Abstract
Background:
Patellofemoral pain (PFP) accounts for up to 40% of knee problems seen in sports clinics and exercise programmes are a key management strategy. Physical factors, such as weak hip and knee muscles and altered movement patterns (kinematics) have been identified in people with PFP but it is not clear whether exercise programmes improve these physical factors and pain. This systematic review investigated the effect of exercise programmes on hip and knee strength, kinematics and pain compared to comparison interventions in people with PFP.
Methods:
Four electronic databases were searched for published and unpublished randomised controlled trials (RCT) from 1950 to June 2018 with cross referencing from retrieved studies and expert review.
Primary outcome was pre-post intervention change in hip strength; secondary outcomes included change in knee strength, hip and knee kinematics and pain.
Two reviewers conducted independent data extraction and quality assessment using the Cochrane risk of bias tool (RoB) and 3 items (presence of random and concealed allocation and outcome assessor blinding) determined whether studies were judged as high, low or unclear RoB. Findings were summarised narratively and standardised mean differences (SMD) or mean differences and 95% confidence intervals (95% CI) were provided for the strength, kinematic and pain outcomes. Meta-analyses were conducted when possible.
Results:
1016 records were retrieved. Fourteen RCTs (Two low, seven unclear and five high RoB) with 635 participants were included. Pooled data from five trials comparing hip with knee strengthening exercises revealed increases in hip (abductor: 0.27(0.05-0.50)p=0.02; lateral rotator: 0.16(0.06-0.39)p=0.15) and knee (extensor 0.15(-0.09-0.39)p<0.01) strength and decreased pain (-0.6 (-1.05-0.19)p<0.01) favouring the hip exercise group. Two RCTs compared weightbearing versus non-weightbearing exercises; there was no between group difference in knee extension strength (0.00(-0.41-0.42)p=0.99) and a non-significant decrease in pain (mean(95% CI) 0.74(-0.42-1.90)p=0.21) favouring weightbearing exercise. Four RCTs compared motor control exercises with knee +/- hip strengthening exercises and found increased hip abductor strength (0.50(-0.01-1.01)p=0.05) and reduction in pain (mean(95% CI)-1.41(-2.08--0.74) p<0.01) favouring motor control exercise and non-significant increases in hip lateral rotator (-0.04(-0.53-0.45)p=0.87) and knee extensor (-0.20(-0.51-0.11)p=0.20) strength favouring the strengthening group. Two RCTs investigated kinematics and found increased hip flexion (0.89(0.37-1.41)p<0.01) and knee adduction (0.52(0.01-1.01)p=0.04) joint angles favouring the motor control exercise.
Three RCTs compared exercise with non-exercise interventions and found between group changes in knee extensor strength (0.87(0.32-1.41)p<0.01) and pain (-1.01(-1.51- -0.51)p <0.01) favouring the exercise group.
Conclusion. There is some evidence from RCTs of variable quality for the effectiveness of hip, knee and motor control exercises on physical factors and pain in people with PFP. Exercise therapy targeting physical factors should be considered when managing people with PFP.
| Original language | English |
|---|---|
| Title of host publication | Rheumatology |
| Editors | Marwan Bukhari |
| Publisher | Oxford University Press |
| Volume | 58 |
| Edition | Supplement 3 |
| Publication status | Published - 2019 |