Constantinou A1, Stasinopoulos D1, Ploutarchou G2
1European University Cyprus, Department of Health Sciences / Physiotherapy Program, Nicosia, Cyprus, 2European University Cyprus, Department of Health Sciences / Physiotherapy program, Nicosia, Cyprus
Background: Various exercise programs targeting knee and/or hip musculature have been proposed to treat patellofemoral pain (PFP), as part or as standalone treatment but no consensus on optimum exercise parameters nor type (strength, power etc.) exists. Up to 80% of people with PFP have recurrence of pain and limited function 5yrs after treatment. This makes researching exercise dose a priority.
Purpose: The purpose of this study was to examine the types of exercise and parameters used for adults with PFP and to establish the level of evidence for the effects.
Methods: A systematic review of randomized controlled trials was performed from November 2017 - January 2018 using Pubmed, EBSCO: (Medline, CINAHL, SportsDiscus & ProQuest) and ScienceDirect. Key words Patellofemoral pain OR Anterior Knee Pain OR PFPS OR Chondromalacia patella AND Exercise OR Rehabilitation OR Therapy OR Physiotherapy AND, RCT OR clinical trial were used individually and in combination with no date restrictions. References from other systematic reviews and scientific journals were also studied for eligibility. Only full text articles in English were included. Participants in studies were adults ages 18 - 40 years with patellofemoral pain. The experimental intervention had to be any type of exercise with parameters clearly described vs other exercise, placebo or other treatment and the main outcome measures had to involve pain, function and/or muscle strength.
Risk of bias was assessed by two independent assessors (A.C. & D.S.) using the criteria of Furlan et al. (2009) and level of evidence was estimated according to van Tulder et al. (2003).
Results: E-search resulted in a total of 166 studies, 50 were excluded as duplicates and 79 after reading titles. Thirty-one were excluded after reading the abstracts and full texts. Two studies were included from references of systematic reviews. Eight RCTs were included for analysis. All studies were high quality as they scored 50% - 75% on the Furlan scale.
Exercise programs were effective in reducing pain and increasing function in all studies, regardless of muscle group targeted (hip or knee). Strength was a secondary outcome in 5 studies and had positive results. The longest term effects (1yr) show that there is moderate evidence that combined stretching with hip and knee exercises, load of 70% of 1 Repetition max in open and closed kinetic chain, 3 t/wk - 4wks (Fukuda, et al., 2012) is more effective than combined stretching with knee exersices in open and closed kinetic chain for reducing pain and increasing function for sedentary women with PFP for mid (6mo) and long term (1yr).
Conclusion(s): It is unclear if the protocol by Fukuda, et al., (2012) will be as effective regardless of gender or physical status or if stretching contributed with added effects. Studies varied in exercise dose and types. Poor exercise protocol description makes reproducibility difficult. Future studies should focus on detailed descriptions, comparing different exercise types (strength, power etc.) and doses, as well as long term follow ups (≥1yr).
Implications: Although exercise is considered the therapy of choice much about its dose effectiveness is still unclear.
Keywords: Patellofemoral pain, exercise, physiotherapy
Funding acknowledgements: None.
Purpose: The purpose of this study was to examine the types of exercise and parameters used for adults with PFP and to establish the level of evidence for the effects.
Methods: A systematic review of randomized controlled trials was performed from November 2017 - January 2018 using Pubmed, EBSCO: (Medline, CINAHL, SportsDiscus & ProQuest) and ScienceDirect. Key words Patellofemoral pain OR Anterior Knee Pain OR PFPS OR Chondromalacia patella AND Exercise OR Rehabilitation OR Therapy OR Physiotherapy AND, RCT OR clinical trial were used individually and in combination with no date restrictions. References from other systematic reviews and scientific journals were also studied for eligibility. Only full text articles in English were included. Participants in studies were adults ages 18 - 40 years with patellofemoral pain. The experimental intervention had to be any type of exercise with parameters clearly described vs other exercise, placebo or other treatment and the main outcome measures had to involve pain, function and/or muscle strength.
Risk of bias was assessed by two independent assessors (A.C. & D.S.) using the criteria of Furlan et al. (2009) and level of evidence was estimated according to van Tulder et al. (2003).
Results: E-search resulted in a total of 166 studies, 50 were excluded as duplicates and 79 after reading titles. Thirty-one were excluded after reading the abstracts and full texts. Two studies were included from references of systematic reviews. Eight RCTs were included for analysis. All studies were high quality as they scored 50% - 75% on the Furlan scale.
Exercise programs were effective in reducing pain and increasing function in all studies, regardless of muscle group targeted (hip or knee). Strength was a secondary outcome in 5 studies and had positive results. The longest term effects (1yr) show that there is moderate evidence that combined stretching with hip and knee exercises, load of 70% of 1 Repetition max in open and closed kinetic chain, 3 t/wk - 4wks (Fukuda, et al., 2012) is more effective than combined stretching with knee exersices in open and closed kinetic chain for reducing pain and increasing function for sedentary women with PFP for mid (6mo) and long term (1yr).
Conclusion(s): It is unclear if the protocol by Fukuda, et al., (2012) will be as effective regardless of gender or physical status or if stretching contributed with added effects. Studies varied in exercise dose and types. Poor exercise protocol description makes reproducibility difficult. Future studies should focus on detailed descriptions, comparing different exercise types (strength, power etc.) and doses, as well as long term follow ups (≥1yr).
Implications: Although exercise is considered the therapy of choice much about its dose effectiveness is still unclear.
Keywords: Patellofemoral pain, exercise, physiotherapy
Funding acknowledgements: None.
Topic: Musculoskeletal: lower limb
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: No ethical approval was needed as this is a Systematic review
All authors, affiliations and abstracts have been published as submitted.
