Sports Medicine Research: In the Lab & In the Field: Novel Clinical Prediction Rule for Patellofemoral Rehabilitation (Sports Med Res)


Monday, July 9, 2018

Novel Clinical Prediction Rule for Patellofemoral Rehabilitation

Treatment Success of Hip and Core or Knee Strengthening for Patellofemoral Pain: Development of Clinical Prediction Rules.

Earl-Boehm JE, Bolgla LA, Emory C, Hamstra-Wright KL, Tarima S, Ferber R. J Athl Train. 2018. [Epub ahead of print]

Take Home Message: Pain, demographics, and hip and core strength or endurance (ability to hold a plank position) may help predict which patients with patellofemoral pain will improve after a hip/core or knee strengthening program.
Clinicians can use clinical prediction rules to identify patients who are likely to respond to a specific rehabilitation program. Numerous factors (for example, weak hip and knee strength, limited hip range of motion) may cause patellofemoral pain syndrome, which can make it challenging for a clinician to select an optimal treatment strategy. No investigators have included hip or pelvic measurements into a clinical prediction model for success after rehabilitation program. Therefore, the authors developed a clinical prediction rule that incorporated clinically measurable factors (age, sex, weight, hip strength, posterior core endurance, iliotibial band flexibility) to predict positive outcomes after hip and core or knee strengthening programs for individuals with patellofemoral pain. The authors did these analyses using data from a previously discussed trial. One hundred and ninety-nine participants were randomly assigned to a hip-and-core-focused (111 participants) or knee-focused (88 participants) rehabilitation. Each group completed a 6-week rehabilitation program that consisted of 3 sessions/week along with a home exercise program. Participants reported pain using a 10-cm visual analog scale and the Kujala Anterior Knee Pain Scale to self-report knee function. A successful rehabilitation was defined as a decrease in visual analog scale by >2 cm or an increase in Anterior Knee Pain Scale by >8 points. Eighty percent of the hip and core-focused group and 77% of the knee-focused group had successful outcomes. Participants in both groups who had successful outcomes maintained their improvements 6 months after rehabilitation. Participants with more pain, better function, and greater lateral core endurance (side-bridge hold), and less anterior core endurance (front plank hold) were more likely to have a successful outcome after hip-and-core-focused program (88% sensitivity and 54% specificity). Individuals with lower weight, weaker hip internal rotation, stronger hip extension, and greater trunk-extension endurance were more likely to have success after knee strengthen program (82% sensitivity and 58% specificity).

The authors found pain, demographics, and hip and core strength or endurance may help predict who will improve after strengthening interventions. Both clinical prediction rules were better at predicting who would be successful than predicting who would not be successful with a rehabilitation program. It was interesting to note that there were different predictive factors per group, which suggests that patients with patellofemoral pain may represent subgroups with different causes and would require different rehabilitation programs. These clinical predictive rules could help clinicians individualize rehabilitation programs to further improve patient care. Medical professionals should be aware of these clinical factors that may predict which rehabilitation programs would be most successful; however, implementation of this clinical production rule should be applied with caution until further validated studies have been conducted.

Questions for Discussion: Have you found specific clinical factors of patellofemoral pain need to be assessed prior to forming a rehabilitation program? Do you incorporate hip and core exercises into your patellofemoral rehabilitation programs?

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

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