Physiotherapy for anterior knee pain: a randomised controlled trial

Abstract

Objective-To determine the eYcacy of the individual components of physiotherapy in subjects with anterior knee pain. Methods-An observer blind, prospective, factorial design randomised controlled trial. 81 young adults with anterior knee pain were randomly allocated to one of four treatment groups: (1) exercise, taping, and education; (2) exercise and education; (3) taping and education; and (4) education alone. Each group received six physiotherapist-led treatments over three months. Follow up took place at three months using the following outcome measures: patient satisfaction (discharge/ refer for further treatment); a visual analogue pain score; the WOMAC lower limb function score; the Hospital Anxiety and Depression scale (HAD); and quadriceps strength. At 12 months the WOMAC and HAD were assessed by postal questionnaire. Results-All groups showed significant improvements in WOMAC, visual analogue, and HAD scores; these improvements did not vary significantly between the four groups or between exercising/ non-exercising and taped/non-taped patients at three and 12 months. However, patients who exercised were significantly more likely to be discharged at three months than non-exercising patients ( 2 , p<0.001). Taping was not significantly associated with discharge. Significantly greater improvements in WOMAC, visual analogue, and the anxiety score (but not the depression score) were seen in patients who were discharged than in those who were referred. Conclusions-The proprioceptive muscle stretching and strengthening aspects of physiotherapy have a beneficial eVect at three months suYcient to permit discharge from physiotherapy. These benefits are maintained at one year. Taping does not influence the outcome.

Hip Strengthening Prior to Functional Exercises Reduces Pain Sooner Than Quadriceps Strengthening in Females With Patellofemoral Pain Syndrome: A Randomized Clinical Trial

“…7,[12][13][14][15]22,39,40,42 However, few of these studies evaluated the efficacy of isolated quadriceps strengthening. Many published rehabilitation protocols target functional exercises in a weight-bearing position, which requires a contribution of both hip and quadriceps musculature.…”

Evaluation of the Scope and Quality of Systematic Reviews on Nonpharmacological Conservative Treatment for Patellofemoral Pain Syndrome

“…Clark 17 High-quality RCT No significant difference between exercise and no exercise groups in pain reduction at 3 mo, or 12 mo (based on means per time-point calculations). Significantly more exercise participants discharged due to treatment satisfaction (number need to treat calculated at 3)…”

Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients

“…4 These tendencies amplify the perception of pain and cause behaviors that increase disability. 79 Clark 15 found that 27% of patients with AKP who were included in a clinical trial showed anxiety symptoms measured with the HAD questionnaire, and after receiving treatment these symptoms improved. Thomeé 117 also found high levels of anxiety in a group of patients with AKP, using the STAI questionnaire (State Trait Anxiety Inventory), finding similar scores to those published for rheumatoid arthritis.…”

“…It is possible that the difference in the results is because this last group was too young, a mean age of 18, or else because of the different type of measurement tool. Clark 15 performed a clinical trial with 81 AKP patients, assigning them randomly to four types of physical therapy treatments. Prior to this treatment, 15% of patients had borderline depression symptoms or a well-established depression measured with the Hospital Anxiety and Depression questionnaire (HAD) scale.…”