Effectiveness of Exercise Therapy Versus Spinal Manual Therapy in Patients With Patellofemoral Pain Syndrome: Medium Term Follow-up Results of a Randomised Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 43
- 主要终点
- Visual analogue scale
研究概览
简要总结
Preliminary results of a pilot study in The Bergman Clinic Naarden (NL) show that a local exercise therapy group may decrease pain by 30% on the visual analogue scale (VAS) after 6 weeks. A reduction of 50% on the VAS was realized in a spinal manual therapy group. Therefore, the aim of this study is to compare the effectiveness of local exercise therapy versus spinal manual therapy in patients with PFPS after 6 weeks of intervention and at 6 weeks of follow-up. To the knowledge of the authors, the clinical effectiveness of spinal manual manipulations on pain, function and strength has not been investigated in the medium term.
详细描述
Interventions
The local exercise therapy group will focus on strengthening knee and hip muscles three times a week for 6 weeks. Once a week, patients will train with the support of a physiotherapist. The physiotherapist gradually increases the intensity of the exercises improving muscle endurance. The exercises will be supplemented with mobilisations of the patellofemoral joint. Twice a week, patients train at home following a prescribed exercise program writing down their work-out in an exercise journal.
The spinal manual therapy group will be treated one a week for 6 weeks. Before the first intervention an experienced manual therapist performed a clinical examination of the lower back, SIJ, hip and knee. Anatomical maps showing innervation areas of spinal nerve roots will be used to explain the regional interdependence model in the treatment of anterior knee pain. Manual therapy treatment will include manipulations of the thoracolumbar (T12-L3) region or SIJ as well as hip joint. Manipulation will be conducted if a restriction of range of motion will be found in any of the regions. Patients will also be asked to do home exercises focusing on mobilizing the thoracolumbar region and to write down their performance in an exercise journal.
The allocation of the patients to their treatment group will be concealed from the researcher that assesses the outcome measures.
Outcome measures The following baseline characteristics will be self-reported: age (in years), weight (in kg), height (in cm), duration of symptoms (in months), weekly participation in sport (yes/no), previously receiving exercise therapy treatment for the knee (yes/no). Patellofemoral chondral lesions will be graded using the Kellgren and Lawrence system for classification of osteoarthritis (grade 0 = definite absence of X-ray changes of osteoarthritis, grade 1 = doubtful joint space narrowing and possible osteophytic lipping, grade 2 = definite osteophytes and possible joint space narrowing).
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Investigator, Outcomes Assessor)
盲法说明
The allocation of the patients to their treatment group will be concealed from the researcher that assesses the outcome measures.
入排标准
- 年龄范围
- 16 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •self-reported unilateral or
- •bilateral anterior knee pain provoked by at least two of the following activities: jumping, squatting, ascending/ descending stairs, kneeling, prolonged sitting and or a
- •positive patellar compression test
排除标准
- •experiencing pain for less than 3 months
- •a history of knee surgery
- •meniscal lesion
- •patellar subluxation/dislocation
- •evidence of tendinopathy or ligamentous pathologies
- •dislocation or fracture in the pelvic region
- •spinal surgery
- •osteoporosis
- •pregnancy
- •neurologic disorders
- •findings of chondromalacia > grade 2 on MRI, echography or X-ray.
研究组 & 干预措施
Local exercise therapy
The local exercise therapy group focused on strengthening knee and hip muscles three times a week for 6 weeks. Once a week, patients trained with the support of a physiotherapist. The physiotherapist gradually increased the intensity of the exercises improving muscle endurance. The exercises were supplemented with mobilisations of the patellofemoral joint. Twice a week, patients trained at home following a prescribed exercise program writing down their work-out in an exercise journal.
干预措施: Local exercise therapy (Procedure)
Spinal manual therapy
The spinal manual therapy group was treated one a week for 6 weeks. Before the first intervention an experienced manual therapist performed a clinical examination of the lower back, SIJ, hip and knee. Anatomical maps showing innervation areas of spinal nerve roots were used to explain the regional interdependence model in the treatment of anterior knee pain. Manual therapy treatment included manipulations of the thoracolumbar (T12-L3) region or SIJ as well as hip joint. Manipulation was conducted if a restriction of range of motion was found in any of the regions. Patients were also asked to do home exercises focusing on mobilizing the thoracolumbar region and to write down their performance in an exercise journal.
干预措施: Spinal manual therapy (Procedure)
结局指标
主要结局
Visual analogue scale
时间窗: 6 weeks after the last intervention (at 12 weeks)
Maximum, minimum and current pain intensity was indicated on a 0-100 mm VAS line.
Functionality
时间窗: 6 weeks after the last intervention (at 12 weeks)
Functionality will be measured using the Dutch version of the anterior knee pain scale (AKPS). The AKPS questionnaire consists of 13 items assessing subjective symptoms and functional limitations totalling a maximum score of 100
Visual analogue scale
时间窗: before the first intervention (at baseline)
Maximum, minimum and current pain intensity was indicated on a 0-100 mm VAS line.
Visual analogue scale
时间窗: 6 weeks after the first intervention (at 6 weeks)
Maximum, minimum and current pain intensity was indicated on a 0-100 mm VAS line.
Functionality
时间窗: before the first intervention (baseline)
Functionality will be measured using the Dutch version of the anterior knee pain scale (AKPS). The AKPS questionnaire consists of 13 items assessing subjective symptoms and functional limitations totalling a maximum score of 100
Functionality
时间窗: 6 weeks after the first intervention (at 6 weeks)
Functionality will be measured using the Dutch version of the anterior knee pain scale (AKPS). The AKPS questionnaire consists of 13 items assessing subjective symptoms and functional limitations totalling a maximum score of 100
次要结局
- Knee extension strength(6 weeks after the last intervention (at 12 weeks))
- Knee extension strength(before the first intervention (baseline))
- Knee extension strength(6 weeks after the first intervention (at 6 weeks))
研究者
Scafoglieri Aldo
Prof. dr. Aldo Scafoglieri
Vrije Universiteit Brussel