Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial (Reprinted from BMJ, vol 337, pg a1735, 2008)

被引:219
作者
Collins, Natalie [1 ]
Crossley, Kay [2 ]
Beller, Elaine [3 ]
Darnell, Ross [1 ]
McPoil, Thomas [4 ]
Vicenzino, Bill [1 ]
机构
[1] Univ Queensland, Sch Hlth & Rehabil Sci, Brisbane, Qld 4072, Australia
[2] Univ Melbourne, Melbourne Sch Engn, Melbourne, Vic 3010, Australia
[3] Univ Queensland, Sch Populat Hlth, Queensland Clin Trials Ctr, Brisbane, Qld 4072, Australia
[4] No Arizona Univ, Dept Phys Therapies, Gait Res Lab, Flagstaff, AZ 86011 USA
基金
英国医学研究理事会;
关键词
ANTERIOR KNEE PAIN; LOWER-LIMB KINEMATICS; INJURIES; ORTHOTICS; SPORT;
D O I
10.1136/bmj.a1735
中图分类号
G8 [体育];
学科分类号
040301 [体育人文社会学];
摘要
Objective To compare the clinical efficacy of foot orthoses in the management of patellofemoral pain syndrome with flat inserts or physiotherapy, and to investigate the effectiveness of foot orthoses plus physiotherapy. Design Prospective, single blind, randomised clinical trial. Setting Single centre trial within a community setting in Brisbane, Australia. Participants 179 participants (100 women) aged 18 to 40 years, with a clinical diagnosis of patellofemoral pain syndrome of greater than six weeks' duration, who had no previous treatment with foot orthoses or physiotherapy in the preceding 12 months. Interventions Six weeks of physiotherapist intervention with off the shelf foot orthoses, flat inserts, multimodal physiotherapy (patellofemoral joint mobilisation, patellar taping, quadriceps muscle retraining, and education), or foot orthoses plus physiotherapy. Main outcome measures Global improvement, severity of usual and worst pain over the preceding week, anterior knee pain scale, and functional index questionnaire measured at 6, 12, and 52 weeks. Results Foot orthoses produced improvement beyond that of flat inserts in the short term, notably at six weeks (relative risk reduction 0.66, 99% confidence interval 0.05 to 1.17; NNT 4 (99% confidence interval 2 to 51). No significant differences were found between foot orthoses and physiotherapy, or between physiotherapy and physiotherapy plus orthoses. All groups showed clinically meaningful improvements in primary outcomes over 52 weeks. Conclusion While foot orthoses are superior to flat inserts according to participants' overall perception, they are similar to physiotherapy and do not improve outcomes when added to physiotherapy in the short term management of patellofemoral pain. Given the long term improvement observed in all treatment groups, general practitioners may seek to hasten recovery by prescribing prefabricated orthoses.
引用
收藏
页码:169 / U30
页数:8
相关论文
共 47 条
[1]
The revised CONSORT statement for reporting randomized trials: Explanation and elaboration [J].
Altman, DG ;
Schulz, KF ;
Moher, D ;
Egger, M ;
Davidoff, F ;
Elbourne, D ;
Gotzsche, PC ;
Lang, T .
ANNALS OF INTERNAL MEDICINE, 2001, 134 (08) :663-694
[2]
*AM COLL FOOT ANKL, 2004, PRESCR CUST FOOT ORT
[3]
[Anonymous], EV BAS MAN AC MUSC P
[4]
[Anonymous], 2001, COCHRANE DB SYST REV, DOI DOI 10.1002/14651858.CD003375
[5]
Patellofemoral pain syndrome - A critical review of the clinical trials on nonoperative therapy [J].
Arroll, B ;
EllisPegler, E ;
Edwards, A ;
Sutcliffe, G .
AMERICAN JOURNAL OF SPORTS MEDICINE, 1997, 25 (02) :207-212
[6]
*AUSTR POD COUNC, 1998, CLIN GUID ORTH THER
[7]
Ballas MT, 1997, AM FAM PHYSICIAN, V55, P2473
[8]
Injuries presenting to an Australian sports medicine centre: A 12-month study [J].
Baquie, P ;
Brukner, P .
CLINICAL JOURNAL OF SPORT MEDICINE, 1997, 7 (01) :28-31
[9]
Systematic review of the quality of randomized controlled trials for patellofemoral pain syndrome [J].
Bizzini, M ;
Childs, JD ;
Piva, SR .
JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, 2003, 33 (01) :4-20
[10]
CHESWORTH B M, 1989, Journal of Orthopaedic and Sports Physical Therapy, V10, P302