Proximal muscle rehabilitation is effective for patellofemoral pain: A systematic review with meta-analysis

Lack, Simon, Barton, Christian, Sohan, Oliver, Crossley, Kay and Morrissey, Dylan (2015) Proximal muscle rehabilitation is effective for patellofemoral pain: A systematic review with meta-analysis. British Journal of Sports Medicine, 49 21: 1365-1376. doi:10.1136/bjsports-2015-094723


Author Lack, Simon
Barton, Christian
Sohan, Oliver
Crossley, Kay
Morrissey, Dylan
Title Proximal muscle rehabilitation is effective for patellofemoral pain: A systematic review with meta-analysis
Journal name British Journal of Sports Medicine   Check publisher's open access policy
ISSN 1473-0480
0306-3674
Publication date 2015
Year available 2015
Sub-type Article (original research)
DOI 10.1136/bjsports-2015-094723
Open Access Status Not yet assessed
Volume 49
Issue 21
Start page 1365
End page 1376
Total pages 13
Place of publication London, United Kingdom
Publisher BMJ Publishing Group
Collection year 2016
Language eng
Formatted abstract
Background Proximal muscle rehabilitation is commonly prescribed to address muscle strength and function deficits in individuals with patellofemoral pain (PFP). This review (1) evaluates the efficacy of proximal musculature rehabilitation for patients with PFP; (2) compares the efficacy of various rehabilitation protocols; and (3) identifies potential biomechanical mechanisms of effect in order to optimise outcomes from proximal rehabilitation in this problematic patient group.

Methods Web of Knowledge, CINAHL, EMBASE and Medline databases were searched in December 2014 for randomised clinical trials and cohort studies evaluating proximal rehabilitation for PFP. Quality assessment was performed by two independent reviewers. Effect size calculations using standard mean differences and 95% CIs were calculated for each comparison.

Results 14 studies were identified, seven of high quality. Strong evidence indicated proximal combined with quadriceps rehabilitation decreased pain and improved function in the short term, with moderate evidence for medium-term outcomes. Moderate evidence indicated that proximal when compared with quadriceps rehabilitation decreased pain in the short-term and medium-term, and improved function in the medium term. Limited evidence indicated proximal combined with quadriceps rehabilitation decreased pain more than quadriceps rehabilitation in the long term. Very limited short-term mechanistic evidence indicated proximal rehabilitation compared with no intervention decreased pain, improved function, increased isometric hip strength and decreased knee valgum variability while running.

Conclusions A robust body of work shows proximal rehabilitation for PFP should be included in conservative management. Importantly, greater pain reduction and improved function at 1 year highlight the long-term value of proximal combined with quadriceps rehabilitation for PFP.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Health and Rehabilitation Sciences Publications
 
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