Publications by authors named "Danilo de Oliveira Silva"

60 Publications

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

Exploring overweight and obesity beyond body mass index: A body composition analysis in people with and without patellofemoral pain.

J Sport Health Sci 2021 Jun 18. Epub 2021 Jun 18.

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

Background: We compared body mass index (BMI), body fat, and skeletal muscle mass between (1) a mixed-sex nonathletic cohort of people with patellofemoral pain (PFP) and pain-free people, and (2) a nonathletic cohort of people with PFP and pain-free people subgrouped by sex (i.e., men and women with PFP vs. pain-free men and women).

Methods: This cross-sectional study included 114 people with PFP (71 women, 43 men) and 54 pain-free controls (32 women, 22 men). All participants attended a single testing session to assess body composition measures, which included BMI, percentage of body fat (%BF), and skeletal muscle mass (both assessed by bioelectrical impedance analysis), and percentage of body fat (%BF) (assessed by skinfold caliper analysis). A one-way univariate analysis of covariance (age and physical activity levels as covariates) was used to compare body composition measures between groups (i.e., PFP vs. pain-free group; women with PFP vs. pain-free women; men with PFP vs. pain-free men).

Results: Women with PFP presented significantly higher BMI, %BF, and %BF, and lower skeletal muscle mass compared to pain-free women (p ≤ 0.04; effect size = ‒0.47 to 0.85). Men with PFP and men and women combined had no differences in BMI, %BF, %BF, and skeletal muscle mass compared to their respective pain-free groups (p > 0.05).

Conclusion: Our findings indicate that BMI and body composition measures should be considered as part of the evaluation and management of people with PFP, especially in women, who have demonstrated higher BMI and body fat and lower skeletal muscle mass compared to pain-free controls. Future studies should not assess body composition measures in a mixed-sex population without distinguishing men participants from women participants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jshs.2021.06.003DOI Listing
June 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

Physiotherapist-led treatment for femoroacetabular impingement syndrome (the PhysioFIRST study): a protocol for a participant and assessor-blinded randomised controlled trial.

BMJ Open 2021 04 7;11(4):e041742. Epub 2021 Apr 7.

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

Introduction: This double-blind, randomised controlled trial (RCT) aims to estimate the effect of a physiotherapist-led intervention with targeted strengthening compared with a physiotherapist-led intervention with standardised stretching, on hip-related quality of life (QOL) or perceived improvement at 6 months in people with femoroacetabular impingement (FAI) syndrome. We hypothesise that at 6 months, targeted strengthening physiotherapist-led treatment will be associated with greater improvements in hip-related QOL or greater patient-perceived global improvement when compared with standardised stretching physiotherapist-led treatment.

Methods And Analysis: We will recruit 164 participants with FAI syndrome who will be randomised into one of the two intervention groups, both receiving one-on-one treatment with the physiotherapist over 6 months. The targeted strengthening physiotherapist-led treatment group will receive a personalised exercise therapy and education programme. The standardised stretching physiotherapist-led treatment group will receive standardised stretching and personalised education programme. Primary outcomes are change in hip-related QOL using International Hip Outcome Tool-33 and patient-perceived global improvement. Secondary outcomes include cost-effectiveness, muscle strength, range of motion, functional task performance, biomechanics, hip cartilage structure and physical activity levels. Statistical analyses will make comparisons between both treatment groups by intention to treat, with all randomised participants included in analyses, regardless of protocol adherence. Linear mixed models (with baseline value as a covariate and treatment condition as a fixed factor) will be used to evaluate the treatment effect and 95% CI at primary end-point (6 months).

Ethics And Dissemination: The study protocol was approved (La Trobe University Human Ethics Committee (HEC17-080)) and prospectively registered with the Australian New Zealand Clinical Trials Registry. The findings of this RCT will be disseminated through peer reviewed scientific journals and conferences. Patients were involved in study development and will receive a short summary following the completion of the RCT.

Trial Registration Number: ACTRN12617001350314.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2020-041742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8031040PMC
April 2021

Telerehabilitation for Knee Osteoarthritis in Brazil: A Feasibility Study.

Int J Telerehabil 2020 Dec 8;12(2):137-148. Epub 2020 Dec 8.

La Trobe University - Rural Health School, Rural Department of Allied Health, Bendigo, Victoria, Australia.

Background: The effectiveness of telerehabilitation for a patient with knee osteoarthritis may depend upon the person's adherence to intervention. Thus, the aim of this study was to investigate whether people with knee osteoarthritis would adhere to exercise-therapy facilitated via multiple media in Brazil, a newly industrialized country.

Method: This is a feasibility study, pre-post intervention. Middle aged (40-50 years) and elderly (≥70 years) people with knee osteoarthritis received in-person exercise-therapy instructions on the first day, along with a booklet and DVD (videos) to take home. Participants also received six motivational phone calls throughout the 12-week treatment. Satisfaction and adherence were assessed one week after intervention with the Exercise Adherence Rating Scale (EARS), sections B and C. Preference on the method used to adhere to exercises was recorded.

Conclusion: Telerehabilitation was well accepted by middle-aged and elderly Brazilians with knee osteoarthritis. The preferred media to enhance adherence, was a booklet with descriptions of the exercises, especially for the elderly cohort.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5195/ijt.2020.6323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757647PMC
December 2020

Women with patellofemoral pain and knee crepitus have reduced knee flexion angle during stair ascent.

Phys Ther Sport 2021 Mar 17;48:60-66. Epub 2020 Dec 17.

University of Toledo, School of Exercise and Rehabilitation Sciences, Toledo, OH, USA. Electronic address:

Objectives: To compare trunk and knee biomechanics of women with and without patellofemoral pain (PFP) and knee crepitus during stair ascent.

Design: Cross-sectional.

Setting: Laboratory-based study.

Participants: 29 women with PFP and knee crepitus (PFP); 28 women with PFP and no knee crepitus (PFP); 17 pain-free women with knee crepitus (Pain-free); and 29 pain-free women without knee crepitus (Pain-free).

Main Outcome Measures: Peak trunk flexion, peak knee flexion, mean knee angular velocity, knee extensor moment at peak knee flexion, peak and impulse of the knee extensor moment.

Results: PFP group performed the stair ascent task with reduced peak knee flexion compared to Pain-free (p = 0.04; Effect size = -0.85) and Pain-free (p = 0.03; Effect size = -0.75). No significant differences among groups were found for peak trunk flexion (p = 0.979), knee angular velocity (p = 0.420), knee extensor moment at peak knee flexion (p = 0.933), peak (p = 0.290) and impulse (p = 0.122) of the knee extensor moment.

Conclusion: Women with concomitant PFP and knee crepitus demonstrated reduced knee flexion during stair ascent, but no significant differences for trunk flexion and knee extensor moment variables were found.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ptsp.2020.12.013DOI Listing
March 2021

Overweight and obesity in young adults with patellofemoral pain: Impact on functional capacity and strength.

J Sport Health Sci 2020 Dec 7. Epub 2020 Dec 7.

Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, 19060-900, Brazil; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia.

Purpose: To (i) investigate the proportion of overweight/obesity in a cohort of young adults with patellofemoral pain (PFP) and (ii) explore the association of body mass index (BMI), body fat, and lean mass with functional capacity and hip and knee strength in people with PFP.

Methods: We included a mixed-sex sample of young adults (18-35 years old) with PFP (n = 100). Measurements for BMI, percentage of body fat, and lean mass (assessed by bioelectrical impedance) were obtained. Functional capacity was assessed by the Anterior Knee Pain Scale, plank test, and single-leg hop test. Strength of the knee extensors, knee flexors, and hip abductors was evaluated isometrically using an isokinetic dynamometer. The proportion of overweight/obesity was calculated based on BMI. The association between BMI, body fat, and lean mass and functional capacity and strength was investigated using partial correlations, followed by hierarchical regression analysis, adjusted for covariates (sex, bilateral pain, and current pain level).

Results: A total of 38% of our cohort had their BMI categorized as overweight/obese. Higher BMI was associated with poor functional capacity (ΔR = 0.06-0.12, p ≤ 0.001) and with knee flexion strength only (ΔR = 0.04, p = 0.030). Higher body fat was associated with poor functional capacity (ΔR = 0.05-0.15, p ≤ 0.015) and reduced strength (ΔR = 0.15-0.23, p < 0.001). Lower lean mass was associated with poor functional capacity (ΔR = 0.04-0.13, p ≤ 0.032) and reduced strength (ΔR = 0.29- 0.31, p < 0.001).

Conclusion: BMI, body fat, and lean mass should be considered in the assessment and management of young people with PFP because it may be detrimental to function and strength.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jshs.2020.12.002DOI Listing
December 2020

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

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

Patients and clinicians managing patellofemoral pain should not rely on general web-based information.

Phys Ther Sport 2020 Sep 28;45:176-180. Epub 2020 Jul 28.

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

Objective: To evaluate the credibility and accuracy of PFP-specific web-based content.

Design: Cross-sectional evaluation of web-based information.

Methods: The study protocol was registered with PROSPERO (CRD42018088671). Two search engines (Google and Bing) were used to search for websites offering information about PFP. Two reviewers assessed the websites for credibility-related and PFP-specific content. PFP-specific content was evaluated according to agreement with current international PFP consensus statements. Based on this, content was rated as (i) Accurate/Clearly described; (ii) Partially accurate/Description lacks clarity; (iii) Inaccurate/Misleading description; or (iv) Not mentioned.

Results: After exclusion of duplicates, forty online websites were included in our analyses. 43% of websites did not mention their source of information, and 48% did not mention if the source material was peer-reviewed. Misleading/inaccurate information was most commonly found in the definition of PFP (20% websites) and clinical examination (15%). Twenty-two percent of websites recommended surgery as treatment. The item most frequently rated as accurate/clearly described was PFP terminology (87.5%).

Conclusion: This study highlights missing, inaccurate or poorly described web-based PFP information. Due to the commonality of PFP and potential for improving self-management, there is an urgent need to develop more accurate and comprehensive web-based patient education resources for PFP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ptsp.2020.07.004DOI Listing
September 2020

Limited Support for Trunk and Hip Deficits as Risk Factors for Athletic Knee Injuries: A Systematic Review With Meta-analysis and Best-Evidence Synthesis.

J Orthop Sports Phys Ther 2020 09 1;50(9):476-489. Epub 2020 Aug 1.

Objective: To determine whether neuromuscular deficits in trunk and hip-related function are risk factors for athletic knee injuries.

Design: Etiology systematic review with meta-analysis.

Literature Search: Six online databases (MEDLINE, Web of Science, Embase, CINAHL, Scopus, and SPORTDiscus) were searched up to April 2019.

Study Selection Criteria: Studies assessing trunk and hip neuromuscular function as risk factors for knee injuries in healthy athletic populations were included.

Data Synthesis: Outcomes were synthesized quantitatively using meta-analysis of odds ratios, and qualitatively using best-evidence synthesis.

Results: Twenty-one studies met the inclusion criteria. There was very low-certainty evidence that greater hip external rotation strength protected against knee injuries (odds ratio = 0.78; 95% confidence interval: 0.70, 0.87; <.05). There was limited evidence that deficits in trunk proprioception and neuromuscular control, and the combination of excessive knee valgus and ipsilateral trunk angle when landing unilaterally from a jump, may be risk factors for knee injuries.

Conclusion: Most variables of trunk and hip function were not risk factors for injuries. Further research is required to confirm whether hip external rotation strength, trunk proprioception and neuromuscular control, and the combination of knee valgus angle and ipsilateral trunk control are risk factors for future knee injuries. .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2519/jospt.2020.9705DOI Listing
September 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

Patient Education for Patellofemoral Pain: A Systematic Review.

J Orthop Sports Phys Ther 2020 Jul 29;50(7):388-396. Epub 2020 Apr 29.

Objective: To evaluate the effect of education interventions compared with any type of comparator on managing patellofemoral pain (PFP).

Design: Intervention systematic review. PROSPERO identifier: CRD42018088671.

Literature Search: MEDLINE, Embase, CINAHL, and Web of Science were searched for studies evaluating the effect of education on clinical and functional outcomes in people with PFP.

Study Selection Criteria: Two reviewers independently assessed studies for inclusion and quality. We included randomized controlled trials on PFP where at least 1 group received an education intervention (in isolation or in combination with other interventions).

Data Synthesis: Available data were synthesized via meta-analysis where possible; data that were not appropriate for pooling were synthesized qualitatively. Interpretation was guided by the Grading of Recommendations Assessment, Development and Evaluation approach.

Results: Nine trials were identified. Low-credibility evidence indicated that health education material alone was inferior to exercise therapy for pain and function outcomes. Low- and very low-credibility evidence indicated that health professional-delivered education alone produced outcomes similar to those of exercise therapy combined with health professional-delivered education for pain and function, respectively.

Conclusion: Health professional-delivered education may produce similar outcomes in pain and function compared to exercise therapy plus health professional-delivered education in people with PFP. .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2519/jospt.2020.9400DOI Listing
July 2020

Two Weeks of Wearing a Knee Brace Compared With Minimal Intervention on Kinesiophobia at 2 and 6 Weeks in People With Patellofemoral Pain: A Randomized Controlled Trial.

Arch Phys Med Rehabil 2020 04 10;101(4):613-623. Epub 2019 Dec 10.

Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, La Trobe University, Melbourne, Australia. Electronic address:

Objective: To investigate the effect of a knee brace compared with minimal intervention on self-reported kinesiophobia and function, objective function, and physical activity level in people with patellofemoral pain (PFP).

Design: Single-blind randomized controlled trial (1:1), parallel.

Participants: Individuals with PFP (N=50).

Main Outcome Measures: Primary: kinesiophobia (Tampa Scale for Kinesiophobia). Secondary: self-reported function (Anterior Knee Pain Scale), physical activity level (International Physical Activity Questionnaire), and objective function (forward step-down test). Outcomes were assessed at baseline (T), at the end of the intervention (2wk) (T), and at 6 weeks after baseline (T).

Intervention: Participants were randomly assigned to 1 of 2 interventions groups: (1) use of knee brace for 2 weeks during daily living, sports, or painful tasks (brace group) and (2) educational leaflet with information about PFP (leaflet group).

Results: The knee brace reduced kinesiophobia in people with PFP compared with minimal intervention with moderate effect size at T=mean difference (95% CI) -5.56 (-9.18 to -1.93) and T=-5.24 (-8.58 to -1.89). There was no significant difference in self-reported and objective function and physical activity level.

Conclusions: The knee brace improved kinesiophobia immediately after intervention (at 2wk) and at 6-week follow-up in people with PFP compared with minimal intervention. A knee brace may be considered within clinically reasoned paradigms to facilitate exercise therapy interventions for people with PFP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.apmr.2019.10.190DOI Listing
April 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

Knee and Hip Isometric Force Steadiness Are Impaired in Women With Patellofemoral Pain.

J Strength Cond Res 2019 Jul 22. Epub 2019 Jul 22.

Laboratory of Biomechanics and Motor Control (LABCOM), Physiotherapy Department, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.

Ferreira, AS, de Oliveira Silva, D, Ferrari, D, Magalhães, FH, Pappas, E, Briani, RV, Pazzinatto, MF, and de Azevedo, FM. Knee and hip isometric force steadiness are impaired in women with patellofemoral pain. J Strength Cond Res XX(X): 000-000, 2019-The purposes were as follows: to compare knee extension and hip abduction force steadiness and maximal strength between women with patellofemoral pain (PFP) and pain-free women; and to investigate whether maximal strength, self-reported pain during force-matching tasks, self-reported knee function, symptoms duration, and physical activity level are associated with knee extension and hip abduction force steadiness. Thirty women with PFP and 30 pain-free women were recruited. Knee extension and hip abduction maximal voluntary isometric contractions and submaximal isometric force-matching tasks were evaluated using an isokinetic dynamometer. Subjects were asked to match a target force corresponding to 10% of their maximal isometric voluntary contraction while force steadiness was computed as the coefficient of variation (CV) of the exerted force. Women with PFP had significant 36% lower knee extension and 33% lower hip abduction peak strength. They also had significant 70% lower knee extension force steadiness and 60% lower hip abduction force steadiness (i.e., higher CV) than pain-free women. Self-reported pain and self-reported knee function were significantly associated (r = 0.61, p < 0.001; r = -0.35, p = 0.05) and able to predict 41% of the variance of knee extensor force steadiness. Hip abductor maximum strength was significantly associated (r = -0.57; p = 0.001) and able to predict 32% of the variance of hip abductor force steadiness. These findings indicate that muscle impairments in PFP go beyond only low knee and hip muscle strength because women with PFP also present deficits in knee extension and hip abduction force steadiness. Evidence-based treatments aiming at improving force steadiness may be a promising addition to PFP rehabilitation programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1519/JSC.0000000000003215DOI Listing
July 2019

A proximal progressive resistance training program targeting strength and power is feasible in people with patellofemoral pain.

Phys Ther Sport 2019 Jul 2;38:59-65. Epub 2019 May 2.

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia; Department of Physiotherapy, São Carlos Federal University, São Carlos, Brazil.

Objectives: To evaluate the feasibility of a 12-week progressive resistance training program for people with patellofemoral pain (PFP) targeting proximal muscle strength and power; and resulting clinical and muscle capacity outcomes.

Design: Feasibility study.

Setting: Clinical environment.

Participants: Mixed-sex sample of people with PFP.

Main Outcome Measures: Feasibility outcomes included eligibility, recruitment rate, intervention adherence, and drop-outs. Secondary outcomes included perceived recovery, physical function (AKPS and KOOS-PF), worst pain (VAS-cm), kinesiophobia (Tampa), physical activity (IPAQ), and hip strength (isometric and 10 repetition maximum) and power.

Results: Eleven people, from 36 who responded to advertisements, commenced the program. One participant withdrew. Ten participants who completed the program reported improvement (3 completely recovered; 6 marked; and 1 moderate). Higher AKPS (effect size [ES] = 1.81), improved KOOS-PF (ES = 1.37), and reduced pain (ES = 3.36) occurred alongside increased hip abduction and extension dynamic strength (ES = 2.22 and 1.92, respectively) and power (ES = 0.78 and 0.77, respectively). Isometric strength improved for hip abduction (ES = 0.99), but not hip extension.

Conclusion: A 12-week progressive resistance training program targeting proximal muscle strength and power is feasible and associated with moderate-large improvements in pain, function, and hip muscle capacity in people with PFP. Further research evaluating the efficacy of progressive resistance training is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ptsp.2019.04.010DOI Listing
July 2019

Impaired Isometric, Concentric, and Eccentric Rate of Torque Development at the Hip and Knee in Patellofemoral Pain.

J Strength Cond Res 2021 Sep;35(9):2492-2497

Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and.

Abstract: Ferreira, AS, de Oliveira Silva, D, Barton, CJ, Briani, RV, Taborda, B, Pazzinatto, MF, and de Azevedo, FM. Impaired isometric, concentric, and eccentric rate of torque development at the hip and knee in patellofemoral pain. J Strength Cond Res 35(9): 2492-2497, 2021-The aims of this study were to compare maximal muscle strength and rate of torque development (RTD) of knee extensor and hip abductor during isometric, concentric, and eccentric contractions between women with and without patellofemoral pain (PFP). Thirty-eight women with PFP (PFPG) and 38 pain-free women (CG) participated in this study. Isometric, concentric, and eccentric maximal torque and RTD of knee extensor and hip abductor were assessed using an isokinetic dynamometer. Rate of torque development was calculated as the change in torque over the change in time from torque onset to 30, 60, and 90% of the maximal torque (RTD30%, RTD60%, and RTD90%) during isometric, concentric, and eccentric contractions. PFPG had lower isometric, concentric, and eccentric knee extensor maximal torque (29.9, 28.3, and 26.7%) compared with the CG. For knee extensor RTD, PFPG had slower isometric RTD30% (17.8%), RTD60% (21.5%), and RTD90% (23.4%); slower concentric RTD30% (35.7%), RTD60% (29.3%), and RTD90% (28.2%); and slower eccentric RTD30% (20.5%), RTD60% (25.2%), and RTD90% (22.5%) compared with the CG. PFPG had lower isometric, concentric, and eccentric hip abductor maximal torque (28.3, 21.8, and 17%) compared with the CG. For hip abductor RTD, PFPG had slower isometric RTD30% (32.6%), RTD60% (31.1%), and RTD90% (25.4%); slower concentric RTD90% (11.5%); and slower eccentric RTD30% (19.8%), RTD60% (26.4%), and RTD90% (24%) compared with the CG. In conclusion, women with PFP presented deficits in both maximal strength and RTD of knee extensor and hip abductor during isometric, concentric, and eccentric contractions, which highlight the potential importance of addressing different aspects of muscle function through exercise therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1519/JSC.0000000000003179DOI Listing
September 2021

Lower Trunk Muscle Thickness Is Associated With Pain in Women With Patellofemoral Pain.

J Ultrasound Med 2019 Oct 27;38(10):2685-2693. Epub 2019 Feb 27.

Laboratory of Biomechanics and Motor Control, School of Science and Technology, Sao Paulo State University, Presidente Prudente, Sao Paulo, Brazil.

Objectives: To compare trunk muscle thickness of women with and without patellofemoral pain (PFP) and to assess the association of trunk muscle thickness with self-reported pain of women with PFP.

Methods: Forty-four women were recruited and divided into 2 groups: a PFP group (n = 22) and a pain-free group (n = 22). The thickness of the following trunk muscles was obtained by B-mode ultrasound imaging: transversus abdominis, obliquus internus (OI), obliquus externus (OE), rectus abdominis, and multifidus. Self-reported pain was measured on a visual analog scale.

Results: The 44 participants were 18 to 35 years old. Women with PFP had lower thickness of the OI and OE than pain-free women, with moderate or large effect sizes ranging from -0.78 to -0.98, which was negatively related to self-reported pain correlations (r = -0.53 to -0.40). The contraction ratios of the OI and OE were also lower in women with PFP than in pain-free women (P < .05). No differences between groups were found for the transversus abdominis, multifidus, and rectus abdominis, with also no correlation with self-reported pain.

Conclusions: Lower thickness of the OI and OE is present in women with PFP, which is related to self-reported pain. These findings might help in understanding the alterations in trunk biomechanics of individuals with PFP and the mechanisms by which interventions targeting trunk muscle strength are beneficial to individuals with PFP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jum.14973DOI Listing
October 2019

Influence of kinesiophobia and pain catastrophism on objective function in women with patellofemoral pain.

Phys Ther Sport 2019 Jan 28;35:116-121. Epub 2018 Nov 28.

São Paulo State University (UNESP), School of Science and Technology, Laboratory of Biomechanics and Motor Control (LABCOM), Presidente Prudente, Brazil; La Trobe Sports and Exercise Medicine Research Centre (LASEM), School of Allied Health, La Trobe University, Bundoora, Victoria, Australia. Electronic address:

Objectives: (i) To compare kinesiophobia, pain catastrophism and objective function between women with patellofemoral pain (PFP) and pain-free; (ii) to investigate the association of kinesiophobia and pain catastrophism with objetive function in women with PFP.

Design: Case-control.

Setting: Laboratory-based.

Participants: Fifty-five women with PFP and forty pain-free women.

Main Outcome Measures: Kinesiophobia and pain catastrophism were assessed using the Tampa Scale of Kinesiophobia and Pain Catastrophizing Scale, respectively. Forward step-down, single leg hop, and modified star balance tests were used to assess objective function. Independent t-tests were used for between-groups comparisons and Pearson correlation coefficients were used to investigate the association between the outcomes.

Results: Women with PFP had significantly worse kinesiophobia (p < 0.001; Effect size (ES) = 1.16), pain catastrophism (p < 0.001; ES = 1.57), and poorer objective function (step-down, (p < 0.001; ES = 0.99); single-leg hop (p = 0.002; ES = 0.74); modified star balance (p < 0.001; ES = 0.66) than pain-free controls. Kinesiophobia and pain catastrophism were not correlated with objective function.

Conclusion: Greater kinesiophobia, pain catastrophism and poorer objective function is evident in women with PFP, compared to pain-free controls. Kinesiophobia and pain catastrophism were not associated with objective function in women with PFP. Future research is necessary to understand how other physical and psychological factors might affect objective function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ptsp.2018.11.013DOI Listing
January 2019

What are the clinical implications of knee crepitus to individuals with knee osteoarthritis? An observational study with data from the Osteoarthritis Initiative.

Braz J Phys Ther 2019 Nov - Dec;23(6):491-496. Epub 2018 Nov 16.

The University of Sydney, Discipline of Physiotherapy, Faculty of Health Sciences, Sydney, NSW, Australia.

Background: Crepitus is a common clinical feature of knee osteoarthritis. However, the importance of crepitus in the overall clinical presentation of individuals with knee osteoarthritis is unknown.

Objective(s): (A) To compare function, pain and quality of life between individuals with knee osteoarthritis with and without crepitus; (B) to compare whether individuals with knee osteoarthritis in both knees, but crepitus in just one, differ in terms of function pain, and knee strength.

Methods: Setting: Observational study.

Participants: (A) A total of 584 participants with crepitus who had the same Kellgren-Lawrence grade on both knees were matched for gender, body mass index and Kellgren-Lawrence grade to participants without crepitus on both knees. (B) 361 participants with crepitus in only one knee and with the same Kellgren-Lawrence grade classification on both knees were included.

Main Outcome Measure(s): A - Self-reported function, pain, quality of life, 20-m walk test and chair-stand test. B -Knee extensor and flexor strength, self-reported function and pain.

Results: A - Individuals with crepitus had lower self-reported function, quality of life and higher pain compared to those without crepitus (3-11%; small effect=0.17-0.41, respectively). No difference was found in objective function between groups. B - Self-reported function was lower in the limb with crepitus compared to the limb without crepitus (15%; trivial effect=0.09). No difference was found in pain and knee strength between-groups.

Conclusion(s): Individuals with knee osteoarthritis and knee crepitus have slightly lower self-reported physical function and knee-related quality of life (small or trivial effect). However, the presence of knee crepitus is not associated with objective function or knee strength.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjpt.2018.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849337PMC
March 2020

Clinically measured hip muscle capacity deficits in people with patellofemoral pain.

Phys Ther Sport 2019 Jan 11;35:69-74. Epub 2018 Nov 11.

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.

Objective: To evaluate differences in clinical measures of hip abductor and extensor capacity (strength, endurance and power) in people with patellofemoral pain (PFP) compared to asymptomatic controls.

Design: Cross-sectional.

Settings: Laboratory.

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

Main Outcome Measures: Strength was evaluated isometrically using a hand-held dynamometer and dynamically using 10 repetitions maximum (10RM) tests. Power was assessed using a linear position transducer. Endurance was assessed using maximum number of repetitions.

Results: The PFP group had significant deficits compared to the control group in isometric strength (21-25%) for hip abduction (ES = 0.98) and extension (ES = 0.85); in 10RM (15-18%) for hip abduction (ES = 0.72) and extension (ES = 0.85); and in power (24-31%) for hip abduction (ES = 0.80), and extension (ES = 0.94). No difference was identified for hip abduction and extension in endurance tests.

Conclusion: Clinical assessments can identify deficits in isometric and dynamic hip strength, as well as power in people with PFP. Hip muscle capacity deficits in people with PFP including strength and power highlight a potential need for more progressive resistance training in this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ptsp.2018.11.003DOI Listing
January 2019

Manifestations of Pain Sensitization Across Different Painful Knee Disorders: A Systematic Review Including Meta-analysis and Metaregression.

Pain Med 2019 02;20(2):335-358

La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.

Objectives: Previous reviews have reported that manifestations of pain sensitization may play an important role in the pain experienced by people with knee osteoarthritis. However, it is unknown if manifestations of pain sensitization are common features across other painful knee disorders or if sensitization requires targeted intervention. This review aims to synthesize the published research investigating manifestations of pain sensitization in painful knee disorders and to evaluate if the manifestations of pain sensitization change in response to treatment.

Methods: The systematic review protocol was registered with PROSPERO (CRD42015024211). We searched Medline, Embase, CINAHL, Web of Science, Sportsdiscus, and Cochrane Central for studies that investigated between-group differences (knee pain vs pain-free subjects) or the effect of treatment on manifestations of pain sensitization. Two reviewers independently assessed studies for inclusion and quality. Available data were synthesized via predetermined levels of evidence, meta-analysis, and metaregression where possible.

Results: Fifty-two studies investigating evidence related to pain sensitization distributed across four different painful knee disorders were identified.

Conclusions: Our meta-analysis provides evidence of pain sensitization in people with knee osteoarthritis (strong evidence), people with patellofemoral pain (moderate evidence), and postmeniscectomy patients (very limited evidence). However, conflicting evidence exists in patellar tendinopathy. Metaregression indicates that pain is associated with pressure pain thresholds in knee osteoarthritis. In people with knee osteoarthritis and patellofemoral pain, several interventions were found to reduce manifestations of pain sensitization. This review highlights that pain sensitization may be amenable to treatment through exercise therapy, mobilization, and pharmacological and surgical intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/pm/pny177DOI Listing
February 2019

Kinesiophobia, but not strength is associated with altered movement in women with patellofemoral pain.

Gait Posture 2019 02 1;68:1-5. Epub 2018 Nov 1.

Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil. Electronic address:

Background: Evidence indicates the presence of both kinesiophobia and knee extension strength deficits in women with patellofemoral pain (PFP). Both impairments may contribute to apparent compensatory gait patterns including reduced cadence and peak knee flexion during stair negotiation.

Research Question: Is kinesiophobia or knee extension strength associated with movement pattern in women with patellofemoral pain?

Methods: Forty women with PFP were assessed with three-dimensional kinematic analyses during stair descent; isokinetic dynamometry of the knee extensors (isometric, concentric and eccentric); and the Tampa scale for kinesiophobia. Pearson coefficients were calculated to determine relationship among variables.

Results: Kinesiophobia correlated significantly with cadence (r = -0.62, p < 0.001), and peak knee flexion (r = -0.76, p < 0.001). No significant correlations were found between any knee extensor strength variables and kinematics (cadence or peak knee flexion); or kinesiophobia (p > 0.05).

Significance: Findings of this study could suggest addressing strength impairments alone may not adequately address kinesiophobia and movement pattern impairments in women with PFP. However, high-quality randomised controlled trials are needed to test this assumption. Further value may be added if currently evidence-based knee strengthening exercise is combined with education and/or graded exposure to address kinesiophobia, and consideration to gait retraining to address altered movement patterns at the knee.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gaitpost.2018.10.033DOI Listing
February 2019

Quadriceps neuromuscular function in women with patellofemoral pain: Influences of the type of the task and the level of pain.

PLoS One 2018 10;13(10):e0205553. Epub 2018 Oct 10.

Physical Therapy Department, School of Science and Technology, São Paulo State University, Presidente Prudente, Sao Paulo, Brazil.

The present study aimed at investigating whether the neuromuscular system behaves differently (in terms of force and muscle activity generation) as a function of the task being performed (i.e. maximal voluntary efforts vs stair negotiation) and the presence of patellofemoral pain (PFP) and possible influences of pain intensity. Thirty-eight women with (n = 19) and without PFP (n = 19) had their knee strength (extension joint torque) measured during maximal voluntary isometric contractions (MVIC) and electromyography (EMG) data recorded during both MVIC and stair ascent tasks, which were performed before and after a loading protocol designed to exacerbate pain symptoms. Women with PFP displayed lower levels of vastus medialis (p = 0.002) and vastus lateralis (p = 0.032) EMG activation during MVIC assessments. Conversely, the PFP group showed higher levels of vastus medialis muscle activity during stair climbing (p = 0.007), which happened exclusively after the loading protocol. Similarly, women with PFP displayed lower knee extensor torque only during the MVIC tests performed after the loading protocol, which was moderately correlated with the increase in self-reported pain (p = 0.041, r = 0.37), whereas the changes in EMG activity during stair ascent were not correlated with changes in pain intensity (p = 0.215, r = 0.12). These results suggest that, in comparison to pain-free controls, women with PFP display lower levels of quadriceps EMG activation during maximal contractions, but higher activation during dynamic tasks (stair ascent). In addition, the moderate association between the decrease in knee extensor torque and increase in self-reported pain indicates that care should be taken by clinicians during quadriceps strength evaluation in women with PFP, as misleading outcomes may emerge if the intensity of knee pain is not considered during screening. Additionally, rehabilitation strategies should focus on both restoring neuromuscular control and increasing muscle strength.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205553PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179260PMC
March 2019
-->