Publications by authors named "Christian J Barton"

80 Publications

Reported practices related to, and capability to provide, first-line knee osteoarthritis treatments: a survey of 1064 Australian physical therapists.

Braz J Phys Ther 2021 Sep 9. Epub 2021 Sep 9.

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Department of Physiotherapy Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Australia.

Background: Physical therapists play a key role in providing first-line knee osteoarthritis treatments, including patient education and exercise therapy.

Objectives: Describe Australian physical therapists' awareness of guidelines; reported practices; and beliefs about capability, opportunity, motivation, and evidence.

Methods: An online cross-sectional survey was completed by physical therapists prior to attending the Good Living with osteoArthritis from Denmark (GLA:D®) Australia training courses (March 2017 to December 2019). The survey instrument was developed by an expert panel and was informed by the Theoretical Domains Framework.

Results: 1064 physical therapists from all Australian states and territories participated. 11% (n = 121) could name an accepted guideline, 98% agreed it was their job to deliver patient education and exercise therapy, and 92% agreed this would optimise outcomes. Most reported providing strength exercise (99%), written exercise instructions (95%), treatment goal discussion (88%), and physical activity advice (83%) all or most of the time. Fewer provided aerobic exercise (66%), neuromuscular exercise (54%), and weight management discussion (56%) all or most of the time. Approximately one quarter (23-24%) believed they did not have the skills, knowledge, or confidence to provide education and exercise therapy recommended by guidelines, and just 48% agreed they had been trained to do so.

Conclusion: Australian physical therapists treating knee osteoarthritis typically provide strength-based home exercise with written instructions, alongside goal setting and physical activity advice. Just one in nine could name a guideline. Education and training activities are needed to support physical therapists to access, read and implement guidelines, especially for aerobic and neuromuscular exercise, and weight management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjpt.2021.08.001DOI Listing
September 2021

Athletic Trainers' Confidence and Knowledge to Manage Patellofemoral Pain.

J Athl Train 2021 Jul 19. Epub 2021 Jul 19.

Department of Kinesiology, University of Connecticut, Storrs, CT. Email: Twitter:

Context: Patellofemoral pain (PFP) is prevalent and challenging to manage. Most people with PFP are unsatisfied with their knee function 6-months following treatment, and report ongoing pain up to 16-years after diagnosis. Confidence and knowledge to provide evidence-based care to people with PFP amongst Athletic Trainers (ATs) is currently unknown.

Objective: Investigate confidence and knowledge of ATs for the treatment, diagnosis, risk factors, and prognosis with current evidence for PFP.

Design: Cross-sectional study.

Setting: Online survey. Patient or Other Participants: A random sample of 3000 ATs were invited to participate; 261 completed the survey (10% participation rate, 88% completion rate).

Main Outcome Measures(s): AT demographics, confidence in PFP management, and knowledge related to diagnosis, risk factors, prognosis and treatment were surveyed. Chi-squared analyses assessed responses related to confidence and knowledge to manage PFP. ATs beliefs about evidence was compared to current evidence available (i.e. consensus statements, position statements, systematic reviews).

Results: 91% of ATs surveyed were confident that their management of PFP aligns with current evidence, but only 59% were confident in identifying risk factors for PFP development. 91-92% of ATs responded that quadriceps and hip muscle weakness were risk factor for PFP, which aligns with current evidence for quadriceps but not hip muscle weakness. 93-97% of AT responses related to therapeutic exercise aligned with current evidence. However, 35-48% of responses supported the use of passive treatments, such as electrophysical agents and ultrasound, which do not align with current evidence.

Conclusion: Most ATs are aware of supporting evidence for therapeutic exercise in PFP management and are confident providing it, providing a strong foundation for evidence-based care. However, varying awareness of evidence related to risk factors and passive treatments for PFP highlights a need for professional development initiatives to better align AT knowledge with current evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4085/1062-6050-0279.21DOI Listing
July 2021

Altmetric Score Has a Stronger Relationship With Article Citations Than Journal Impact Factor and Open Access Status: A Cross-Sectional Analysis of 4,022 Sports Science Articles.

J Orthop Sports Phys Ther 2021 Jul 1:1-19. Epub 2021 Jul 1.

La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, La Trobe University, Melbourne, VIC, Australia.

Objective: To assess the relationship of individual article citations in the Sport Sciences field to (i) journal impact factor; (ii) each article's open access status; and (iii) Altmetric score components.

Design: Cross-sectional.

Methods: We searched the ISI Web of Knowledge InCites Journal Citation Reports database "Sport Sciences" category for the 20 journals with the highest 2-year impact factor in 2018. We extracted the impact factor for each journal and each article's open access status (yes or no). Between September 2019 and February 2020, we obtained individual citations, Altmetric scores and details of Altmetric components (e.g. number of tweets, Facebook posts, etc.) for each article published in 2017. Linear and multiple regression models were used to assess the relationship between the dependent variable (citation number) and the independent variables article Altmetric score and open access status, and journal impact factor.

Results: 4,022 articles were included. Total Altmetric score, journal impact factor and open access status, respectively explained 32%, 14%, and 1% of the variance in article citations (when combined, the variables explained 40% of the variance in article citations). The number of tweets related to an article was the Altmetric component that explained the highest proportion of article citations (37%).

Conclusion: Altmetric scores in Sports Sciences journals have a stronger relationship with number of citations than does journal impact factor or open access status. Twitter may be the best social media platform to promote a research article as it has a strong relationship with article citations. .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2519/jospt.2021.10598DOI Listing
July 2021

Patient education improves pain and function in people with knee osteoarthritis with better effects when combined with exercise therapy: a systematic review.

J Physiother 2021 Jul 20;67(3):177-189. Epub 2021 Jun 20.

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia. Electronic address:

Question: Is patient education effective as a standalone intervention or combined with other interventions for people with knee osteoarthritis?

Design: Systematic review of randomised controlled trials. MEDLINE, EMBASE, SPORTDiscus, CINAHL and Web of Science were searched from inception to April 2020. The Cochrane Risk of Bias tool was used for included studies, and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to interpret certainty of results.

Participants: People with knee osteoarthritis.

Intervention: Any patient education intervention compared with any non-pharmacological comparator.

Outcome Measures: Primary outcomes were self-reported pain and function.

Results: Twenty-nine trials involving 4,107 participants were included, informing low to very-low certainty evidence. Nineteen of 28 (68%) pooled comparisons were not statistically significant. Patient education was superior to usual care for pain (SMD -0.35, 95% CI -0.56 to -0.14) and function in the short term (-0.31, 95% CI -0.62 to 0.00), but inferior to exercise therapy for pain in the short term (0.77, 95% CI 0.07 to 1.47). Combining patient education with exercise therapy produced superior outcomes compared with patient education alone for pain in the short term (0.44, 95% CI 0.19 to 0.69) and function in the short (0.81, 95% CI 0.54 to 1.08) and medium term (0.39, 95% CI 0.15 to 0.62). When using the Western Ontario and McMaster Universities Osteoarthritis Index for these comparisons, clinically important differences indicated that patient education was inferior to exercise therapy for pain in the short term (MD 1.56, 95% CI 0.14 to 2.98) and the combination of patient education and exercise therapy for function in the short term (8.94, 95% CI 6.05 to 11.82).

Conclusion: Although patient education produced statistically superior short-term pain and function outcomes compared with usual care, differences were small and may not be clinically important. Patient education should not be provided as a standalone treatment and should be combined with exercise therapy to provide statistically superior and clinically important short-term improvements in function compared with education alone.

Registration: PROSPERO CRD42019122004.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jphys.2021.06.011DOI Listing
July 2021

REPORT-PFP: a consensus from the International Patellofemoral Research Network to improve REPORTing of quantitative PatelloFemoral Pain studies.

Br J Sports Med 2021 Jun 14. Epub 2021 Jun 14.

Sports and Exercise Medicine, Queen Mary University of London, London, UK.

Patellofemoral pain is a common and often debilitating musculoskeletal condition. Clinical translation and evidence synthesis of patellofemoral pain research are compromised by heterogenous and often inadequately reported study details. This consensus statement and associated checklist provides standards for REPORTing of quantitative PatelloFemoral Pain (REPORT-PFP) research to enhance clinical translation and evidence synthesis, and support clinician engagement with research and data collection. A three-stage Delphi process was initiated at the 2015 International Patellofemoral Research Network (iPFRN) retreat. An initial e-Delphi activity (n=24) generated topics and items, which were refined at the 2017 iPFRN retreat, and voted on prior to and following the 2019 iPFRN retreat (n=51 current and past retreat participants). Voting criteria included 'strongly recommended' (essential), 'recommended' (encouraged) and uncertain/unsure. An item was included in the checklist if ≥70% respondents voted 'recommended'. Items receiving ≥70% votes for 'strongly recommended' were labelled as such. The final REPORT-PFP checklist includes 31 items (11 strongly recommended, 20 recommended), covering (i) demographics (n=2,4); (ii) baseline symptoms and previous treatments (n=3,7); (iii) outcome measures (2,4); (iv) outcomes measure description (n=1,2); (v) clinical trial methodology (0,3) and (vi) reporting study results (n=3,0). The REPORT-PFP checklist is ready to be used by researchers and clinicians. Strong stakeholder engagement from clinical academics during development means consistent application by the international patellofemoral pain research community is likely. Checklist adherence will improve research accessibility for clinicians and enhance future evidence synthesis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2020-103700DOI Listing
June 2021

Knowledge, confidence and learning needs of physiotherapists treating persistent knee pain in Australia and Canada: a mixed-methods study.

Physiother Theory Pract 2021 Apr 19:1-13. Epub 2021 Apr 19.

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Plenty Road, Bundoora, VIC, Australia 3086.

: To determine the knowledge and confidence of physiotherapists in managing knee osteoarthritis (OA) and patellofemoral pain (PFP); and explore their learning behaviors and preferences related to the management of these knee conditions.: One hundred and sixteen Australian and Canadian Physiotherapists were recruited via social media, e-mail, and an online course. Part 1: Quantitative involved an online survey evaluating knowledge of evidence and confidence in providing treatments for knee OA and PFP. Part 2: Qualitative involved semi-structured interviews with 13 participants exploring current practice and learning needs, that were analyzed using an initial framework structured on interview questions, followed by inductive approach to identify additional themes.: Awareness regarding evidence supporting exercise for knee OA and PFP was good (89-96%), and qualitative themes indicated physiotherapists emphasized exercise-therapy and education. Perceived value of passive treatments and surgery varied. Preference for face-to-face workshops to address learning needs, alongside describing time and cost barriers to access them, emerged from qualitative findings. Online learning formats were viewed as convenient, but not as effective as face-to-face learning.: Knowledge and confidence related to interventions for knee OA and PFP of Australian and Canadian physiotherapist participants broadly aligns with guidelines. Knowledge translation strategies focused on face-to-face workshops, supported by online education may help to bridge evidence-to-practice gaps.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09593985.2021.1906805DOI Listing
April 2021

Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values.

Br J Sports Med 2021 Oct 30;55(19):1106-1118. Epub 2021 Mar 30.

Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia.

Objective: To develop a best practice guide for managing people with plantar heel pain (PHP).

Methods: Mixed-methods design including systematic review, expert interviews and patient survey.

Data Sources: Medline, Embase, CINAHL, SPORTDiscus, Cochrane Central Register of Controlled Trials, trial registries, reference lists and citation tracking. Semi-structured interviews with world experts and a patient survey.

Eligibility Criteria: Randomised controlled trials (RCTs) evaluating any intervention for people with PHP in any language were included subject to strict quality criteria. Trials with a sample size greater than n=38 were considered for proof of efficacy. International experts were interviewed using a semi-structured approach and people with PHP were surveyed online.

Results: Fifty-one eligible trials enrolled 4351 participants, with 9 RCTs suitable to determine proof of efficacy for 10 interventions. Forty people with PHP completed the online survey and 14 experts were interviewed resulting in 7 themes and 38 subthemes. There was good agreement between the systematic review findings and interview data about taping (SMD: 0.47, 95% CI 0.05 to 0.88) and plantar fascia stretching (SMD: 1.21, 95% CI 0.78 to 1.63) for first step pain in the short term. Clinical reasoning advocated combining these interventions with education and footwear advice as the core self-management approach. There was good expert agreement with systematic review findings recommending stepped care management with focused shockwave for first step pain in the short-term (OR: 1.89, 95% CI 1.18 to 3.04), medium-term (SMD 1.31, 95% CI 0.61 to 2.01) and long-term (SMD 1.67, 95% CI 0.88 to 2.45) and radial shockwave for first step pain in the short term (OR: 1.66, 95% CI 1.00 to 2.76) and long term (OR: 1.78, 95% CI 1.07 to 2.96). We found good agreement to 'step care' using custom foot orthoses for general pain in the short term (SMD: 0.41, 95% CI 0.07 to 0.74) and medium term (SMD: 0.55, 95% CI 0.09 to 1.02).

Conclusion: Best practice from a mixed-methods study synthesising systematic review with expert opinion and patient feedback suggests core treatment for people with PHP should include taping, stretching and individualised education. Patients who do not optimally improve may be offered shockwave therapy, followed by custom orthoses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2019-101970DOI Listing
October 2021

Exploring views of orthopaedic surgeons, rheumatologists and general practitioners about osteoarthritis management.

Musculoskeletal Care 2021 Mar 12. Epub 2021 Mar 12.

Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Background: Delivery of recommended treatments for hip and knee osteoarthritis (OA) is known to be discordant with guideline recommendations. However, professional views related to OA management across medical and surgical disciplines are not well understood. The aim of this study was to explore the views of medical professionals about management of hip and knee OA.

Methods: Qualitative study. Semistructured individual interviews were conducted with orthopaedic surgeons, rheumatologists and general practitioners routinely involved in the management of OA. Interviews were audiotaped, transcribed, member-checked, coded and thematically analysed.

Results: Fifteen medical professionals were interviewed. Three main themes were: (i) recognition of the importance of nonsurgical management of hip and knee OA, focussed on self-management, exercise-therapy, weight management and analgesia; (ii) joint replacement being considered the 'last resort' for end stage disease not responding to nonsurgical management; and (iii) determination of management 'success' through patient perceptions was more common than the use of validated instruments. Views on management broadly converged across disciplines, except for the role of joint replacement, considered an adjunct in the overall management of OA by rheumatologists and as a definitive cure by orthopaedic surgeons.

Conclusions: Aligning with current guidelines, medical professionals recognised the importance of nonsurgical management focussed on exercise-therapy for hip and knee OA, and concurred that joint replacement surgery should be a last resort. A focus on patient education was less prominent, which along with implementation of validated outcome measures in routine medical practice, may require greater health system support.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/msc.1549DOI Listing
March 2021

Infographic. ACL injury journey: an education aid.

Br J Sports Med 2021 Jun 27;55(12):697-698. Epub 2021 Jan 27.

La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2020-102273DOI Listing
June 2021

Exercise-therapy and education for individuals one year after anterior cruciate ligament reconstruction: a pilot randomised controlled trial.

BMC Musculoskelet Disord 2021 Jan 11;22(1):64. Epub 2021 Jan 11.

La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Humans Services and Sport, La Trobe University, Bundoora, 3086, Australia.

Background: Guided rehabilitation beyond 6-months is rare following anterior cruciate ligament reconstruction (ACLR), despite high prevalence of unacceptable symptoms and quality of life (QoL). Our primary aim was to determine the feasibility of a randomised controlled trial (RCT) evaluating a physiotherapist-guided intervention for individuals 1-year post-ACLR with persistent symptoms. Our secondary aim was to determine if a worthwhile treatment effect could be observed for the lower-limb focussed intervention (compared to the trunk-focussed intervention), for improvement in knee-related QoL, symptoms, and function.

Design: Participant- and assessor-blinded, pilot feasibility RCT.

Methods: Participant eligibility criteria: i) 12-15 months post-ACLR; ii) < 87.5/100 on the Knee injury and Osteoarthritis Outcome Score (KOOS) QoL subscale; and either a one-leg rise test < 22 repetitions, single-hop < 90% limb symmetry; or Anterior Knee Pain Scale < 87/100. Participants were randomised to lower-limb or trunk-focussed focussed exercise and education. Both interventions involved 8 face-to-face physiotherapy sessions over 16-weeks. Feasibility was assessed by eligibility rate (> 1 in 3 screened), recruitment rate (> 4 participants/month), retention (< 20% drop-out), physiotherapy attendance and unsupervised exercise adherence (> 80%). Between-group differences for knee-related QoL (KOOS-QoL, ACL-QoL), symptoms (KOOS-Pain, KOOS-Symptoms), and function (KOOS-Sport, functional performance tests) were used to verify that the worthwhile effect (greater than the minimal detectable change for each measure) was contained within the 95% confidence interval.

Results: 47% of those screened were eligible, and 27 participants (3 participants/month; 48% men, 34±12 years) were randomised. Two did not commence treatment, and two were lost to follow-up (16% drop-out). Physiotherapy attendance was > 80% for both groups but reported adherence to unsupervised exercise was low (< 55%). Both interventions had potentially worthwhile effects for KOOS-QoL and ACL-QoL, while the lower-limb focussed intervention had potentially greater effects for KOOS-Sport, KOOS-Pain, and functional performance.

Conclusions: A larger-scale RCT is warranted. All feasibility criteria were met, or reasonable recommendations could be made to achieve the criteria in future trials. Strategies to increase recruitment rate and exercise adherence are required. The potential worthwhile effects for knee-related QoL, symptoms, and function indicates a fully-powered RCT may detect a clinically meaningful effect.

Trial Registration: Prospectively registered ( ACTRN12616000564459 ).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12891-020-03919-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802328PMC
January 2021

Knee flexor strength and rate of torque development deficits in women with patellofemoral pain are related to poor objective function.

Gait Posture 2021 01 16;83:100-106. Epub 2020 Oct 16.

La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia.

Background: Deficits in knee flexor strength and rate of torque development (RTD) might be present in women with patellofemoral pain (PFP). In addition, maximal strength and RTD of the knee flexors and extensors might be related with subjective and objective function in women with PFP. However, both conjectures are still poorly understood.

Research Question: Do women with PFP have deficits in the maximal strength and RTD of the knee flexors and extensors during isometric, concentric, and eccentric contractions? Is there a relationship between maximal strength and RTD of the knee flexors and extensors with subjective and objective function in women with PFP?

Methods: Fifty-six women with, and 46 women without, PFP participated. Maximal strength and RTD (to 30% and 60% maximal torque) during isometric, concentric, and eccentric contractions of the knee flexors and extensors were assessed using an isokinetic dynamometer. Objective assessment included single leg hop test (SLHT) and forward step-down test (FSDT). Subjective assessment involved the anterior knee pain scale.

Results: Women with PFP had small to large deficits in maximal strength and RTD of the knee flexors and extensors during isometric, concentric and eccentric contractions (Effect sizes: -0.43 to -1.10; p ≤ 0.016). Small to moderate correlations of maximal concentric and eccentric knee flexor strength and RTD with SLHT and FSDT (r = 0.28 to 0.41; p ≤ 0.037) were identified. Subjective or objective function were not correlated with maximal isometric knee flexor strength and RTD, or any knee extensor measures (p > 0.05).

Significance: Maximal strength and RTD deficits of the knee flexors and extensors were identified in this female PFP cohort, but they were unrelated to subjective function. The relationship of concentric and eccentric knee flexor strength and RTD deficits with poor objective function should be considered in future exercise trials for women with PFP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gaitpost.2020.10.011DOI Listing
January 2021

Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review.

J Clin Med 2020 Oct 23;9(11). Epub 2020 Oct 23.

Department of General Practice, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.

Patellofemoral pain (PFP) and patellofemoral osteoarthritis (PFOA) are common, persistent conditions that may lie along a pathological spectrum. While evidence supports exercise-therapy as a core treatment for PFP and PFOA, primary care physicians commonly prescribe medication, or refer for surgical consults in persistent cases. We conducted a systematic review of medical interventions (pharmaceutical, nutraceutical, and surgical) for PFP and PFOA to inform primary care decision making.

Methods: Following protocol registration, we searched seven databases for randomized clinical trials of our target interventions for PFP and PFOA. Our primary outcome was pain. We assessed risk of bias, calculated standardized mean differences (SMDs) and determined the level of evidence for each intervention.

Results: We included 14 publications investigating pharmaceutical or nutraceutical interventions, and eight publications investigating surgical interventions. Two randomized control trials (RCTs) provided moderate evidence of patellofemoral arthroplasty having similar pain outcomes compared to total knee arthroplasty in isolated PFOA, with SMDs ranging from -0.3 (95% CI -0.8, 0.2, Western Ontario McMaster Pain Subscale, 1 year post-surgery) to 0.3 (-0.1, 0.7, SF-36 Bodily Pain, 2 years post-surgery). Remaining studies provided, at most, limited evidence. No efficacy was demonstrated for oral nonsteroidal anti-inflammatories or arthroscopic surgery.

Conclusions: Pharmaceutical and nutraceutical prescriptions, and surgical referrals are currently being made with little supporting evidence, with some interventions showing limited efficacy. This should be considered within the broader context of evidence supporting exercise-therapy as a core treatment for PFP and PFOA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9113397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690719PMC
October 2020

Fear of movement and (re)injury is associated with condition specific outcomes and health-related quality of life in women with patellofemoral pain.

Physiother Theory Pract 2020 Oct 27:1-10. Epub 2020 Oct 27.

La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.

Objectives: Investigate the association of fear of movement and (re)injury with clinical outcomes in women with patellofemoral pain (PFP).

Methods: This cross-sectional study included 92 women with PFP who completed the TAMPA scale for kinesiophobia. The TAMPA score and its two subscales - activity avoidance and somatic focus were correlated with BMI, physical activity level, pain catastrophizing scale, health-related quality of life, pain sensitivity via pressure pain threshold, self-reported disability, and worst knee pain in last month.

Results: Greater fear of movement and (re)injury, activity avoidance, and somatic focus were correlated with lower local pain sensitivity (rho = -0.29 to -0.55), lower health-related quality of life (rho = -0.38 to -0.42), greater pain catastrophizing (rho = 0.41 to 0.47), and greater self-reported disability (rho = -0.31 to -0.52). Greater fear of movement and (re)injury and activity avoidance were correlated with adjacent and remote pain sensitivity (rho = -0.24 to -0.39). Greater fear of movement and (re)injury and somatic focus were correlated with greater worst knee pain in last month (rho = 0.21 to 0.32). Fear of movement and (re)injury predicted pain measures, disability, and health-related quality of life (p ≤ 0.010).

Conclusion: The relationship of greater fear of movement and (re)injury with greater disability, pain catastrophizing, pain sensitization, and poorer health-related quality of life highlights the potential importance of considering this psychological feature of PFP during assessment and management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09593985.2020.1830323DOI Listing
October 2020

Novel Stepped Care Approach to Provide Education and Exercise Therapy for Patellofemoral Pain: Feasibility Study.

J Med Internet Res 2020 07 22;22(7):e18584. Epub 2020 Jul 22.

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.

Background: Patellofemoral pain (PFP) impairs joint- and health-related quality of life and may be associated with knee osteoarthritis. We developed a novel, 2-phase, stepped-care approach for PFP, combining (1) self-directed web-based education and exercise therapy with (2) physiotherapist-supported education and exercise therapy. Physiotherapy sessions can be provided using 2 different modalities: face-to-face and telerehabilitation.

Objective: This study aims to (1) determine the feasibility of our stepped-care approach, (2) explore patient-reported outcomes following self-directed web-based education and exercise therapy in people with PFP (phase 1), and (3) estimate the differences in treatment effects between face-to-face and telerehabilitation to support further education and exercise therapy (phase 2) in those who had not completely recovered following self-directed care.

Methods: Phase 1 involved 6 weeks of self-directed web-based education and exercise therapy. Phase 2 involved random allocation to a further 12 weeks of physiotherapist-led (up to 8 sessions) education and exercise therapy delivered face-to-face or via telerehabilitation to participants who did not rate themselves as completely recovered following phase 1. Feasibility indicators of process, adherence, and participant retention were collected as primary outcomes alongside patient-reported outcomes on Global Rating of Change and knee pain, disability, knee-related quality of life, pain catastrophism, kinesiophobia, and knee self-efficacy. All participants were assessed at baseline, 6 weeks, and 18 weeks.

Results: A total of 71 participants were screened to identify 35 participants with PFP to enter the study. Overall, 100% (35/35) and 88% (31/35) of the participants were followed up with at 6 and 18 weeks, respectively. In phase 1 of the study, participants accessed the My Knee Cap website for an average of 6 (7.5) days and performed the exercises for an average of 2.5 (3.6) times per week. A total of 20% (7/35) of the participants reported that they had completely recovered at 6 weeks. Furthermore, 93% (26/28) of the participants who were followed up and had not completely recovered at 6 weeks agreed to be enrolled in phase 2. No statistically significant differences were found between the face-to-face and telerehabilitation groups for any outcome. The novel stepped-care approach was associated with marked improvement or complete recovery in 40% (14/35) of the participants following phase 1 and 71% (25/35) of the participants following phase 2.

Conclusions: Self-directed web-based education and exercise therapy for people with PFP is feasible, as noted by the high rate of participant retention and home exercise adherence achieved in this study. Furthermore, 20% (7/35) of people reported complete recovery at 6 weeks. Both face-to-face and telerehabilitation physiotherapy should be considered for those continuing to seek care, as there is no difference in outcomes between these delivery modes. Determining the efficacy of the stepped-care model may help guide more efficient health care for PFP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/18584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407256PMC
July 2020

Pain and disability in women with patellofemoral pain relate to kinesiophobia, but not to patellofemoral joint loading variables.

Scand J Med Sci Sports 2020 Nov 27;30(11):2215-2221. Epub 2020 Jul 27.

Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil.

Background: Altered patellofemoral joint (PFJ) loading and elevated kinesiophobia are commonly reported in people with patellofemoral pain (PFP). However, the relative relationship of these physical-psychological variables with pain and disability in people with PFP is unknown.

Aim: To explore the relationship of PFJ loading during stair ascent and kinesiophobia, with self-reported pain and disability in women with PFP.

Methods: Fifty-seven women with PFP completed the Tampa Scale for Kinesiophobia, a Visual Analog Scale (0-100 mm) for pain during stair ascent, and the Anterior Knee Pain Scale (disability). Stair ascent mechanics were assessed via three-dimensional motion analysis while participants ascended an instrumented seven-step staircase. Peak PFJ contact force and stress, and PFJ contact force and stress loading rates were estimated using a musculoskeletal model. The relationships of PFJ kinetics during stair ascent and kinesiophobia, with the Anterior Knee Pain Scale (disability) and pain during stair ascent, were evaluated with Spearman rank correlation. Variables (kinetics and kinesiophobia) significantly correlating with the dependent variables (pain and disability) were inserted in linear regression models.

Results: Kinesiophobia was moderately associated with self-reported pain (rho = 0.37) and disability (rho = -0.58) in women with PFP. No PFJ loading variables were found to be associated with self-reported pain or disability (P > .05). Kinesiophobia explained 14% of the variance of participants' pain while ascending stairs and 33% of the variance of participant's self-reported disability.

Conclusion: Addressing kinesiophobia during treatment of women with PFP may be important to reduce self-reported pain and disability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/sms.13767DOI Listing
November 2020

Gluteal muscle activity during running in asymptomatic people.

Gait Posture 2020 07 6;80:268-273. Epub 2020 Jun 6.

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Australia; Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Australia; Northern Centre for Health, Education and Research, Northern Health, Victoria, Australia. Electronic address:

Background: Hip abductor muscle function is associated with running-related injuries. Previous electromyography (EMG) studies that reporting gluteal muscle activity when running have failed to account for the multiple segments of the gluteals, and have used surface electrodes, which may be contaminated by cross-talk of surrounding muscles.

Research Question: This study aimed to: (i) develop EMG profiles of gluteus medius (GMed - anterior, middle and posterior) and gluteus minimus (GMin - anterior and posterior) segments during running; (ii) compare the activation patterns of each gluteal segment between running and walking; and (iii) compare surface EMG signals of running and walking to fine wire EMG signals of middle GMed.

Methods: Ten physically active and asymptomatic people participated. Gluteal segment activation was assessed during running and walking over 10 m. Muscle activation was assessed using bipolar fine wire intramuscular EMG electrodes and GMed activation was also assessed using surface EMG.

Results: During running, all gluteal segments presented peak amplitude during the stance phase and anterior GMin presented additional second peak amplitude during the swing phase. All gluteal segments evaluated demonstrated consistently higher amplitudes during the stance and swing phases of running compared to walking. The mean amplitude assessed using surface EMG was 32-87% higher compared to fine wire during both phases for running and walking.

Significance: Greater activation of GMed segments during the stance phase and the increased anterior GMin activity during the swing phase indicate a potentially important role for pelvis and hip stabilization, respectively, which should be considered during development of targeted rehabilitation for running populations. The overestimated activation using surface electrodes highlights a limitation of using surface EMG during running and walking.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gaitpost.2020.06.008DOI Listing
July 2020

Subclassification of recreational runners with a running-related injury based on running kinematics evaluated with marker-based two-dimensional video analysis.

Phys Ther Sport 2020 Jul 28;44:99-106. Epub 2020 Apr 28.

KU Leuven, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Campus Bruges, Belgium.

Objectives: To explore whether homogeneous subgroups could be discriminated within a population of recreational runners with a running-related injury based on running kinematics evaluated with marker-based two-dimensional video analysis.

Design: Cross-sectional.

Setting: Research laboratory.

Participants: Fifty-three recreational runners (15 males, 38 females) with a running-related injury.

Main Outcome Measures: Foot and tibia inclination at initial contact, and hip adduction and knee flexion at midstance were measured in the frontal and sagittal plane with marker-based two-dimensional video analysis during shod running on a treadmill at preferred speed. The four outcome measures were clustered using K-means cluster analysis (n = 2-10). Silhouette coefficients were used to detect optimal clustering.

Results: The cluster analysis led to the classification of two distinct subgroups (mean silhouette coefficient = 0.53). Subgroup 1 (n = 39) was characterized by significantly greater foot inclination and tibia inclination at initial contact compared to subgroup 2 (n = 14).

Conclusion: The existence of different subgroups demonstrate that the same running-related injury can be represented by different kinematic presentations. A subclassification based on the kinematic presentation may help clinicians in their clinical reasoning process when evaluating runners with a running-related injury and could inform targeted intervention strategy development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ptsp.2020.04.032DOI Listing
July 2020

Limb symmetry index on a functional test battery improves between one and five years after anterior cruciate ligament reconstruction, primarily due to worsening contralateral limb function.

Phys Ther Sport 2020 Jul 8;44:67-74. Epub 2020 May 8.

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Australia. Electronic address:

Objective: Evaluate change in functional performance from 1- to 5-years after anterior cruciate ligament reconstruction (ACLR).

Methods: 59 participants (38 men) aged 29 ± 16 years completed three hops and one-leg rise 1- and 5-years following ACLR. Linear mixed-effects models evaluated differences in change between the ACLR and contralateral limbs. Participants were classified with stable, improving or worsening function relative to previously published minimal detectable change thresholds. Healthy controls completed the three hops (n = 41) and one-leg rise (n = 31) as reference data.

Results: The contralateral limb had a significantly greater decrease in functional performance between 1- and 5-years for the three hops, compared to the ACLR limb. Worsening was more common in the contralateral limb than the ACLR limb; resulting in significant improvements in the LSI for the single hop (mean 87% at 1-year to 95% at 5-years), side hop (77%to 86%) and one-leg rise (76% to85%). Performance of both ACLR and contralateral limbs and the LSI remained below the healthy controls.

Conclusion: Functional performance changes differ between limbs between 1- and 5-years post-ACLR. The LSI should not be used in isolation to evaluate functional performance changes after ACLR, as it may overestimate functional improvement, due to worsening contralateral limb function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ptsp.2020.04.031DOI Listing
July 2020

Infographic. Running myth: switching to a non-rearfoot strike reduces injury risk and improves running economy.

Br J Sports Med 2021 Feb 18;55(3):175-176. Epub 2020 May 18.

La Trobe Sports and Exercise Research Centre, La Trobe University, Melbourne, Victoria, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2020-102262DOI Listing
February 2021

Impaired Knee Muscle Capacity Is Correlated With Impaired Sagittal Kinematics During Jump Landing in Women With Patellofemoral Pain.

J Strength Cond Res 2020 Apr 24. Epub 2020 Apr 24.

Department of Physiotherapy, São Carlos Federal University, São Carlos, Brazil.

Nunes, GS, Barton, CJ, and Serrão, FV. Impaired knee muscle capacity is correlated with impaired sagittal kinematics during jump landing in women with patellofemoral pain. J Strength Cond Res XX(X): 000-000, 2020-Knee and hip muscle capacity is impaired in women with patellofemoral pain (PFP), but little is known about the rate of force development (RFD) at the knee. Impaired muscle capacity may contribute to reduced sagittal plane movement at the knee and hip during jump landing in women with PFP. This study aimed to (a) compare knee extensor muscle capacity (including RFD), and hip abductor and extensor muscle capacity between women with and without PFP; and (b) evaluate the relationship between hip/knee muscle capacity and sagittal kinematics during single-legged drop jump landing in women with PFP. Fifty-two physically active women (26 with PFP and 26 controls) participated. Rate of force development (in %/ms), isometric, concentric, and eccentric torque (in N·m·kg × 100) were evaluated using isokinetic dynamometry, and knee and hip kinematics were evaluated using three-dimensional motion capture. Compared with the control group (CG), the PFP group (PFPG) presented lower isometric (12%, PFPG = 217.2 ± 46.0; CG = 246.5 ± 38.8; p = 0.02), concentric (21%, PFPG = 133.0 ± 42.6; CG = 169.2 ± 28.8; p < 0.01), and eccentric (17%, PFPG = 172.9 ± 56.7; CG = 208.4 ± 59.4; p = 0.03) knee extension torque; lower RFD until 30% (30%, PFPG = 0.57 ± 0.27; CG = 0.83 ± 0.37; p < 0.01) and 60% (31%, PFPG = 0.47 ± 0.24; CG = 0.67 ± 0.33; p = 0.01) of maximal isometric torque; and lower concentric hip abduction (13%, PFPG = 94.7 ± 19.1; CG = 108.4 ± 17.5; p = 0.01) and extension (17%, PFPG = 134.4 ± 34.3; CG = 162.6 ± 38.0; p < 0.01) torque. Significant correlations between reduced RFD for knee extension and reduced sagittal plane knee/hip range of motion during landing were identified (r = 0.39-0.49). In conclusion, women with PFP have impaired knee extensor isometric and dynamic strength, and RFD. Impaired knee extensor RFD is associated with a stiffer landing strategy (reduced movement).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1519/JSC.0000000000003616DOI Listing
April 2020

Poor functional performance 1 year after ACL reconstruction increases the risk of early osteoarthritis progression.

Br J Sports Med 2020 May 10;54(9):546-553. Epub 2020 Apr 10.

Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia

Background: Not meeting functional performance criteria increases reinjury risk after ACL reconstruction (ACLR), but the implications for osteoarthritis are not well known.

Objective: To determine if poor functional performance post-ACLR is associated with risk of worsening early osteoarthritis features, knee symptoms, function and quality of life (QoL).

Methods: Seventy-eight participants (48 men) aged 28±15 years completed a functional performance test battery (three hop tests, one-leg-rise) 1 year post-ACLR. Poor functional performance was defined as <90% limb symmetry index (LSI) on each test. At 1 and 5 years, MRI, Knee injury Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective form were completed. Primary outcomes were: (i) worsening patellofemoral and tibiofemoral MRI-osteoarthritis features (cartilage, bone marrow lesions (BMLs) and meniscus) and (ii) change in KOOS and IKDC scores, between 1 and 5 years.

Results: Only 14 (18%) passed (≥90% LSI on all tests) the functional test battery. Poor functional performance on the battery (all four tests <90% LSI) 1 year post-ACLR was associated with 3.66 times (95% CI 1.12 to 12.01) greater risk of worsening patellofemoral BMLs. A triple-crossover hop <90% LSI was associated with 2.09 (95% CI 1.15 to 3.81) times greater risk of worsening patellofemoral cartilage. There was generally no association between functional performance and tibiofemoral MRI-osteoarthritis features, or KOOS/IKDC scores.

Conclusion: Only one in five participants met common functional performance criteria (≥90% LSI all four tests) 1 year post-ACLR. Poor function on all four tests was associated with a 3.66 times increased risk of worsening patellofemoral BMLs, and generally not associated with decline in self-reported outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2019-101503DOI Listing
May 2020

Is markerless, smart phone recorded two-dimensional video a clinically useful measure of relevant lower limb kinematics in runners with patellofemoral pain? A validity and reliability study.

Phys Ther Sport 2020 May 10;43:36-42. Epub 2020 Feb 10.

Sports & Exercise Medicine, Queen Mary University of London, United Kingdom; Physiotherapy Department, Barts Health NHS Trust, London, UK.

Objectives: Investigate the validity and reliability of markerless, smart phone collected, two-dimensional (2D) video, analysed using the 'Hudl technique' application, compared to three-dimensional (3D) kinematics during running, in participants with patellofemoral pain (PFP).

Design: Validity/reliability study.

Setting: Biomechanics laboratory.

Participants: Males/females with PFP (n = 21, 10 males, 11 females, age 32.1 months [±12.9]).

Main Outcome Measures: Manually synchronised 2D and 3D measurement of peak hip adduction (HADD) and peak knee flexion (KFLEX) during running.

Results: 2D and 3D measures of peak KFLEX (p = 0.02, d = 1.13), but not peak HADD (p = 0.25, d = -0.27), differed significantly. Poor validity was identified for 2D measurement of peak HADD (ICC 0.06, 95% CI -0.35, 0.47) and peak KFLEX ICC 0.42, 95% CI (-0.10, 0.75). Moderate intra-rater reliability was identified for both variables (ICC 0.61-65), alongside moderate inter-rater reliability for peak KFLEX (ICC 0.71) and poor inter-rater reliability for peak HADD (ICC 0.31).

Conclusions: Measurement of peak HADD and KFLEX in runners with PFP using markerless, smart phone collected 2D video, analysed using the Hudl technique Application is invalid, with poor to moderate reliability. Investigation of alternate 2D video approaches to increase precision is warranted. At present, 2D video analysis of running using Hudl Technique cannot be advocated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ptsp.2020.02.004DOI Listing
May 2020

Infographic. Roadmap to managing a person with musculoskeletal pain irrespective of body region.

Br J Sports Med 2020 May 20;54(9):554-555. Epub 2020 Jan 20.

Curtin University, School of Physiotherapy and Exercise Science, Perth, Western Australia, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2019-101681DOI Listing
May 2020

What are the Benefits and Risks Associated with Changing Foot Strike Pattern During Running? A Systematic Review and Meta-analysis of Injury, Running Economy, and Biomechanics.

Sports Med 2020 May;50(5):885-917

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, 3086, Australia.

Background: Running participation continues to increase. The ideal strike pattern during running is a controversial topic. Many coaches and therapists promote non-rearfoot strike (NRFS) running with a belief that it can treat and prevent injury, and improve running economy.

Objective: The aims of this review were to synthesise the evidence comparing NRFS with rearfoot strike (RFS) running patterns in relation to injury and running economy (primary aim), and biomechanics (secondary aim).

Design: Systematic review and meta-analysis. Consideration was given to within participant, between participant, retrospective, and prospective study designs.

Data Sources: MEDLINE, EMBASE, CINAHL, and SPORTDiscus.

Results: Fifty-three studies were included. Limited evidence indicated that NRFS running is retrospectively associated with lower reported rates of mild (standard mean difference (SMD), 95% CI 3.25, 2.37-4.12), moderate (3.65, 2.71-4.59) and severe (0.93, 0.32-1.55) repetitive stress injury. Studies prospectively comparing injury risk between strike patterns are lacking. Limited evidence indicated that running economy did not differ between habitual RFS and habitual NRFS runners at slow (10.8-11.0 km/h), moderate (12.6-13.5 km/h), and fast (14.0-15.0 km/h) speeds, and was reduced in the immediate term when an NRFS-running pattern was imposed on habitual RFS runners at slow (10.8 km/h; SMD = - 1.67, - 2.82 to - 0.52) and moderate (12.6 km/h; - 1.26, - 2.42 to - 0.10) speeds. Key biomechanical findings, consistently including both comparison between habitual strike patterns and following immediate transition from RFS to NRFS running, indicated that NRFS running was associated with lower average and peak vertical loading rate (limited-moderate evidence; SMDs = 0.72-2.15); lower knee flexion range of motion (moderate-strong evidence; SMDs = 0.76-0.88); reduced patellofemoral joint stress (limited evidence; SMDs = 0.63-0.68); and greater peak internal ankle plantar flexor moment (limited evidence; SMDs = 0.73-1.33).

Conclusion: The relationship between strike pattern and injury risk could not be determined, as current evidence is limited to retrospective findings. Considering the lack of evidence to support any improvements in running economy, combined with the associated shift in loading profile (i.e., greater ankle and plantarflexor loading) found in this review, changing strike pattern cannot be recommended for an uninjured RFS runner.

Prospero Registration: CRD42015024523.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40279-019-01238-yDOI Listing
May 2020

Infographic running myth: static stretching reduces injury risk in runners.

Br J Sports Med 2020 Sep 6;54(17):1058-1059. Epub 2019 Nov 6.

Physical Therapy and Movement Science, University of Montana, Missoula, Montana, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2019-101169DOI Listing
September 2020

It is time to move beyond 'body region silos' to manage musculoskeletal pain: five actions to change clinical practice.

Br J Sports Med 2020 Apr 11;54(8):438-439. Epub 2019 Oct 11.

School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2018-100488DOI Listing
April 2020

Infographic. Running myth: strength training should be high repetition low load to improve running performance.

Br J Sports Med 2020 Jul 25;54(13):813-814. Epub 2019 Sep 25.

Physical Therapy and Movement Science, University of Montana, Missoula, Montana, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2019-101168DOI Listing
July 2020

People with patellofemoral pain have impaired functional performance, that is correlated to hip muscle capacity.

Phys Ther Sport 2019 Nov 27;40:85-90. Epub 2019 Aug 27.

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Australia. Electronic address:

Objective: To (i) compare objective function in a range of tasks between people with and without patellofemoral pain (PFP); and (ii) evaluate the relationship of objective function with hip muscle capacity and self-reported function in people with PFP.

Design: Cross-sectional.

Settings: Laboratory.

Participants: Thirty-two physically active people (16 with PFP and 16 controls).

Main Outcome Measures: Functional assessments included stair climbing (time), single-legged chair stand (repetitions), step down (repetitions), forward hop for distance and side hop (repetitions). Hip abductor and extensor capacity assessments included power, endurance, isometric and dynamic strength. Self-reported function included the Kujala scale and Patellofemoral sub-scale of the Knee injury and Osteoarthritis Outcome Score (KOOS-PF).

Results: The PFP group was 15% slower climbing stairs (effect size [ES] = 0.90), performed 12% fewer chair stands (ES = 0.62) and forward hopped 20% shorter (ES = 0.79) compared to controls. Lower hip muscle strength and power correlated with lower objective function (r = 0.52-0.78). Lower Kujala scores correlated with longer stair climbing time (r = -0.53).

Conclusion: People with PFP have objective functional impairments, that are associated with reduced hip muscle capacity, indicating progressive resistance training may be beneficial. Absence of a strong correlation between self-reported, and objective, function indicates assessment of both when treating people with PFP is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ptsp.2019.08.010DOI Listing
November 2019

Three steps to changing the narrative about knee osteoarthritis care: a call to action.

Br J Sports Med 2020 Mar 4;54(5):256-258. Epub 2019 Sep 4.

University of Melbourne Department of Surgery, St Vincents Hospital, Melbourne, Victoria, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2019-101328DOI Listing
March 2020
-->