Outcome Predictors for Conservative Patellofemoral Pain Management: A Systematic Review and Meta-Analysis

Lack, Simon, Barton, Christian, Vicenzino, Bill and Morrissey, Dylan (2014) Outcome Predictors for Conservative Patellofemoral Pain Management: A Systematic Review and Meta-Analysis. Sports Medicine, 44 12: 1703-1716. doi:10.1007/s40279-014-0231-5

Author Lack, Simon
Barton, Christian
Vicenzino, Bill
Morrissey, Dylan
Title Outcome Predictors for Conservative Patellofemoral Pain Management: A Systematic Review and Meta-Analysis
Journal name Sports Medicine   Check publisher's open access policy
ISSN 0112-1642
Publication date 2014-08-07
Year available 2014
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1007/s40279-014-0231-5
Open Access Status
Volume 44
Issue 12
Start page 1703
End page 1716
Total pages 14
Place of publication Auckland, New Zealand
Publisher Springer International Publishing
Collection year 2015
Language eng
Abstract Background Patellofemoral pain (PFP) is highly prevalent within both sporting and recreationally active populations. Multiple treatment approaches have been advocated for the management of PFP, attempting to address both intrinsic and extrinsic factors thought to contribute to the development and persistence of pain. A number of predictors of treatment success have been proposed, and evaluated, for directing intervention choice. Objective Our aim was to systematically review the literature that identifies outcome predictors of specific conservative interventions in the management of PFP, including quality of the current evidence, to guide clinical practice and future studies investigating outcome predictors within this population. Data Sources The AMED, CINAHL, EMBASE, MEDLINE and Web of Science databases were searched from inception to April 2013. Study Selection Randomized controlled trials (RCTs) and cohort studies. Study Appraisal and Synthesis Methods Following initial searching, all potential papers were assessed by two independent reviewers for inclusion using a checklist developed from the inclusion criteria. Cited, and citing, references were also searched in Google Scholar, but unpublished work was not sought. Methodological quality was assessed using a previously designed quality assessment scale. Definitions for levels of evidence were guided by recommendations made by van Tulder et al. Results Fifteen low-quality (LQ) cohort studies were included. No RCTs were found. This systematic review identified the evaluation of 205 conservative management outcome predictor variables. Of this large number of variables that have been assessed, 19 (9 %) were found to significantly predict a successful outcome. Where two or more outcome predictors and success determinants were consistent between studies, data were pooled. Within these studies, the low number of participants per output variable, and absence of controls, is likely to compromise the validity of the predictor's accuracy. Very limited evidence identified higher functional index questionnaire scores (mean 0.82, 95 % confidence interval [CI] 0.18-1.46), greater forefoot valgus (mean 0.67, 95 % CI 0.05-1.28) and greater rearfoot eversion magnitude peak (mean -0.93, 95 % CI -1.84 to -0.01) to significantly predict improved outcomes with orthoses interventions. Shorter symptom duration (p = 0.019), lower frequency of pain (p = 0.012), younger age, faster vastus medialis oblique reflex response time (p = 0.026), negative patella apprehension, absence of chondromalacia patella, tibial tubercle deviation of <14.6 mm and greater total quadriceps cross-sectional area on magnetic resonance imaging (p = 0.01), and reduced eccentric average quadriceps peak torque (p = 0.015) significantly predicted exercise intervention success following multivariate statistical analysis. Limited evidence identified increased Q-angle (mean 0.38, 95 % CI 0.05-0.72) and very limited evidence identified greater usual pain (mean 0.43, 95 % CI 0.01-0.85) to predict taping intervention success. Conclusions This systematic review provides a comprehensive summary of current derivation level studies identifying indicators of prediction for conservative PFP management. The overall strength of evidence was low. With appropriate caution, clinicians should consider taping for those with greater usual pain, orthoses for older individuals and exercise for younger individuals, and orthoses intervention for patients with greater forefoot valgus and rearfoot eversion magnitude peak. RCTs with evaluation of outcome prediction as a primary aim are clearly warranted to provide clinicians with robust evidence and facilitate evidence-informed, tailored intervention to this heterogeneous patient population.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2015 Collection
School of Health and Rehabilitation Sciences Publications
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