Effectiveness of conservative treatment for patellofemoral pain syndrome: A systematic review and meta-analysis
Mikhail Saltychev, Rebecca A. Dutton, Katri Laimi, Gary S. Beaupré, Petri Virolainen, Michael Fredericson
Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, PO Box 52, FIN-20521 Turku, Finland.E-mail: firstname.lastname@example.org
Objective: To evaluate the evidence regarding the effectiveness of conservative treatment in reducing patellofemoral pain.
Data sources: CENTRAL, MEDLINE, CINAHL, and PEDro databases.
Study selection: Adults with patellofemoral pain, randomized controlled trials only, any conservative treatment compared with placebo, sham, other conservative treatment, or no treatment. Two independent reviewers.
Data extraction: Data were extracted from the full-text of the articles, based on Cochrane Collaboration recommendations. The outcome of interest was the difference between groups regarding change in pain severity.
Data synthesis: The majority of studies were underpowered. More than 80% of the 37 trials did not show a clinically significant benefit. Clinically significant effects of different sizes were found for 7 trials (6 studies out of 7 had short follow-ups). These effects were found for: (i) pulsed electromagnetic fields combined with home exercise –33.0 (95% CI –45.2 to –20.8); (ii) hip muscle strengthening –65.0 (95% CI –87.7 to –48.3) and –32.0 (–37.0 to –27.0); (iii) weight-bearing exercise –40.0 (95% CI –49.4 to –30.6); (iv) neuromuscular facilitation combined with aerobic exercise and stretching –60.1 (95% CI –66.9 to –54.5); (v) postural stabilization –24.4 (95% CI –33.5 to –15.3); and (vi) patellar bracing –31.6 (95% CI –35.2 to –28.0).
Conclusion: There is no evidence that a single treat-ment modality works for all patients with patellofemoral pain. There is limited evidence that some treatment modalities may be beneficial for some subgroups of patients with patellofemoral pain.
In the systematic review of 37 randomized controlled trials on different treatments of patellofemoral pain, more than 80% of the trials did not show a clinically significant benefit. In some trials, clinically significant effects of different magnitude were observed for pulsed electromagnetic fields when combined with home exercise, hip muscle strengthening, weight-bearing exercise, neuromuscular facilitation combined with aerobic exercise and stretching, postural stabilization, and patellar bracing. There is so far no evidence that a single treatment modality works for all patients with patellofemoral pain. There is limited evidence that some treatments modalities may be beneficial for some subgroups of patients with patellofemoral pain.
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