Predictors for identifying patients with patellofemoral pain syndrome responding to femoral nerve mobilization.

Abstract

To identify the predictors for successful neurodynamic management in patients with patellofemoral pain syndrome. Prospective cohort, prediction rule study. Hospital. Patients with patellofemoral pain syndrome (N=51) underwent clinical examination and measurement of physical parameters, including femoral slump test, lower-extremity alignment, flexibility and muscle strength, and functional level. Patients received 6 treatment sessions of femoral nerve mobilization within 2 weeks. Pain level during functional testing was assessed before and after the first and sixth session of treatment. Patients were then grouped into responder and nonresponder groups. Criteria for the responder group was a pain score decrease ≥50% or Global Rating Scale score ≥4. Chi-square and independent t tests were used to identify potential variables with a significance level of .10, and stepwise logistic regression was used to find predictors with a significance level of .05. Twenty-five patients responded to the initial treatment (immediate effect), and 28 patients responded after 6 sessions (longer-term effect). A positive femoral slump test was identified as the predictor for the immediate treatment effect. The prediction factors for the longer-term effect included responding to femoral nerve mobilization the first time and a bilateral difference in hip extension angles. Application of the clinical predictors improved the success rate to 90% for 1 treatment session and 93% for 6 treatment sessions. Clinicians could use the positive femoral slump test and a bilateral difference in hip extension angles during the femoral slump test to determine whether or not patients with patellofemoral pain syndrome might benefit from femoral nerve mobilization.