Comparative effectiveness of treatments for patellofemoral pain: A living systematic review with network meta-Analysis

Marinus Winters*, Sinéad Holden, Carolina Bryne Lura, Nicky J. Welton, Deborah M. Caldwell, Bill T. Vicenzino, Adam Weir, Michael Skovdal Rathleff

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

6 Citations (Scopus)
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Abstract

Objective To investigate the comparative effectiveness of all treatments for patellofemoral pain (PFP). Design Living systematic review with network meta-Analysis (NMA). Data sources Sensitive search in seven databases, three grey literature resources and four trial registers. Eligibility criteria Randomised controlled trials evaluating any treatment for PFP with outcomes â € any improvement', and pain intensity. Data extraction Two reviewers independently extracted data and assessed risk of bias with Risk of Bias Tool V.2. We used Grading of Recommendations, Assessment, Development and Evaluation to appraise the strength of the evidence. Primary outcome measure â € Any improvement' measured with a Global Rating of Change Scale. Results Twenty-Two trials (with forty-eight treatment arms) were included, of which approximately 10 (45%) were at high risk of bias for the primary outcome. Most comparisons had a low to very low strength of the evidence. All treatments were better than wait and see for any improvement at 3 months (education (OR 9.6, 95% credible interval (CrI): 2.2 to 48.8); exercise (OR 13.0, 95% CrI: 2.4 to 83.5); education+orthosis (OR 16.5, 95% CrI: 4.9 to 65.8); education+exercise+patellar taping/mobilisations (OR 25.2, 95% CrI: 5.7 to 130.3) and education+exercise+patellar taping/mobilisations+orthosis (OR 38.8, 95% CrI: 7.3 to 236.9)). Education+exercise+patellar taping/mobilisations, with (OR 4.0, 95% CrI: 1.5 to 11.8) or without orthosis (OR 2.6, 95% CrI: 1.7 to 4.2), were superior to education alone. At 12 months, education or education+any combination yielded similar improvement rates. Summary/conclusion Education combined with a physical treatment (exercise, orthoses or patellar taping/mobilisation) is most likely to be effective at 3 months. At 12 months, education appears comparable to education with a physical treatment. There was insufficient evidence to recommend a specific type of physical treatment over another. All treatments in our NMA were superior to wait and see at 3 months, and we recommend avoiding a wait-And-see approach. PROSPERO registeration number PROSPERO registration CRD42018079502.

Original languageEnglish
Pages (from-to)369-377
Number of pages9
JournalBritish Journal of Sports Medicine
Volume55
Issue number7
DOIs
Publication statusPublished - 1 Apr 2021

Bibliographical note

Funding: The Tryg Foundation is acknowledged for provided support for this project (Grant ID: 118547). The foundation had no role in the planning, conduct or reporting of this work.

Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved.

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