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Delgadillo BE, Bui A, Debski AM, Miller B, Wu DO SS. Efficacy of Osteopathic Manipulative Treatment for Pain Reduction in Patients With Patellofemoral Pain Syndrome: A Meta-Analysis of Randomized Controlled Trials. Cureus 2024; 16:e59439. [PMID: 38826947 PMCID: PMC11140634 DOI: 10.7759/cureus.59439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Patellofemoral pain syndrome (PFPS) is among the most common causes of musculoskeletal pain in the United States. It is defined as retropatellar or peripatellar pain that is reproduced with functional activities that load the patellofemoral joint in a flexed position, such as stair climbing or squatting. While it presents in both adolescents and adults, it is commonly found in physically active individuals, such as athletes and military recruits. Exploring the role of osteopathic manipulative treatment (OMT) in PFPS is of particular interest given the absence of a definitive treatment and the poor long-term prognosis associated with PFPS. This meta-analysis includes three studies exploring the use of OMT to reduce pain in patients suffering from PFPS and exploring the efficacy of OMT as a primary intervention. In these studies, pain assessments, pre-treatment, and post-treatment follow-up of at least 30 days were performed using a 10-cm visual analog scale (VAS). The mean difference in pain between OMT and no treatment (NT) groups using the random effects model was -3.95 (-6.39; -1.50) with a p<0.01, suggesting OMT resulted in significant knee pain reduction in those with PFPS. A measure of heterogeneity, known as I2, was found to be high at 97%, which suggests caution should be taken when interpreting the overall results. Given the lack of definitive treatment and the poor long-term prognosis for PFPS, the authors suggest OMT provides an effective option for pain relief in patients with PFPS. Further research is needed to provide results that may be more clinically applicable or valuably interpreted.
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Affiliation(s)
- Blake E Delgadillo
- Orthopaedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Audrey Bui
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Alyssa M Debski
- Anatomy, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Brooke Miller
- Urology, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Shan Shan Wu DO
- Allergy/Immunology, Allergy/Immunology Associates, Inc., Mayfield Heights, USA
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Batista NP, de Oliveira Silva D, Mochizuki L, Norte GE, Bazett-Jones DM. Clinic- and laboratory-based measures of postural control in patellofemoral pain: A systematic review with meta-analysis and evidence gap map. Gait Posture 2024; 109:189-200. [PMID: 38341930 DOI: 10.1016/j.gaitpost.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent musculoskeletal disorder associated with functional impairments. Although postural control is commonly assessed in people with PFP, there are inconsistent results regarding potential postural control deficits in this population. RESEARCH QUESTION This review aims to evaluate whether postural control is impaired in people with patellofemoral pain (PFP) and the effectiveness of interventions on postural control measures. METHODS We searched six databases from their inception to May 5, 2023. We included studies assessing clinic- or laboratory-based postural control measures in people with PFP compared to pain-free controls, and intervention studies with PFP populations. We assessed risk of bias using the Joanna Briggs Institute critical appraisal checklists and the Cochrane Risk of Bias 2 tool. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We used random-effects meta-analyses considering subgroups based on type of task, measure, and intervention. RESULTS Fifty-three studies were included. Very low certainty evidence indicated that people with PFP have shorter anterior (SMD = 0.53, 95 %CI:0.16,0.90), posteromedial (SMD = 0.54, 95 %CI:0.04,1.03) and posterolateral (SMD = 0.59, 95 %CI:0.11,1.07) reach distance, and worse composite score (SMD = 0.46, 95 %CI:0.22,0.70). Very low to moderate certainty evidence indicated that people with PFP have worse anterior-posterior and overall stability indexes during single-leg stance (SMD = -0.71, 95 %CI:-1.29,-0.14; SMD = -0.63, 95 %CI:-0.94,-0.32) and overall stability index during double-leg stance (SMD = -0.39, 95 %CI:-0.78,-0.00), but no differences in center of pressure area during stair ascent (SMD = 0.32, 95 %CI:-2.72, 3.36). Low certainty evidence indicated that kinesio taping improved anterior reach distance (SMD = -0.49, 95 %CI:-0.89,-0.09), while no significant differences were observed between pre- and post-intervention outcomes for conventional rehabilitation and rigid taping. SIGNIFICANCE Clinicians should use clinic- (star excursion or Y-balance tests) and laboratory-based (stability indexes) measures to identify impairments of postural control in people with PFP. Low certainty of evidence suggests short-term improvement in postural control with kinesio taping.
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Affiliation(s)
- Natanael P Batista
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
| | - Danilo de Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
| | - Luis Mochizuki
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
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Irving R, Schmidt E, Stone M, Fleming RK, Xie JY. Meta-epidemiologic review: blinding and sham treatment in clinical trial design for osteopathic manipulative treatment research. INT J OSTEOPATH MED 2024; 51:100705. [PMID: 38312536 PMCID: PMC10836155 DOI: 10.1016/j.ijosm.2023.100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Objective To analyze the consistency of study designs in osteopathic manipulative treatment (OMT) research, focusing on blinding protocols and the use of sham treatments. Data Source and Study Selection PubMed and CINAHL were searched in January 2022. A total of 83 research studies between 2009 and 2021 were selected based on the presence of a double- or single-blind study design and/or sham treatment. Data Extraction and Analysis Data regarding the primary outcome measures, blinding design, measures used to determine success of blinding, osteopathic technique used, and sham technique used for each eligible study were extracted and compared among different study designs. Results A total of 5968 subjects participated in the 83 trials. The study population mainly consisted of asymptomatic individuals (25%) and chronic back pain patients (19%). Light touch was employed most commonly (49%) as the sham treatment, followed by unrelated sham (20%) and incomplete maneuvers (20%). Most studies blinded the subjects (80%) or the outcome evaluator/data analyzer (71%), while only 20% studies blinded the osteopathic physicians. Conclusions Strict double-blinding is achievable for OMT clinical research by blinding the subjects and data collectors/analyzers rather than the osteopaths providing the actual treatment. The use of questionnaires to determine the success of blinding should be considered. Additionally, including OMT-naïve subjects is preferred to enhance blinding success. When designing a sham treatment, careful consideration should be given to blinding the data collector, accounting for the placebo effect, and incorporating an additional no-treatment control group to improve the rigor of the study design.
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Affiliation(s)
- Richard Irving
- Department of Basic Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR, USA
| | - Emma Schmidt
- Department of Basic Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR, USA
| | - Michaela Stone
- Biology Department, Arkansas Biosciences Institute, Arkansas State University, Jonesboro, AR, USA
| | - Regina K. Fleming
- Department of Osteopathic Manipulative Medicine, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR, USA
| | - Jennifer Yanhua Xie
- Department of Basic Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR, USA
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Shakouri A, Kamali F, Mohamadi M, Nouhi E. Lumbopelvic manipulation alone versus combined with dry needling in physically active patients with patellofemoral pain syndrome: A randomized clinical trial. J Bodyw Mov Ther 2024; 37:220-225. [PMID: 38432809 DOI: 10.1016/j.jbmt.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/06/2023] [Accepted: 11/13/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Patellofemoral pain syndrome (PFPS) is prevalent in physically active people. The multifactorial nature of PFPS necessitates multimodal treatment for this condition. The present study aimed to compare the efficacy of lumbopelvic manipulation alone versus manipulation plus dry needling in physically active patients with PFPS. METHOD Thirty patients (18 women and 12 men) with a diagnosis of PFPS entered this randomized controlled clinical trial and were divided into two groups: lumbopelvic manipulation alone or lumbopelvic manipulation plus dry needling. The interventions were applied for 3 sessions every other day. Dry needling was performed on the quadratus lumborum and gluteus medius muscles. Pain intensity, Kujala score and side-plank time were recorded at baseline, post-intervention and 1 month after the intervention. RESULTS The results of Friedman's test showed statistically significant differences in pain and function in participants during the study period, and post hoc tests revealed differences between the two groups in behavior of the marginal means (p < 0.001). CONCLUSION The use of lumbopelvic manipulation plus dry needling in the quadratus lumborum and gluteus medius muscles may be more effective than manipulation alone in alleviating pain and promoting function in physically active patients with PFPS.
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Affiliation(s)
- Amin Shakouri
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran; Physiotherapy, National University of Medical Science Spain, Spain.
| | - Fahime Kamali
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.
| | - Marzieh Mohamadi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.
| | - Esmat Nouhi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.
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Ranjbar P, Davarian S, Mohammadi M, Ghotbi N, Rezaeian T. Knee joint repositioning error in different trunk positions among females with chronic nonspecific low back pain: A cross-sectional study. J Bodyw Mov Ther 2023; 35:140-144. [PMID: 37330760 DOI: 10.1016/j.jbmt.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 09/19/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Proprioception is a self-perceived sense of position and movement of one's body and its deficits can lead to motor control problems such as delayed muscle reflexes. Previous studies have confirmed lumbar proprioception impairments among individuals with Low Back Pain (LBP), which can afflict the normal central sensory-motor control and hence increases the risk of abnormal loading on the lumbar spine. Although the local investigation of proprioception is important, its influence on other joints in a kinetic chain particularly between extremities and spine should not be ignored. Therefore, the aim of this study was to compare the proprioception of knee joint in different trunk positions among females with chronic nonspecific low back pain (CNSLBP) and healthy females. DESIGN The study included 24 healthy subjects and 25 patients with CNSLBP participated in this study. Repositioning error of knee joint in four different lumbar positions including flexion, neutral position, 50% ROM of left rotation and 50% ROM right rotation was evaluated using an inclinometer. Absolute error and constant error were obtained and analyzed. RESULTS Absolute error in flexion and neutral positions in the individuals with CNSLBP were significantly higher than in healthy individuals; whereas, there was no significant difference in absolute and constant error between the two groups in 50% rotation to either side. CONCLUSION This study showed that knee joint repositioning accuracy was reduced in patients with CNSLBP compared to healthy ones.
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Affiliation(s)
- Parisa Ranjbar
- Physical Therapy Department, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran.
| | - Sanaz Davarian
- Physical Therapy Department, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran.
| | - Mostafa Mohammadi
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nastaran Ghotbi
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Tahere Rezaeian
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran.
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Nunes GS, Rodrigues DZ, Hörbe L, Prates I, Tessarin BM, Serrão FV, de Noronha M. Is Postural Control Affected in People with Patellofemoral Pain and Should it be Part of Rehabilitation? A Systematic Review with Meta-analysis. SPORTS MEDICINE - OPEN 2022; 8:144. [PMID: 36504326 PMCID: PMC9742077 DOI: 10.1186/s40798-022-00538-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Growing evidence supports that exercise therapy is effective for patellofemoral pain (PFP) rehabilitation. Nevertheless, the improvements have been reported not to be sustained in the long term, suggesting that the current protocols may not comprehend all required functional factors to provide a consistent recovery. A potential neglected factor in treatment protocols for PFP is postural control. However, it is unclear whether this population presents balance impairments or the influence of postural control on pain and function during rehabilitation programmes. OBJECTIVE To investigate whether (Q1) balance is impaired in people with PFP compared to controls, (Q2) conservative interventions are effective to improve balance in people with PFP, and (Q3) balance exercises are effective to improve pain and function in people with PFP. DATA SOURCES Medline, Embase, CINAHL, SPORTDiscus, Web of Science and Cochrane Library, supplemented by hand searching of reference lists, citations and relevant systematic reviews in the field. METHODS A systematic review with meta-analysis was conducted according to the Cochrane recommendations and reported according to the PRISMA statement recommendations. We included cross-sectional studies comparing balance between people with and without PFP; and randomised controlled trials verifying the effect of conservative intervention on balance and the effect of balance intervention on pain and function in people with PFP. The risk of bias was assessed using the Epidemiological Appraisal Instrument for cross-sectional studies and the Physiotherapy Evidence Database scale for randomised controlled trials. RESULTS From 15,436 records, 57 studies (Q1 = 28, Q2 = 23, Q3 = 14) met the eligibility criteria. Meta-analyses indicated that people with PFP have worse anteroposterior (very low grade evidence, standardised mean difference [SMD] = 1.03, 95% CI 0.40-1.66) and mediolateral (moderate grade evidence, SMD = 0.87, 95% CI 0.31-1.42) balance compared to controls. Moderate grade evidence indicated that overall balance is not affected in people with PFP (SMD = 0.38, 95% CI - 0.05-0.82). Low to very low grade evidence indicates that interventions are ineffective for mediolateral (SMD = 0.01, 95% CI - 0.51-0.53) and overall (SMD = 0.49, 95% CI - 0.14-1.11) balance improvements, and low grade evidence indicates that interventions are effective to improve anteroposterior balance (SMD = 0.64, 95% CI 0.04-1.23). Moderate to low grade evidence indicated that balance interventions are effective to reduce pain (SMD = 0.82, 95% CI 0.26-1.38) and improve function (SMD = 0.44, 95% CI 0.09-0.80) when measured using questionnaires; and very low grade evidence indicated no efficacy for function measured via functional tests (SMD = 0.73, 95% CI - 0.16-1.61). CONCLUSION People with PFP likely present balance deficits compared to asymptomatic people. There was insufficient evidence to support the efficacy of interventions to improve or modify balance in people with PFP. Also, there was insufficient evidence to support the efficacy of balance exercises to improve pain and function in people with PFP. Trial Registration The present systematic review was registered in PROSPERO (CRD42018091717).
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Affiliation(s)
- Guilherme S. Nunes
- grid.411239.c0000 0001 2284 6531Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS CEP 97105-900 Brazil
| | - Diênifer Zilmer Rodrigues
- grid.411239.c0000 0001 2284 6531Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS CEP 97105-900 Brazil
| | - Luiza Hörbe
- grid.411239.c0000 0001 2284 6531Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS CEP 97105-900 Brazil
| | - Izabela Prates
- grid.411239.c0000 0001 2284 6531Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS CEP 97105-900 Brazil
| | - Bruna M. Tessarin
- grid.411247.50000 0001 2163 588XDepartment of Physiotherapy, São Carlos Federal University, São Carlos, Brazil
| | - Fábio V. Serrão
- grid.411247.50000 0001 2163 588XDepartment of Physiotherapy, São Carlos Federal University, São Carlos, Brazil
| | - Marcos de Noronha
- grid.1018.80000 0001 2342 0938Rural Department of Allied Health, La Trobe University, Bendigo, VIC Australia
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Souza GDSD, Rossato CE, Silveira AFD. SEBT in individuals with patellofemoral pain: an integrative review. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Decreased postural stability can be observed in individuals with patellofemoral pain (PP). The Star Excursion Balance Test (SEBT) is widely used to assess deficits that need to be improved, with different application methods and result presentation formats. Objective: To map SEBT use in individuals with PP, characterizing the studies that applied it to identify different application methods and result presentation formats. Methods: The review included randomized and non-randomized clinical trials, cross-sectional, case-control and cohort studies. Searches were performed in Pubmed and SciElo databases. Data extracted from eligible studies were divided into categories: (I) study characterization (II) SEBT application methods and result presentation formats. Results: A total of 177 studies were identified in the databases, 13 of which were selected. There are a growing number of new studies that assess the dynamic postural control of individuals with PP using the SEBT, and a variety of test application and result presentation formats. Conclusion: The SEBT is a useful, easy-to-apply test that identifies changes in dynamic postural control in individuals with PP. Different application and result presentation formats are in accordance with the literature, but it is recommended that future studies apply the protocols most widely used in previous studies that exhibit a low risk of bias, in order to improve repeatability and comparisons between studies.
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Ebrahimi N, Rojhani-Shirazi Z, Yoosefinejad AK, Nami M. The effects of virtual reality training on clinical indices and brain mapping of women with patellofemoral pain: a randomized clinical trial. BMC Musculoskelet Disord 2021; 22:900. [PMID: 34696764 PMCID: PMC8544183 DOI: 10.1186/s12891-021-04785-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Virtual reality training (VRT) is a new method for the rehabilitation of musculoskeletal impairments. However, the clinical and central effects of VRT have not been investigated in patients with patellofemoral pain (PFP). To comprehensively assess the effects of VRT on clinical indices and brain function, we used a randomized clinical trial based on clinical and brain mapping assessment. Methods Twenty-six women with PFP for more than 6 months were randomly allocated to 2 groups: intervention and control. The intervention consisted of lifestyle education + 8 weeks VRT, in 24 sessions each lasting 40 min of training, whereas the control group just received lifestyle education. The balance was the primary outcome and was measured by the modified star excursion balance test. Secondary outcomes included pain, function, quality of life, and brain function which were assessed by visual analogue scale, step down test and Kujala questionnaire, SF-36, and EEG, respectively. Pre-intervention, post-intervention and follow-up (1 month after the end of the intervention) measurements were taken for all outcome measures except EEG, which was evaluated only at pre-intervention and post-intervention). Analyses of variance was used to compare the clinical outcomes between the two groups. The independent t-test also was used for between group EEG analyses. Results Balance score (P < 0.001), function (P < 0.001), and quality of life (P = 0.001) improved significantly at post-intervention and 1 month follow-up in the VRT group compared with the control group. VRT group showed a significantly decreased pain score (P = 0.004). Alpha (P < 0.05) and theta (P = 0.01) power activity also increased in the brain of the VRT group. Conclusion This study demonstrated that long term VRT was capable of improving both clinical impairments and brain function in patients with PFP. Therefore, therapists and clinicians can use this method as a more holistic approach in the rehabilitation of PFP. Trial registration IRCT, IRCT20090831002391N40. Registered 23 / 10 / 2019.
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Affiliation(s)
- Naghmeh Ebrahimi
- Student Research Committee, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Chamran Blvd., Abiverdi 1Street, P.O. Box: 71345-1733, Shiraz, Iran
| | - Zahra Rojhani-Shirazi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Chamran Blvd., Abiverdi 1Street, P.O. Box: 71345-1733, Shiraz, Iran.,Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Kordi Yoosefinejad
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Chamran Blvd., Abiverdi 1Street, P.O. Box: 71345-1733, Shiraz, Iran. .,Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Nami
- Neuroscience Center, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama City, 084301103, Panama.,Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, 71348-14336, Iran.,Dana Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, 71364-76172, Iran.,Academy of Health, Senses Cultural Foundation, Sacramento, CA, 66006, USA.,Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS), Pardis, Tehran, 1658344575, Iran
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