effective management included—(1) PFP is a multifactorial condition requiring an individually tailored multimodal approach. (2) Immediate pain relief should be a priority to gain patient trust. (3) Patient empowerment by emphasising active over passive interventions is important. (4) Good patient education and activity modification is essential. Future research priorities include identifying risk factors, testing effective prevention, developing education strategies, evaluating the influence of psychosocial factors on treatment outcomes and how to address them, evaluating the efficacy of movement pattern retraining and improving clinicians’ assessment skills to facilitate optimal individual prescription.Conclusions and relevanceEffective management of PFP requires consideration of a number of proven conservative interventions. An individually tailored multimodal intervention programme including gluteal and quadriceps strengthening, patellar taping and an emphasis on education and activity modification should be prescribed for patients with PFP. We provide a ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’ outlining key considerations.

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“…In the present article, we have summarised the findings on the efficacy of multimodal treatment (predominantly exercise) from the three largest trials concerning patients with PFP, focusing on the long-term success rate 1 year after receiving multimodal treatment, and with a particular focus on the success across the different age groups, including adolescents, young adults and adults. [61], van Linschoten et al [27], and Østeraas et al [62] The two largest randomised controlled trials on adults are Collins et al and van Linschoten et al [26,27], and the largest trial on adolescents is Rathleff et al [22]. These three trials used similar outcomes and established successful outcome using 5-and 7-point Likert scales, which makes a comparison across studies possible.…”

Section: Effect Of Multimodal Treatmentmentioning

confidence: 99%

Patellofemoral Pain in Adolescence and Adulthood: Same Same, but Different?

et al. 2015

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The mainstay of patellofemoral pain (PFP) treatment is exercise therapy, often in combination with adjunct treatments such as patient education, orthoses, patella taping and stretching, making the intervention multimodal in nature. The vast majority of randomised controlled trials among patients with PFP have investigated the effect of treatment among adults (>18 years of age). So, while systematic reviews and meta-analyses provide evidence-based recommendations for treating PFP, these recommendations are largely based upon the trials in adults. In the present article, we have summarised the findings on the efficacy of multimodal treatment (predominantly exercise) from the three largest trials concerning patients with PFP, focusing on the long-term success-rate 1 year after receiving multimodal treatment, and with a particular focus on the success rate across the different age groups, including both adolescents, young adults and adults. The results of this paper show that there appears to be a difference in the success rate between adolescents and adults, despite providing similar exercise treatment and having similar exercise compliance. While PFP may present in a similar fashion in adolescence and adults, it may not be the same underlying condition or stage, and different treatments may be required. Collectively, this highlights the importance of increasing our understanding of the underlying pathology, pain mechanisms and why treatment may-or may not-work in adolescents and adults with PFP.

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Dose–response effects of medical exercise therapy in patients with patellofemoral pain syndrome: a randomised controlled clinical trial

Cited by 57 publications

References 33 publications

Current management strategies for patellofemoral pain: an online survey of 99 practising UK physiotherapists

Current management strategies for patellofemoral pain: an online survey of 99 practising UK physiotherapists

The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning

Patellofemoral Pain in Adolescence and Adulthood: Same Same, but Different?

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