ORCID Profile
0000-0002-4187-7058
Current Organisation
Universidade Estadual Paulista Júlio de Mesquita Filho
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Publisher: Faculty of Kinesiology, University of Zagreb
Date: 2016
DOI: 10.26582/K.48.2.14
Abstract: The purpose of this study was to analyze the test-retest reliability of the median frequency (MDF) and root mean square (RMS) used to determine the onset of neuromuscular fatigue (NF) during sustained fatiguing contractions of the quadriceps. Eighteen healthy men were tested on two days, and electromyographic (EMG) signals were recorded from the vastus medialis (VM), rectus femoris (RF) and vastus lateralis (VL) during sustained isometric contractions at 20 and 70% of maximum voluntary contractions (MVC) held until exhaustion. The reliability of endurance time was excellent at 20% MVC and poor at 70% MVC. EMG variables were evaluated: (1) at the beginning of the test (2) at NF and (3) at the end of the test. The NF time values presented poor reliability. The MDF has shown, in general, poor reliability at 20 and 70% MVC, whereas the RMS reliability presented better results for both loads, especially for RF, followed by the VM and VL muscles. The MDF and RMS values extracted from NF showed poor reliability at 20 and 70% MVC, which suggests caution in using these variables extracted from the EMG signal to determine the onset of NF.
Publisher: BMJ
Date: 16-03-2018
DOI: 10.1136/BJSPORTS-2017-098099
Abstract: To systematically review evidence of primary outcomes from randomised controlled trials (RCTs) examining the effect of treatment strategies on quality of life (QoL) or psychosocial factors in in iduals with knee osteoarthritis (OA). Systematic review with meta-analysis. Medline, Embase, SPORTDiscus, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from inception to November 2017. We included RCTs investigating the effect of conservative interventions on QoL or psychosocial factors in in iduals with knee OA. Only RCTs considering these outcomes as primary were included. Pooled data supported the use of exercise therapy compared with controls for improving health-related and knee-related QoL. There was limited evidence that a combined treatment of yoga, transcutaneous electrical stimulation and ultrasound may be effective in improving QoL. Limited evidence supported the use of cognitive behavioural therapies (with or without being combined with exercise therapy) for improving psychosocial factors such as self-efficacy, depression and psychological distress. Exercise therapy (with or without being combined with other interventions) seems to be effective in improving health-related and knee-related QoL or psychosocial factors of in iduals with knee OA. In addition, evidence supports the use of cognitive behavioural therapies (with or without exercise therapy) for improving psychosocial factors such as self-efficacy, depression and psychological distress in in iduals with knee OA. CRD42016047602.
Publisher: Elsevier BV
Date: 03-2017
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 09-2020
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.CLINBIOMECH.2021.105544
Abstract: Impaired knee extension biomechanics and spinal excitability have been reported in women with patellofemoral pain, but their relationship has not been explored. A significant relationship between them could indicate the need for investigating the potential benefits of disinhibitory interventions for women with patellofemoral pain. Thus, this study aimed to investigate the relationship between vastus medialis Hoffmann reflex and (1) maximal isometric, concentric and eccentric knee extensor strength and rate of torque development (2) knee extensor torque steadiness and (3) knee extensor moment during functional tasks in women with patellofemoral pain. Spinal excitability of twenty-four participants was assessed by the litude of maximal vastus medialis Hoffmann reflex. Knee extensor strength, rate of torque development and torque steadiness were assessed using an isokinetic dynamometer. Knee extensor moment during step-down and stair descent tasks were obtained using a three-dimensional motion analysis system. A moderate negative relationship was found between vastus medialis Hoffmann reflex and knee extensor torque steadiness (r = -0.35 p = 0.05) whereas a moderate positive relationship was found with maximal isometric knee extensor strength (r = 0.37 p = 0.044). No significant relationships were found between vastus medialis Hoffmann reflex and the other variables. Our findings provide insight on the relationship between spinal excitability and neuromuscular control of maximal and submaximal isometric torque production in women with patellofemoral pain. Conversely, spinal excitability does not seem to be related with dynamic torques and moments of the knee extensors in women with patellofemoral pain.
Publisher: Human Kinetics
Date: 2023
Abstract: Context : To determine (1) whether physical function and fear of movement are prospectively associated with the risk of females developing patellofemoral pain (PFP) and (2) whether they change following development of PFP. Design : Prospective observational study. Methods : A total of 114 asymptomatic females (18–22 y old) completed assessment of physical function (forward step-down test and single-leg hop for distance) and fear of movement using the T a Scale for Kinesiophobia at baseline and 2-year follow-up. Presence of symptoms of PFP was monitored bimonthly. Results : Ninety participants (retention rate = 79%) completed the 2-year follow-up assessment, with 27 (24% of the cohort) developing PFP. Physical function, including forward step-down test ( P = .659) and single-leg hop for distance ( P = .825), and fear of movement ( P = .479) were not associated with the risk of developing PFP. Females who developed PFP presented with reduced forward step-down repetitions (mean difference = 2.8 95% confidence interval, 0.2 to 5.3) and single-leg hop for distance (10.2 95% confidence interval, 2.7 to 17.7 cm) at 2-year follow-up. There was no statistically significant difference between those who did and did not develop PFP for fear of movement (−3.4 95% confidence interval, −7.0 to 0.2). Conclusions : Physical function and fear of movement were not associated with the risk of developing PFP in young females. However, the change over time in the step-down and single-leg hop for distance tests may suggest that, even in the early stages of PFP, young females present impaired physical function compared with females who did not develop symptoms. Fear of movement may develop due to persistent PFP, and does not appear to be a risk factor or key feature in females with PFP of short symptoms duration.
Publisher: Elsevier BV
Date: 11-2019
Publisher: Elsevier BV
Date: 09-2020
Publisher: Wiley
Date: 27-02-2019
DOI: 10.1002/JUM.14973
Abstract: To compare trunk muscle thickness of women with and without patellofemoral pain (PFP) and to assess the association of trunk muscle thickness with self-reported pain of women with PFP. Forty-four women were recruited and ided into 2 groups: a PFP group (n = 22) and a pain-free group (n = 22). The thickness of the following trunk muscles was obtained by B-mode ultrasound imaging: transversus abdominis, obliquus internus (OI), obliquus externus (OE), rectus abdominis, and multifidus. Self-reported pain was measured on a visual analog scale. The 44 participants were 18 to 35 years old. Women with PFP had lower thickness of the OI and OE than pain-free women, with moderate or large effect sizes ranging from -0.78 to -0.98, which was negatively related to self-reported pain correlations (r = -0.53 to -0.40). The contraction ratios of the OI and OE were also lower in women with PFP than in pain-free women (P < .05). No differences between groups were found for the transversus abdominis, multifidus, and rectus abdominis, with also no correlation with self-reported pain. Lower thickness of the OI and OE is present in women with PFP, which is related to self-reported pain. These findings might help in understanding the alterations in trunk biomechanics of in iduals with PFP and the mechanisms by which interventions targeting trunk muscle strength are beneficial to in iduals with PFP.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.JSAMS.2016.09.004
Abstract: To compare pressure pain threshold (PPT) around the knee (local hyperalgesia) and at a site remote to the knee (widespread hyperalgesia) between female runners with and without patellofemoral pain (PFP) and to evaluate the relationship between running volume, self-reported knee function and PPT measures. Cross-sectional study. Twenty female runners with PFP and twenty pain-free female runners participated in the study. PPTs were measured using a handheld pressure algometer at four sites in the patellar region: quadriceps tendon, medial patella, lateral patella and patellar tendon and on the contralateral upper limb. Additionally, all participants were asked to report their average weekly running volume in a typical month and answer the anterior knee pain scale (AKPS) questionnaire. For all sites, female runners with PFP presented lower PPT measures in comparison with control group (P<0.017). There were negative correlations between AKPS and running volume (ρ=-0.88 P<0.001) and between all PPTs and the running volume in the PFP group with correlation (ρ) values ranging between -0.46 and -0.70 (P<0.022). There were positive correlations between all PPTs and AKPS with correlation (ρ) value from 0.50 to 0.69 (P<0.030). Lower PPTs locally and remote to the knee in female runners with PFP indicate the presence of local and widespread hyperalgesia. Additionally, this hyperalgesia, which is related to self-reported knee function, appears to be increased by greater running volumes. Development and evaluation of non-mechanical interventions for the management of running-related PFP in females may be needed to address this apparent hyperalgesia.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.APMR.2018.06.024
Abstract: The aims of this study were threefold: (1) to compare the litude of patellar tendon reflex (T-reflex) between women with patellofemoral pain (PFP) and pain-free controls (2) to compare the litude of vastus medialis Hoffmann reflex (VM H-reflex) between women with PFP and pain-free controls (3) to investigate the association between the litude of patellar T-reflex and VM H-reflex in women with PFP and pain-free controls. Cross-sectional observational study. Laboratory of biomechanics and motor control. Thirty women with PFP and 30 pain-free women aged 18 to 35 years (N=60). Peak-to-peak litudes of maximal VM H-reflex (elicited via electrical stimulation on the femoral nerve) and patellar T-reflex (elicited via mechanical percussion on the patellar tendon) were estimated. Women with PFP had significant lower litude of patellar T-reflex (mean difference=0.086 95% confidence interval=0.020 to 0.151 P=.010 moderate effect) and VM H-reflex (mean difference=0.150 95% confidence interval =0.073 to 0.227 P<.001 large effect) compared to pain-free controls. The VM H-reflex was strongly correlated with patellar T-reflex in both PFP group (r=0.66 P<.001) and control group (r=0.72 P<.001). As the T-reflex is easier to perform than H-reflex assessments in a clinical setting, it represents a feasible option to assess the impaired excitability of the stretch reflex pathway associated with PFP.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.GAITPOST.2018.10.033
Abstract: Evidence indicates the presence of both kinesiophobia and knee extension strength deficits in women with patellofemoral pain (PFP). Both impairments may contribute to apparent compensatory gait patterns including reduced cadence and peak knee flexion during stair negotiation. Is kinesiophobia or knee extension strength associated with movement pattern in women with patellofemoral pain? Forty women with PFP were assessed with three-dimensional kinematic analyses during stair descent isokinetic dynamometry of the knee extensors (isometric, concentric and eccentric) and the T a scale for kinesiophobia. Pearson coefficients were calculated to determine relationship among variables. Kinesiophobia correlated significantly with cadence (r = -0.62, p < 0.001), and peak knee flexion (r = -0.76, p 0.05). Findings of this study could suggest addressing strength impairments alone may not adequately address kinesiophobia and movement pattern impairments in women with PFP. However, high-quality randomised controlled trials are needed to test this assumption. Further value may be added if currently evidence-based knee strengthening exercise is combined with education and/or graded exposure to address kinesiophobia, and consideration to gait retraining to address altered movement patterns at the knee.
Publisher: Elsevier BV
Date: 2021
Publisher: Human Kinetics
Date: 12-2015
Abstract: In iduals with patellofemoral pain (PFP) use different motor strategies during unipodal support in stair climbing activities, which may be assessed by vertical ground reaction force parameters. Thus, the aims of this study were to investigate possible differences in first peak, valley, second peak, and loading rate between recreational female athletes with PFP and pain-free athletes during stair climbing in order to determine the association and prediction capability between these parameters, pain level, and functional status in females with PFP. Thirty-one recreational female athletes with PFP and 31 pain-free recreational female athletes were evaluated with three-dimensional kinetics while performing stair climbing to obtain vertical ground reaction force parameters. A visual analog scale was used to evaluate the usual knee pain. The anterior knee pain scale was used to evaluate knee functional score. First peak and loading rate were associated with pain ( r = .46, P = .008 r = .56, P = .001, respectively) and functional limitation ( r = .31, P = .049 r = −.36, P = .032, respectively). Forced entry regression revealed the first peak was a significant predictor of pain (36.5%) and functional limitation (28.7%). Our findings suggest that rehabilitation strategies aimed at correcting altered vertical ground reaction force may improve usual knee pain level and self-reported knee function in females with PFP.
Publisher: Elsevier BV
Date: 07-2022
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.MEHY.2017.08.019
Abstract: Patellofemoral pain (PFP) is one of the most common conditions in orthopedic practice while recent evidence has suggested that it may be a predisposing factor to patellofemoral osteoarthritis. In addition to biomechanical alterations associated with the pathomechanisms underlying PFP, the investigation of neurophysiological alterations has provided novel information in the understanding of the pathophysiology of PFP. For instance, women with PFP present lower litude of the vastus medialis (VM) H-reflexes compared to pain-free controls, which suggests that the excitability of spinal reflexes might be a promising tool for discriminating woman with PFP in clinical practice. However, the cross-sectional design of the current research does not inform whether the reduced excitability predisposes to or is the consequence of PFP. Therefore, two hypotheses can be raised: (1) the reduction in excitability of the α-motoneurons is a risk factor for PFP Or, (2) the reduction in H-reflex excitability is a consequence of PFP due to pain. If the former hypothesis is proven correct, it may help in the early identification of in iduals with PFP. If the latter, it may help understand the reduced excitability as a consequence of the long-term pain, which may be interfering in the recovery of in iduals with PFP in a long-term basis. In addition, exploring such hypotheses may have direct rehabilitative and prevention implications for PFP and its putative progression to knee osteoarthritis.
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.CLINBIOMECH.2014.12.009
Abstract: Excessive rearfoot eversion is thought to be a risk factor for patellofemoral pain development, due to the kinesiological relationship with ascendant adaptations. In iduals with patellofemoral pain are often diagnosed through static clinical tests, in scientific studies and clinical practice. However, the adaptations seem to appear in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Thus, the aim of this study was to determine the reliability and differentiation capability of three rearfoot eversion measures: rearfoot range of motion, static clinical test and static measurement using a three-dimensional system. A total of 29 in iduals with patellofemoral pain and 25 control in iduals (18-30 years) participated in this study. Each subject underwent three-dimensional motion analysis during stair climbing and static clinical tests. Intraclass correlation coefficient and standard error measurements were performed to verify the reliability of the variables and receiver operating characteristic curves to show the diagnostic accuracy of each variable. In addition, analyses of variance were performed to identify differences between groups. Rearfoot range of motion demonstrated higher diagnostic accuracy (an area under the curve score of 0.72) than static measures and was able to differentiate the groups. Only the static clinical test presented poor and moderate reliability. Other variables presented high to very high values. Rearfoot range of motion was the variable that presented the best results in terms of reliability and differentiation capability. Static variables do not seem to be related to patellofemoral pain and have low accuracy values.
Publisher: Elsevier BV
Date: 03-2023
Publisher: FapUNIFESP (SciELO)
Date: 03-2016
Publisher: FapUNIFESP (SciELO)
Date: 06-2014
DOI: 10.1590/S1980-65742014000200012
Abstract: This study aimed to determine and analyze the neuromuscular fatigue onset by median frequency (MDF) and the root mean square (RMS) behavior of an electromyographic signal (EMG). Eighteen healthy men with no prior knee problems initially performed three maximum voluntary isometric contractions (MVIC). After two days of MVIC test, participants performed a fatiguing protocol in which they performed submaximal knee-extension contractions at 20% and 70% MVIC held to exhaustion. The MDF and RMS values from the EMG signals were recorded from the vastus medialis (VM) and the vastus lateralis (VL). Analysis of the MDF and RMS behavior enabled identification of neuromuscular fatigue onset for VM and VL muscles in 20% and 70% loads. Alterations between the VM and VL in the neuromuscular fatigue onset, at 20% and 70% MVIC, were not significant. These findings suggest that the methodology proposal was capable of indicating minute differences sensible to alterations in the EMG signals, allowing identification of the moment when the MDF and the RMS showed significant changes in behavior. The methodology used was also a viable one for describing and identifying the neuromuscular fatigue onset by means of the analysis of EMG signals.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.CLINBIOMECH.2014.12.014
Abstract: Despite its high incidence, patellofemoral pain etiology remains unclear. No prior study has compared surface electromyography frequency domain parameters and surface electromyography time domain variables, which have been used as a classic analysis of patellofemoral pain. Thirty one women with patellofemoral pain and twenty eight pain-free women were recruited. Each participant was asked to descend a seven step staircase and data from five successful trials were collected. During the task, the vastus medialis and vastus lateralis muscle activities were monitored by surface electromyography. The data were processed and analyzed in four variables of the frequency domain (median frequency, low, medium and high frequency bands) and three time domain variables (Automatic, Cross-correlation and Visual Onset between the vastus medialis and vastus lateralis muscles). Reliability, Receiver Operating Characteristic curves and regression models were performed. The medium frequency band was the most reliable variable and different between the groups for both muscles, also demonstrated the best values of sensitivity and sensibility, 72% and 69% for the vastus medialis and 68% and 62% for the vastus lateralis, respectively. The frequency variables predicted the pain of in iduals with patellofemoral pain, 26% for the vastus medialis and 20% for the vastus lateralis, being better than the time variables, which achieved only 7%. The frequency domain parameters presented greater reliability, diagnostic accuracy and capacity to predict pain than the time domain variables during stair descent and might be a useful tool to diagnose in iduals with patellofemoral pain.
Publisher: Elsevier BV
Date: 05-2018
Publisher: Informa UK Limited
Date: 27-10-2020
DOI: 10.1080/09593985.2020.1830323
Abstract: Investigate the association of fear of movement and (re)injury with clinical outcomes in women with patellofemoral pain (PFP). This cross-sectional study included 92 women with PFP who completed the TAMPA scale for kinesiophobia. The TAMPA score and its two subscales - activity avoidance and somatic focus were correlated with BMI, physical activity level, pain catastrophizing scale, health-related quality of life, pain sensitivity via pressure pain threshold, self-reported disability, and worst knee pain in last month. Greater fear of movement and (re)injury, activity avoidance, and somatic focus were correlated with lower local pain sensitivity (rho = -0.29 to -0.55), lower health-related quality of life (rho = -0.38 to -0.42), greater pain catastrophizing (rho = 0.41 to 0.47), and greater self-reported disability (rho = -0.31 to -0.52). Greater fear of movement and (re)injury and activity avoidance were correlated with adjacent and remote pain sensitivity (rho = -0.24 to -0.39). Greater fear of movement and (re)injury and somatic focus were correlated with greater worst knee pain in last month (rho = 0.21 to 0.32). Fear of movement and (re)injury predicted pain measures, disability, and health-related quality of life (p ≤ 0.010). The relationship of greater fear of movement and (re)injury with greater disability, pain catastrophizing, pain sensitization, and poorer health-related quality of life highlights the potential importance of considering this psychological feature of PFP during assessment and management.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2021
DOI: 10.1519/JSC.0000000000003215
Abstract: Ferreira, AS, de Oliveira Silva, D, Ferrari, D, Magalhães, FH, Pappas, E, Briani, RV, Pazzinatto, MF, and de Azevedo, FM. Knee and hip isometric force steadiness are impaired in women with patellofemoral pain. J Strength Cond Res 35(10): 2878–2885, 2021—The purposes were as follows: to compare knee extension and hip abduction force steadiness and maximal strength between women with patellofemoral pain (PFP) and pain-free women and to investigate whether maximal strength, self-reported pain during force-matching tasks, self-reported knee function, symptoms duration, and physical activity level are associated with knee extension and hip abduction force steadiness. Thirty women with PFP and 30 pain-free women were recruited. Knee extension and hip abduction maximal voluntary isometric contractions and submaximal isometric force-matching tasks were evaluated using an isokinetic dynamometer. Subjects were asked to match a target force corresponding to 10% of their maximal isometric voluntary contraction while force steadiness was computed as the coefficient of variation (CV) of the exerted force. Women with PFP had significant 36% lower knee extension and 33% lower hip abduction peak strength. They also had significant 70% lower knee extension force steadiness and 60% lower hip abduction force steadiness (i.e., higher CV) than pain-free women. Self-reported pain and self-reported knee function were significantly associated ( r = 0.61, p 0.001 r = −0.35, p = 0.05) and able to predict 41% of the variance of knee extensor force steadiness. Hip abductor maximum strength was significantly associated ( r = −0.57 p = 0.001) and able to predict 32% of the variance of hip abductor force steadiness. These findings indicate that muscle impairments in PFP go beyond only low knee and hip muscle strength because women with PFP also present deficits in knee extension and hip abduction force steadiness. Evidence-based treatments aiming at improving force steadiness may be a promising addition to PFP rehabilitation programs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2021
Publisher: FapUNIFESP (SciELO)
Date: 06-2015
DOI: 10.1590/S1980-65742015000200012
Abstract: Reliability is essential to all aspects of the measure, as it shows the quality of the information and allows rational conclusions with regard to the data. There has been controversial results regarding the reliability of electromyographic parameters assessed during stair ascent and descent in in iduals with patellofemoral pain syndrome (PFPS). Therefore, this study aims to determine the reliability of time and frequency domain electromyographic parameters on both gestures in women with PFPS. Thirty-one women with PFPS were selected to participate in this study. Data from vastus lateralis and medialis were collected during stair deambulation. The selected parameters were: automatic onset, median frequency bands of low, medium and high frequency. Reliability was determined by intraclass correlation coefficient and the standard error of measurement. The frequency domain variables have shown good reliability, with the stair ascent presenting the best rates. On the other hand, onset has proved to be inconsistent in all measures. Our findings suggest that stair ascent is more reliable than stair descent to evaluate subjects with PFPS in the most cases.
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.JELEKIN.2015.10.012
Abstract: The aims of this study were to examine group differences in muscle activation onset of the vastus medialis (VM) in relation to the vastus lateralis (VL) and pain level during stair ascent in females with patellofemoral pain (PFP) who maintain high and moderate levels of physical activity to determine the association between physical activity level and muscle activation onset. Forty-three females with PFP and thirty-eight pain-free females were recruited and ided into four groups based on their level of physical activity: females with PFP (n=26) and pain-free females (n=26) who practiced a moderate level of physical activity and females with PFP (n=17) and pain-free females (n=12) who practiced an intense amount of physical activity. Participants were asked to ascend a seven-step staircase and the VM and VL activation onset was determined. Females with PFP who practiced high level of physical activity demonstrated delayed onset of VM (4.06ms) compared to healthy females (-14.4ms). Conversely, females with PFP who practiced moderate level of physical activity did not present VM delay (-2.48ms) in comparison to healthy females (-9.89ms). Furthermore, physical activity significantly correlated to the muscle activation onset difference (p=0.005 R=0.60). These findings may explain why controversial results regarding VM and VL muscle activation onset have been found.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.PTSP.2018.07.007
Abstract: Compare anthropometric characteristics, function, kinesiophobia, catastrophism and knee extensor strength between women (i) with PFP and crepitus (PFP Cross-sectional. Laboratory study. 65 women with PFP and 51 pain-free women. Objective assessment of knee crepitus, forward step-down and single leg hop tests knee extensor strength tests and subjective ratings of function, kinesiophobia, pain catastrophising and knee stiffness. Crepitus was more common in women with PFP (50.7%) compared to those without (33.3%) (χ Kinesiophobia, catastrophism, knee stiffness, strength and physical function are all impaired in women with PFP, regardless of crepitus. In pain-free women, crepitus was associated with poorer objective function.
Publisher: JMIR Publications Inc.
Date: 22-07-2020
DOI: 10.2196/18584
Abstract: Patellofemoral pain (PFP) impairs joint- and health-related quality of life and may be associated with knee osteoarthritis. We developed a novel, 2-phase, stepped-care approach for PFP, combining (1) self-directed web-based education and exercise therapy with (2) physiotherapist-supported education and exercise therapy. Physiotherapy sessions can be provided using 2 different modalities: face-to-face and telerehabilitation. This study aims to (1) determine the feasibility of our stepped-care approach, (2) explore patient-reported outcomes following self-directed web-based education and exercise therapy in people with PFP (phase 1), and (3) estimate the differences in treatment effects between face-to-face and telerehabilitation to support further education and exercise therapy (phase 2) in those who had not completely recovered following self-directed care. Phase 1 involved 6 weeks of self-directed web-based education and exercise therapy. Phase 2 involved random allocation to a further 12 weeks of physiotherapist-led (up to 8 sessions) education and exercise therapy delivered face-to-face or via telerehabilitation to participants who did not rate themselves as completely recovered following phase 1. Feasibility indicators of process, adherence, and participant retention were collected as primary outcomes alongside patient-reported outcomes on Global Rating of Change and knee pain, disability, knee-related quality of life, pain catastrophism, kinesiophobia, and knee self-efficacy. All participants were assessed at baseline, 6 weeks, and 18 weeks. A total of 71 participants were screened to identify 35 participants with PFP to enter the study. Overall, 100% (35/35) and 88% (31/35) of the participants were followed up with at 6 and 18 weeks, respectively. In phase 1 of the study, participants accessed the My Knee Cap website for an average of 6 (7.5) days and performed the exercises for an average of 2.5 (3.6) times per week. A total of 20% (7/35) of the participants reported that they had completely recovered at 6 weeks. Furthermore, 93% (26/28) of the participants who were followed up and had not completely recovered at 6 weeks agreed to be enrolled in phase 2. No statistically significant differences were found between the face-to-face and telerehabilitation groups for any outcome. The novel stepped-care approach was associated with marked improvement or complete recovery in 40% (14/35) of the participants following phase 1 and 71% (25/35) of the participants following phase 2. Self-directed web-based education and exercise therapy for people with PFP is feasible, as noted by the high rate of participant retention and home exercise adherence achieved in this study. Furthermore, 20% (7/35) of people reported complete recovery at 6 weeks. Both face-to-face and telerehabilitation physiotherapy should be considered for those continuing to seek care, as there is no difference in outcomes between these delivery modes. Determining the efficacy of the stepped-care model may help guide more efficient health care for PFP.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.PTSP.2018.07.005
Abstract: To investigate pain level and function limitation in adolescent athletes and physically active non-athletes with PFP. Cross-sectional study. Adolescent athletes were recruited at a sport center complex. Adolescent non-athletes were recruited from upper secondary schools. 108 adolescents diagnosed with PFP: 42 adolescent athletes and 66 adolescent non-athletes. To evaluate the level of pain, a visual analog scale (VAS) was used and to evaluate the overall function, the Knee Outcome in Osteoarthritis Survey (KOOS) was used. The adolescent athletes scored significantly higher in the VAS (Mean difference = 0.97 (95% CI = 0.35 1.60) p = 0.003) compared to adolescent non-athletes. Adolescent athletes scored lower in the KOOS - Symptoms, Pain, Knee-related quality of life and Sport and recreation dimensions - than the non-athletes, however, the minimally clinically important difference was not achieved in Pain dimension. There was no significant difference in the Activities of daily living dimension of the KOOS. Adolescent athletes presented higher levels of pain and lower physical function status compared with physically active non-athletes. This provides an important insight to the management of PFP in adolescent athletes as worst functional status is linked with poor prognosis in patients with PFP.
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.APMR.2016.06.011
Abstract: To determine the association between the litude of vastus medialis (VM) Hoffmann reflex (H-reflex) and pain level, self-reported physical function, and chronicity of pain in women with patellofemoral pain (PFP). Cross-sectional study. Laboratory of biomechanics and motor control. Women diagnosed with PFP (N=15) aged 18 to 35 years. Not applicable. Data on worst pain level during the previous month, self-reported physical function, and symptom duration (chronicity) were collected from the participants. Maximum evoked responses were obtained by electrical stimulation applied to the femoral nerve and peak-to-peak litudes of normalized maximal H-reflexes (maximal Hoffmann reflex/maximal motor wave ratios) of the VM were calculated. A Pearson product-moment correlation matrix (r) was used to explore the relations between the litude of VM H-reflex and worst pain during the previous month, self-reported function, and chronicity of pain. Strong negative correlations were found between the litude of VM H-reflex and worst pain in the previous month (r=-.71 P=.003) and chronicity (r=-.74 P=.001). A strong positive correlation was found between the litude of VM H-reflex and self-reported physical function (r=.62 P=.012). The strong and significant relations reported in this study suggest that women with PFP showing greater VM H-reflex excitability tend to have lower pain, better physical function, and more recent symptoms. Therefore, rehabilitation strategies designed to increase the excitability of the monosynaptic stretch reflex should be considered in the treatment of women with PFP if their effectiveness is demonstrated in future studies.
Publisher: Public Library of Science (PLoS)
Date: 10-10-2018
Publisher: JMIR Publications Inc.
Date: 05-03-2020
Abstract: atellofemoral pain (PFP) impairs joint- and health-related quality of life and may be associated with knee osteoarthritis. We developed a novel, 2-phase, stepped-care approach for PFP, combining (1) self-directed web-based education and exercise therapy with (2) physiotherapist-supported education and exercise therapy. Physiotherapy sessions can be provided using 2 different modalities: face-to-face and telerehabilitation. his study aims to (1) determine the feasibility of our stepped-care approach, (2) explore patient-reported outcomes following self-directed web-based education and exercise therapy in people with PFP (phase 1), and (3) estimate the differences in treatment effects between face-to-face and telerehabilitation to support further education and exercise therapy (phase 2) in those who had not completely recovered following self-directed care. hase 1 involved 6 weeks of self-directed web-based education and exercise therapy. Phase 2 involved random allocation to a further 12 weeks of physiotherapist-led (up to 8 sessions) education and exercise therapy delivered face-to-face or via telerehabilitation to participants who did not rate themselves as completely recovered following phase 1. Feasibility indicators of process, adherence, and participant retention were collected as primary outcomes alongside patient-reported outcomes on Global Rating of Change and knee pain, disability, knee-related quality of life, pain catastrophism, kinesiophobia, and knee self-efficacy. All participants were assessed at baseline, 6 weeks, and 18 weeks. total of 71 participants were screened to identify 35 participants with PFP to enter the study. Overall, 100% (35/35) and 88% (31/35) of the participants were followed up with at 6 and 18 weeks, respectively. In phase 1 of the study, participants accessed the My Knee Cap website for an average of 6 (7.5) days and performed the exercises for an average of 2.5 (3.6) times per week. A total of 20% (7/35) of the participants reported that they had completely recovered at 6 weeks. Furthermore, 93% (26/28) of the participants who were followed up and had not completely recovered at 6 weeks agreed to be enrolled in phase 2. No statistically significant differences were found between the face-to-face and telerehabilitation groups for any outcome. The novel stepped-care approach was associated with marked improvement or complete recovery in 40% (14/35) of the participants following phase 1 and 71% (25/35) of the participants following phase 2. elf-directed web-based education and exercise therapy for people with PFP is feasible, as noted by the high rate of participant retention and home exercise adherence achieved in this study. Furthermore, 20% (7/35) of people reported complete recovery at 6 weeks. Both face-to-face and telerehabilitation physiotherapy should be considered for those continuing to seek care, as there is no difference in outcomes between these delivery modes. Determining the efficacy of the stepped-care model may help guide more efficient health care for PFP.
Publisher: Springer Singapore
Date: 2019
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.KNEE.2017.01.002
Abstract: Efforts to reduce the financial costs related to anterior cruciate ligament reconstruction (ACLR) include reducing the length of hospitalization of the patient undergoing ACLR. However, it is unclear if inpatient and outpatient ACLR differ in terms of safety, satisfaction, costs and clinical outcomes. To systematically review and synthesize the literature that directly compared costs and outcomes after outpatient and inpatient ACLR. Studies that directly compared outcomes of inpatient and outpatient ACLR were retrieved via searches in MEDLINE, EMBASE, CINAHL, AMED, Cochrane, SPORTDiscus, Web of Science and SCOPUS databases. Random effects meta-analysis and descriptive analysis were performed for relevant outcomes. Costs analysis suggests that outpatient ACLR may be a cost effective procedure with savings ranging from $1371 to $7390. There were no differences for systemic and local complications p=0.64 (odds ratio 1.65, 95% confidence interval 0.20 to 13.49) and p=0.72 (0.81, 0.26 to 2.56) respectively, or pain in the second and seventh days after surgery, p=0.78 (mean difference -0.16 95% confidence interval -1.28 to 0.96) and p=0.44 (0.48, -0.75 to 1.71), respectively. However, the outpatient group had less pain than the inpatient group in the first and third days after surgery, p=0.0001 (-0.39, -0.57 to -0.21) and p=0.0001(-0.39, -0.39 to -0.20), respectively. Descriptive analysis revealed that the outpatient group experienced similar or better satisfaction, strength and knee function compared to the inpatient group. Complications, pain, satisfaction, knee function and strength are similar or better after outpatient compared to inpatient ACLR. Furthermore, cost savings may be achieved with outpatient ACLR. However, included studies presented low methodological quality and the quality of evidence was very low, so these results need to be confirmed by future studies. PROSPERO (CRD42015024990).
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.APMR.2019.10.190
Abstract: To investigate the effect of a knee brace compared with minimal intervention on self-reported kinesiophobia and function, objective function, and physical activity level in people with patellofemoral pain (PFP). Single-blind randomized controlled trial (1:1), parallel. In iduals with PFP (N=50). Primary: kinesiophobia (T a Scale for Kinesiophobia). Secondary: self-reported function (Anterior Knee Pain Scale), physical activity level (International Physical Activity Questionnaire), and objective function (forward step-down test). Outcomes were assessed at baseline (T Participants were randomly assigned to 1 of 2 interventions groups: (1) use of knee brace for 2 weeks during daily living, sports, or painful tasks (brace group) and (2) educational leaflet with information about PFP (leaflet group). The knee brace reduced kinesiophobia in people with PFP compared with minimal intervention with moderate effect size at T The knee brace improved kinesiophobia immediately after intervention (at 2wk) and at 6-week follow-up in people with PFP compared with minimal intervention. A knee brace may be considered within clinically reasoned paradigms to facilitate exercise therapy interventions for people with PFP.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 10-2018
Abstract: Two-dimensional (2-D) analysis is commonly used to quantify frontal plane kinematics of the trunk and lower extremity. However, there are conflicting results regarding the reliability and validity of these measurements. To synthesize the current literature to determine whether 2-D analysis is a reliable and valid method of measuring frontal plane kinematics of the trunk and lower extremity during squatting, landing, and cutting tasks. For this systematic review with meta-analysis, MEDLINE, CINAHL, Embase, Scopus, and SPORTDiscus databases were searched from inception until March 2017. The authors included 16 studies that evaluated the reliability and/or validity of 2-D measurements of frontal plane trunk and/or lower extremity kinematics when compared to 3-D measurements during any of the following tasks: squatting, landing, or cutting. Intrarater reliability (intraday and interday) and interrater reliability of the 2-D video measurements varied from moderate to excellent. In terms of validity, there was poor agreement between the 2-D and 3-D methods, with no correlation between 2-D knee frontal plane projection angle and 3-D knee frontal plane angles (r = 0.127, P = .094) for the single-leg squat, but a moderate to good relationship (r = 0.619, P<.001) for the landing task. Two-dimensional video analysis of frontal plane trunk and lower extremity kinematics is reliable, but this appears to be dependent on the task and the type of reliability evaluated. The current evidence does not support the use of 2-D video analysis for measuring trunk and lower extremity frontal plane kinematics when accurate measures are required. Diagnosis, level 3. J Orthop Sports Phys Ther 2018 (10):812-822. Epub 12 Jun 2018. doi:10.2519/jospt.2018.8006.
Publisher: Oxford University Press (OUP)
Date: 25-04-2016
DOI: 10.1093/PM/PNW068
Abstract: Compare pressure pain thresholds (PPTs) at the knee and a site remote to the knee in female adults with patellofemoral pain (PFP) to pain-free controls before and after a patellofemoral joint (PFJ) loading protocol designed to aggravate symptoms. Cross-sectional study SETTING: Participants were recruited via advertisements in fitness centers, public places for physical activity and universities. Thirty-eight females with patellofemoral pain, and 33 female pain-free controls. All participant performed a novel PFJ loading protocol involving stair negotiation with an extra load equivalent 35% of body mass. PPTs and current knee pain (measured on a visual analogue scale) was assessed before and after the loading protocol. PPTs were measured at four sites around the knee and one remote site on the upper contralateral limb. Females with PFP demonstrated significantly lower PPTs locally and remote to the knee, both before and after the PFJ loading protocol when compared to control group. Following the loading protocol, PPTs at knee were significantly reduced by 0.54 kgf (95%CI = 0.33 0.74) for quadriceps tendon, 0.38 kgf (95%CI = 0.14 0.63) for medial patella, and 0.44 kgf (95%CI = 0.18 0.69) for lateral patella. No significant change in PPT remote to the knee was observed - 0.10 kgf (95%CI = -0.04 0.24). Female adults with PFP have local and widespread hyperalgesia compared to pain free controls. A novel loading protocol designed to aggravate symptoms, lowers the PPTs locally at the knee but has no effect on PPT on the upper contralateral limb. This suggests widespread hyperalgesia is not affected by acute symptom aggravation.
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.APMR.2015.12.017
Abstract: To investigate whether vastus medialis (VM) Hoffmann reflexes (H-reflexes) differ on the basis of the presence or absence of patellofemoral pain (PFP) and to assess the capability of VM H-reflex measurements in accurately discriminating between women with and without PFP. Cross-sectional study. Laboratory of biomechanics and motor control. Women (N=30) aged 18 to 35 years were recruited, consisting of 2 groups: women with PFP (n=15) and asymptomatic controls (n=15). Not applicable. Maximum evoked responses were obtained by electrical stimulation applied to the femoral nerve, and peak-to-peak litudes of maximal Hoffmann reflex (Hmax) and maximal motor wave (Mmax) ratios were calculated. Independent s les t tests were performed to identify differences between groups, and a receiver operating characteristic curve was constructed to assess the discriminatory capability of VM H-reflex measurements. VM Hmax/Mmax ratios were significantly lower in participants with PFP than in pain-free participants (P=.007). In addition, the VM Hmax/Mmax ratios presented large and balanced discriminatory capability values (sensitivity, 73% specificity, 67%). This study is the first to show that VM H-reflexes are lower in women with PFP than in asymptomatic controls. Therefore, increasing the excitation of the spinal cord in PFP participants may be essential to maintaining the gains acquired during the rehabilitation programs.
Publisher: Wiley
Date: 27-07-2020
DOI: 10.1111/SMS.13767
Publisher: BMJ
Date: 23-06-2019
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.CLINBIOMECH.2015.06.021
Abstract: Stair ascent is an activity that exacerbates symptoms of in iduals with patellofemoral pain. The discomfort associated with this activity usually results in gait modification such as reduced knee flexion in an attempt to reduce pain. Although such compensatory strategy is a logical approach to decrease pain, it also reduces the normal active shock absorption increasing loading rates and may lead to deleterious and degenerative changes of the knee joint. Thus, the aims of this study were (i) to investigate whether there is reduced knee flexion in adults with PFP compared to healthy controls and (ii) to analyze loading rates in these subjects, during stair climbing. Twenty-nine in iduals with patellofemoral pain and twenty-five control in iduals (18-30 years) participated in this study. Each subject underwent three-dimensional kinematic and kinetic analyses during stair climbing on two separate days. Between-groups analyses of variance were performed to identify differences in peak knee flexion and loading rates. Intraclass correlation coefficient was performed to verify the reliability of the variables. On both days, the patellofemoral pain group demonstrated significantly reduced peak knee flexion and increased loading rates. In addition, the two variables obtained high to very high reliability. Reduced knee flexion during stair climbing as a strategy to avoid anterior knee pain does not seem to be healthy for lower limb mechanical distributions. Repeated loading at higher loading rates may be damaging to lower limb joints.
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.KNEE.2016.01.014
Abstract: Altered hip, knee and foot kinematics have been systematically observed in in iduals with patellofemoral pain (PFP). However, less attention has been given to the altered dynamic postural control associated with PFP. Additionally, the relative contribution of kinematic impairments to the postural behavior of subjects with PFP remains an open question that warrants investigation. The aims of this study were: i) to investigate possible differences in hip adduction, rearfoot eversion, knee flexion and displacement area of the center of pressure (COP) in in iduals with PFP in comparison to controls during stair ascent and (ii) to determine which kinematic parameter is the best predictor of the displacement area of the COP measured during the stance phase of the stair ascent. Twenty-nine females with PFP and 25 asymptomatic pain-free females underwent three-dimensional kinematic and COP analyses during stair ascent. Between-group comparisons were made using independent t-tests. Regression models were performed to identify the capability of each kinematic factor in predicting the displacement area of the COP. Reduced knee flexion and displacement area of the COP as well as increased peak hip adduction and peak rearfoot eversion were observed in in iduals with PFP as compared to controls. Peak hip adduction was the best predictor of the displacement area of the COP (r(2)=23.4%). The excessive hip adduction was the biggest predictor of the displacement area of the COP. Based on our findings, proximally targeted interventions may be of major importance for the functional reestablishment of females with PFP.
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.CLINBIOMECH.2016.04.009
Abstract: Several hypotheses have been proposed to explain the pathomechanisms underlying patellofemoral pain (PFP). Concurrent evaluation of lower limb mechanics in the same PFP population is needed to determine which may be more important to target during rehabilitation. This study aimed to investigate possible differences in rearfoot eversion, hip adduction, and knee flexion during stair ascent the relationship between these variables and the discriminatory capability of each in identifying females with PFP. Thirty-six females with PFP and 31 asymptomatic controls underwent three-dimensional kinematic analyses during stair ascent. Between-group comparisons were made for peak rearfoot eversion, hip adduction, and knee flexion. Pearson's correlation coefficients were calculated to evaluate relationships among these parameters. Receiver operating characteristic curves were applied to identify the discriminatory capability of each. Females with PFP ascended stairs with reduced peak knee flexion, greater peak hip adduction and peak rearfoot eversion. Peak hip adduction (>10.6° sensitivity=67%, specificity=77%) discriminated females with PFP more effectively than rearfoot eversion (>5.0° sensitivity=58%, specificity=67%). Reduced peak hip adduction was found to be associated with reduced peak knee flexion (r=0.54, p=0.002) in females with PFP. These findings indicate that proximal, local, and distal kinematics should be considered in PFP management, but proximally targeted interventions may be most important. The relationship of reduced knee flexion with reduced hip adduction also indicates a possible compensatory strategy to reduce patellofemoral joint stress, and this may need to be addressed during rehabilitation.
Publisher: Elsevier BV
Date: 07-2019
Publisher: Elsevier BV
Date: 09-2023
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 07-2020
Abstract: To evaluate the effect of education interventions compared with any type of comparator on managing patellofemoral pain (PFP). Intervention systematic review. PROSPERO identifier: CRD42018088671. MEDLINE, Embase, CINAHL, and Web of Science were searched for studies evaluating the effect of education on clinical and functional outcomes in people with PFP. Two reviewers independently assessed studies for inclusion and quality. We included randomized controlled trials on PFP where at least 1 group received an education intervention (in isolation or in combination with other interventions). Available data were synthesized via meta-analysis where possible data that were not appropriate for pooling were synthesized qualitatively. Interpretation was guided by the Grading of Recommendations Assessment, Development and Evaluation approach. Nine trials were identified. Low-credibility evidence indicated that health education material alone was inferior to exercise therapy for pain and function outcomes. Low- and very low-credibility evidence indicated that health professional-delivered education alone produced outcomes similar to those of exercise therapy combined with health professional-delivered education for pain and function, respectively. Health professional-delivered education may produce similar outcomes in pain and function compared to exercise therapy plus health professional-delivered education in people with PFP.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.GAITPOST.2018.03.037
Abstract: Patellofemoral pain (PFP) has been linked to increased patellofemoral joint stress as a result of excessive hip internal rotation. Lower hip strength and/or excessive rearfoot eversion have been used to explain such altered movement pattern however, it is unknown which one is the best predictor of excessive hip internal rotation. To investigate if peak rearfoot eversion and/or peak concentric hip abductor strength can predict peak hip internal rotation during stair ascent in women with PFP. This cross-sectional study included thirty-seven women with PFP which underwent three-dimensional kinematic analysis during stair ascent and hip abductor strength analysis in an isokinetic dynamometer. A forced entry linear regression model analysis was carried out to determine which independent variables present the best capability to predict the hip internal rotation. Peak concentric hip abductor strength significantly predicted peak hip internal rotation during stair ascent (R Findings indicate that hip muscle strength seems to be related with hip internal rotation in all women with PFP. Rearfoot eversion seems to be related with hip internal rotation only in a subgroup with excessive rearfoot eversion.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.GAITPOST.2017.07.034
Abstract: This study investigated whether women with patellofemoral pain (PFP) present kinematic alterations in proximal, local, and distal factors simultaneously, and determined the association between the number of kinematic alterations, pain level, and functional status. A three-dimensional motion analysis system was used to analyze the peak hip adduction, peak knee flexion, and peak rearfoot eversion, addressing the proximal, local, and distal factors, respectively, in fifty women. Functional status and pain level were assessed using the anterior knee pain scale (AKPS) and a visual analogic scale. Receiver operating characteristic curves were calculated to identify participants with and without kinematic alterations and the number of them was obtained for each participant. Associations between the number of kinematic alterations, pain level, and AKPS score were determined by the Pearson correlation. Results showed that 52% of women with PFP presented at least two kinematic alterations of which 24% were local roximal, 16% local/distal, and 12% proximal/distal. Three kinematic alterations were found in 48% of the women with PFP. A strong positive correlation was found between the number of kinematic alterations and pain (r=0.78 p<0.001). A strong negative correlation was found between the number of altered kinematics and functional status (r=-0.79 p<0.001). Findings revealed that women with PFP presented at least two kinematic alterations and a higher number of kinematic alterations was associated with higher pain levels and lower functional status. Clinicians should carefully assess movement pattern of women with PFP as it could indicate a more severe condition, which is associated with a poor prognosis.
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.KNEE.2018.03.009
Abstract: The etiology of patellofemoral pain (PFP) is thought to be the result of increased patellofemoral joint (PFJ) load and aberrant lower extremity mechanics, including altered vertical ground reaction forces (VGRF). However, few studies have investigated the association between an increase in pain and VGRF loading rates in the context of PFP. Thus, this study aimed to investigate the immediate effects of PFJ loading on pain and VGRF loading rate, and to see if there is a link between modification of both pain and VGRF loading rate during stair negotiation. Thirty-four women with PFP underwent VGRF analysis during stair negotiation under two conditions: with (condition 2) and without (condition 1) being previously submitted to a PFJ loading protocol in order to or not to exacerbate their knee pain, respectively. The VGRF loading rates were significantly higher in condition 2 (Mean ± standard deviation (SD)=4.0±0.6N/s) compared to condition 1 (Mean±SD=3.6±0.5N/s) during stair ascent and during stair descent (Mean±SD: condition 1=6.3±1.1N/s condition 2=7.0±1.4N/s). In addition, VGRF loading rates were higher during stair descent compared to stair ascent in both conditions. There were significant correlations between the increase in pain and VGRF loading rate during both tasks. There seemed to be an important relation between the increase in pain and VGRF loading rates in women with PFP. Based on these findings, interventions aimed at reducing VGRF loading rates are important in the context of PFP.
Publisher: Springer Science and Business Media LLC
Date: 12-2022
DOI: 10.1186/S40798-022-00536-6
Abstract: The trunk is the foundation for transfer and dissipation of forces throughout the lower extremity kinetic chain. In iduals with knee disorders may employ trunk biomechanical adaptations to accommodate forces at the knee or compensate for muscle weakness. This systematic review aimed to synthesize the literature comparing trunk biomechanics between in iduals with knee disorders and injury-free controls. Five databases were searched from inception to January 2022. Observational studies comparing trunk kinematics or kinetics during weight-bearing tasks (e.g., stair negotiation, walking, running, landings) between in iduals with knee disorders and controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and evidence gap maps were created. A total of 81 studies investigating trunk biomechanics across six different knee disorders were included (i.e., knee osteoarthritis [OA], total knee arthroplasty [TKA], patellofemoral pain [PFP], patellar tendinopathy [PT], anterior cruciate ligament deficiency [ACLD], and anterior cruciate ligament reconstruction [ACLR]). In iduals with knee OA presented greater trunk flexion during squatting (SMD 0.88, 95% CI 0.58–1.18) and stepping tasks (SMD 0.56, 95% CI 0.13–.99) ipsilateral and contralateral trunk lean during walking (SMD 1.36 95% CI 0.60–2.11) and sit-to-stand (SMD 1.49 95% CI 0.90–2.08), respectively. Greater trunk flexion during landing tasks in in iduals with PFP (SMD 0.56 95% CI 0.01–1.12) or ACLR (SMD 0.48 95% CI 0.21–.75) and greater ipsilateral trunk lean during single-leg squat in in iduals with PFP (SMD 1.01 95% CI 0.33–1.70) were also identified. No alterations in trunk kinematics of in iduals with TKA were identified. Evidence gap maps outlined the lack of investigations for in iduals with PT or ACLD, as well as for trunk kinetics across knee disorders. In iduals with knee OA, PFP, or ACLR present with altered trunk kinematics in the sagittal and frontal planes. The findings of this review support the assessment of trunk biomechanics in these in iduals in order to identify possible targets for rehabilitation and avoidance strategies. Trial registration: PROSPERO registration number: CRD42019129257.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.PTSP.2018.06.002
Abstract: (i) To assess the reliability of knee crepitus measures, (ii) to investigate the association between knee crepitus and PFP (iii) to investigate the relationship between knee crepitus with self-reported function, physical activity and pain. Cross-sectional. Laboratory-based study. 165 women with PFP and 158 pain-free women. Knee crepitus test, anterior knee pain scale (AKPS) and self-reported worst knee pain in the last month, knee pain after 10 squats and knee pain after 10 stairs climbing. Knee crepitus clinical test presented high reliability Kappa value for PFP group was 0.860 and for pain-free group was 0.906. There is a significantly greater proportion of those with crepitus in the PFP group than in the pain-free group (OR = 4.19). Knee crepitus had no relationship with function (rpb = 0.03 p = 0.727), physical activity level (rpb = 0.010 p = 0.193), worst pain (rpb = 0.11 p = 0.141), pain climbing stairs (rpb = 0.10 p = 0.194) and pain squatting (rpb = 0.02 p = 0.802). Women who presents knee crepitus have 4 times greater odds to be in a group with PFP compared to those who do not. However, knee crepitus has no relationship with self-reported clinical outcomes of women with PFP.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.CLINBIOMECH.2015.09.002
Abstract: The elevated Q-angle seems to be one of the most suggested factors contributing to patellofemoral pain. Females with patellofemoral pain are often evaluated through static clinical tests in clinical practice. However, the adaptations seem to appear more frequently in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Therefore, the aim of this study was to determine the reliability and discriminatory capability of three Q-angle measurements: a static clinical test, peak dynamic knee valgus during stair ascent and a static measurement using a three-dimensional system. Twenty-nine females with patellofemoral pain and twenty-five pain-free females underwent clinical Q-angle measurement and static and dynamic knee valgus measurements during stair ascent, using a three-dimensional system. All measurements were obtained and comparisons between groups, reliability and discriminatory capability were calculated. Peak dynamic knee valgus was found to be greater in the patellofemoral pain group. On the other hand, no significant effects were found for static knee valgus or clinical Q-angle measurements between groups. The dynamic variable demonstrated the best discriminatory capability. Low values of reliability were found for clinical Q-angle, in contrast to the high values found for the three-dimensional system measurements. Based on our findings, avoiding or correcting dynamic knee valgus during stair ascent may be an important component of rehabilitation programs in females with patellofemoral pain who demonstrate excessive dynamic knee valgus. Q-angle static measurements were not different between groups and presented poor values of discriminatory capability.
Location: Brazil
No related grants have been discovered for Fabio Azevedo.