Predictors of treatment response to strengthening and stretching exercises for patellofemoral pain: An examination of patellar alignment
Resource
Knee, 22(6), 494-498
Journal
The Knee
Pages
494-498
Date Issued
2015
Date
2015
Author(s)
Peng, Hsien-Te
Song, Chen-Yi
Abstract
Background: Closed kinetic chain and quadriceps strengthening, combined with flexibility exercises of the lower limb musculature, is a common treatment for patellofemoral pain syndrome (PFPS). The effectiveness has been well documented; however, very little is known about which factors predict treatment success. ;Methods: A total of 43 female subjects with PFPS participated in an eight-week progressive leg press (LP) strengthening and stretching exercise program. A decrease of 1.5 cm on a 10 cm visual analog scale (VAS) score was used as an indicator for treatment success. The baseline patellar tilt angle difference (PTA-d) due to quadriceps contraction prior to treatment was evaluated as a predictor of treatment success. The logistic regression and receiver operating characteristics (ROC) curve analysis were performed to investigate the predictive value of PTA-d. ;Results: PTA-d could significantly predict the treatment success of LP strengthening and stretching exercises. The odds ratio (OR) for having an unsuccessful outcome was 1.19 (95% confidence interval (CI), 1.03-1.39, P < 0.021) per degree increment of PTA-d. The most optimal cut-off value for the clinical discrimination of treatment success after LP strengthening and stretching exercise was 15 of PTA-d (sensitivity = 0.74, specificity = 0.71). The area under the ROC curve was 0.73 (standard error = 0.08). ;Conclusions: Female patients with PFPS whose quadriceps contraction reduced the lateral patellar tilt prior to LP strengthening and stretching exercise treatment are more likely to experience pain relief. It seems clinically important to check dynamic patellar tilt characteristics before treatment to aid in clinical decision making. Level of evidence: Cohort, II (C) 2014 Elsevier B.V. All rights reserved.
Subjects
Patellofemoral pain
Patella
Quadriceps
Exercise
Other Subjects
adult; Article; clinical article; clinical examination; controlled study; diagnostic test accuracy study; female; health program; human; kinesiotherapy; muscle contraction; muscle training; musculoskeletal system parameters; outcome assessment; patellar tilt angle difference; patellofemoral pain syndrome; prediction; predictive value; priority journal; progressive leg press strengthening; quadriceps femoris muscle; receiver operating characteristic; reference value; sensitivity and specificity; stretching exercise; therapy effect; treatment duration; treatment response; visual analog scale; exercise; follow up; middle aged; muscle strength; pain measurement; patellofemoral pain syndrome; pathophysiology; physiology; procedures; resistance training; treatment outcome; young adult; Adult; Exercise; Female; Follow-Up Studies; Humans; Middle Aged; Muscle Strength; Pain Measurement; Patellofemoral Pain Syndrome; Quadriceps Muscle; Resistance Training; Treatment Outcome; Young Adult