Six Treatments Have Positive Effects at 3 Months for People With Patellofemoral Pain: A Systematic Review With Meta-analysis.

Abstract

<b>OBJECTIVE:</b> To determine the effects of nonsurgical treatments on pain and function in people with patellofemoral pain (PFP). <b>DESIGN:</b> Systematic review with meta-analysis. <b>LITERATURE SEARCH:</b> We searched MEDLINE, Web of Science, and Scopus databases from their inception until May 2022 for interventional randomized controlled trials (RCTs) in people with PFP. <b>STUDY SELECTION CRITERIA:</b> We included RCTs that were scored ≥7 on the PEDro scale. <b>DATA SYNTHESIS:</b> We extracted homogenous pain and function data at short- (≤3 months), medium- (>3 to ≤12 months) and long-term (>12 months) follow-up. Interventions demonstrated <i>primary efficacy</i> if outcomes were superior to sham, placebo, or wait-and-see control. Interventions demonstrated <i>secondary efficacy</i> if outcomes were superior to an intervention with primary efficacy. <b>RESULTS:</b> We included 65 RCTs. Four interventions demonstrated short-term <i>primary efficacy</i>: knee-targeted exercise therapy for pain (standardized mean difference [SMD], 1.16; 95% CI: 0.66, 1.66) and function (SMD, 1.19; 95% CI: 0.51, 1.88), combined interventions for pain (SMD, 0.79; 95% CI: 0.26, 1.29) and function (SMD, 0.98; 95% CI: 0.47, 1.49), foot orthoses for global rating of change (OR = 4.31; 95% CI: 1.48, 12.56), and lower-quadrant manual therapy for function (SMD, 2.30; 95% CI: 1.60, 3.00). Two interventions demonstrated short-term <i>secondary efficacy</i> compared to knee-targeted exercise therapy: hip-and-knee-targeted exercise therapy for pain (SMD, 1.02; 95% CI: 0.58, 1.46) and function (SMD, 1.03; 95% CI: 0.61, 1.45), and knee-targeted exercise therapy and perineural dextrose injection for pain (SMD, 1.34; 95% CI: 0.72, 1.95) and function (SMD, 1.21; 95% CI: 0.60, 1.82). <b>CONCLUSIONS:</b> Six interventions had positive effects at 3 months for people with PFP, with no intervention adequately tested beyond this time point. <i>J Orthop Sports Phys Ther 2022;52(11):750-768. Epub: 8 September 2022. doi:10.2519/jospt.2022.11359</i>.