Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 84
Filtrar
Mais filtros

Tipo de documento
Intervalo de ano de publicação
1.
Br J Sports Med ; 58(14): 792-804, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38889956

RESUMO

OBJECTIVE: To compare the effectiveness of adjunct treatments combined with exercise to exercise alone in people with patellofemoral pain (PFP) and explore the quality of intervention descriptions in randomised controlled trials (RCTs). DESIGN: Systematic review. DATA SOURCES: Seven databases were searched in November 2023. ELIGIBILITY: RCTs that evaluated the effectiveness of any adjunct treatment combined with exercise to exercise alone on self-reported pain and function in people with PFP. RESULTS: We included 45 RCTs (2023 participants), with 25 RCTs (1050 participants) contributing to meta-analyses. Pooled analysis indicated very low-certainty evidence that neuromuscular electrical stimulation or monopolar dielectric diathermy combined with exercise leads to small and large improvements in self-reported pain when compared with exercise alone (standardised mean difference (95% CI)=-0.27 (-0.53 to -0.02) and -2.58 (-4.59 to -0.57), respectively) in the short-term. For self-reported pain and function, very low-certainty evidence indicates that knee taping, whole-body vibration, electromyographic biofeedback and knee brace combined with exercise do not differ from exercise alone. Interventions are poorly described in most RCTs, adjunct treatments scored on average 14/24 and exercise therapy 12/24 in the Template for Intervention Description and Replication checklist. CONCLUSION: Neuromuscular electrical stimulation and monopolar dielectric diathermy combined with exercise seem to improve self-reported pain in people with PFP compared with exercise alone. Knee taping, whole-body vibration, electromyographic biofeedback and knee brace do not offer additional benefits to exercise alone. Most interventions are poorly described, which is detrimental to translating research knowledge into clinical practice. PROSPERO REGISTRATION NUMBER: CRD42020197081.


Assuntos
Terapia por Exercício , Síndrome da Dor Patelofemoral , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Fita Atlética , Terapia Combinada , Diatermia , Terapia por Exercício/métodos , Síndrome da Dor Patelofemoral/terapia
2.
Br J Sports Med ; 2024 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-39375004

RESUMO

OBJECTIVE: Knee crepitus, the audible crackling or grinding noise during knee movement, can be experienced across the lifespan and create concern for underlying pathology. Our systematic review aims to provide a summary estimate of knee crepitus prevalence and its association with structural pathology among the general population and across knee conditions. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, CENTRAL, Web of Science, SPORTDiscus and CINAHL. ELIGIBILITY CRITERIA: Studies evaluating knee crepitus prevalence. RESULTS: 103 studies involving 36 439 participants (42 816 knees) were included. Based on very low certainty evidence, the pooled prevalence of knee crepitus in the general population was 41% (7609 knees; 95% CI 36% to 45%; I2=92.6%); in pain-free persons 36% (852 knees; 95% CI 23% to 50%; I2=91.9%), and in those with osteoarthritis (OA) 81% (18 821 knees; 95% CI 75% to 87%; I2=97.9%). Across other musculoskeletal knee conditions, the pooled prevalence of knee crepitus ranged from 35% (ligament injury; 2740 knees; 95% CI 27% to 44%; I2=95.6%) to 61% (cartilage pathology; 1445 knees; 95% CI 40% to 81%; I2=98.2%). There was low to very low certainty evidence of an association between knee crepitus and radiographic OA (OR 3.79, 95% CI 1.99 to 7.24; 1725 knees; I2=53.0%) and several OA-related features on magnetic resonance imaging (MRI). CONCLUSION: In this review, knee crepitus was prevalent in the general population, pain-free persons, those with knee OA and other musculoskeletal knee conditions. Knee crepitus was associated with a more than threefold increased odds of radiographic OA diagnosis and several OA-related MRI features. The low to very low certainty of evidence informing our aggregated prevalence estimates and association outcomes suggest that results should be interpreted with caution.

3.
J Arthroplasty ; 38(2): 281-285, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36067885

RESUMO

BACKGROUND: Anterior knee pain following total knee arthroplasty (TKA) is associated with patient dissatisfaction. Factors related to postoperative anterior knee pain and its impact on patient outcomes are poorly understood. The following are the aims of this study: (1) to report the prevalence of anterior knee pain before and after TKA using a posterior-stabilized prosthesis with routine patellar resurfacing; (2) to investigate the association of preoperative clinical factors with the presence of anterior knee pain after TKA; and (3) to explore the association of postoperative anterior knee pain with postoperative self-reported function and quality of life. METHODS: This retrospective study included 506 patients who had undergone elective primary unilateral TKA with a posterior-stabilized prosthesis and patellar resurfacing. Outcome measures prior to and 12 months after TKA included self-reported anterior knee pain, knee function, and quality of life. RESULTS: Prevalence of anterior knee pain was 72% prior to and 15% following TKA. Patients who had preoperative anterior knee pain had twice the risk of experiencing anterior knee pain after TKA than patients who did not have preoperative anterior knee pain (risk ratio: 2.37, 95% CI 1.73-2.96). Greater severity of preoperative anterior knee pain and worse self-reported function were associated with the presence of postoperative anterior knee pain (rho = 0.15, P < .01; rho = 0.13, P < .01, respectively). Preoperative age, gender, and quality of life were not associated with postoperative anterior knee pain. Greater severity of postoperative anterior knee pain was associated with worse knee function at 12 months postoperative (rho = 0.49, P < .01). CONCLUSION: One in 7 patients reported anterior knee pain 12 months following posterior-stabilized and patella-resurfaced TKA. The presence of preoperative anterior knee pain and worse self-reported function are associated with postoperative anterior knee pain.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Artroplastia do Joelho/efeitos adversos , Patela/cirurgia , Estudos Retrospectivos , Prevalência , Qualidade de Vida , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/etiologia , Resultado do Tratamento , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Dor/epidemiologia , Dor/etiologia , Dor/cirurgia
4.
J Sport Rehabil ; 32(3): 235-241, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36191905

RESUMO

CONTEXT: Injury surveillance and training load monitoring are both essential for the development of preventative strategies for gradual-onset musculoskeletal injuries in elite sport. Our aim was to survey health professionals working with elite tennis players on whether and how they monitor injuries and training load. DESIGN: A cross-sectional multinational online open-survey. METHODS: The survey was developed and advertised in English, Spanish, and Portuguese languages on social media channels, a tennis academic journal, professional tennis associations, and clinical networks of the research team, from December 2020 to April 2021. RESULTS: 72 health professionals from 27 different countries working with elite tennis players responded to the survey. Injury surveillance is performed by 94% (68/72) of the survey respondents, with only 10% (7/68) using the consensus-recommended Oslo Sports Trauma Research Center questionnaire. Most common barriers identified by health professionals to injury surveillance are time constraints (66%), lack of knowledge (43%), and technology (31%). Training load monitoring is performed by 50% (36/72) of the health professionals working with elite tennis players. Main metrics monitored are weekly differences in training load (72%) and acute:chronic workload ratio (58%). Most common reasons for training load monitoring are injury prevention (94%), training planning (81%), and player feedback (53%). CONCLUSIONS: Despite a high percentage of health professionals implementing injury surveillance metrics, most of them do not use any validated method. Only half of health professionals working with elite tennis players monitor training load. Lack of knowledge and technology were the main barriers reported for adequately monitoring injuries.


Assuntos
Traumatismos em Atletas , Esportes , Tênis , Humanos , Tênis/lesões , Estudos Transversais , Traumatismos em Atletas/epidemiologia , Inquéritos e Questionários
5.
J Sport Rehabil ; 32(1): 24-30, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35894902

RESUMO

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 Tampa 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.


Assuntos
Síndrome da Dor Patelofemoral , Feminino , Humanos , Estudos Prospectivos , Cinesiofobia , Movimento , Medo
6.
Salud Publica Mex ; 64: S31-S39, 2022 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-36130385

RESUMO

The continuous development in telecommunication tech-nologies has created opportunities for health professionals to optimise healthcare delivery by adopting digital tools into rehabilitation programs (i.e., telerehabilitation). These tech-nological advances, along with the demographic and social characteristics of each country, have made the implementa-tion of telerehabilitation a disparate process across regions. We have gathered the experience of four countries (Australia, Chile, Brazil, and Colombia) in two different regions (Ocea-nia and South America) to recompile the history pre- and post-Covid-19 outbreak until January of 2021, the barriers to, and facilitators of telerehabilitation, and outline the future challenges for these countries.


Assuntos
COVID-19 , Telerreabilitação , Brasil , Surtos de Doenças , Humanos , Modalidades de Fisioterapia
7.
Br J Sports Med ; 55(20): 1135-1143, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34127482

RESUMO

Patellofemoral pain is a common and often debilitating musculoskeletal condition. Clinical translation and evidence synthesis of patellofemoral pain research are compromised by heterogenous and often inadequately reported study details. This consensus statement and associated checklist provides standards for REPORTing of quantitative PatelloFemoral Pain (REPORT-PFP) research to enhance clinical translation and evidence synthesis, and support clinician engagement with research and data collection. A three-stage Delphi process was initiated at the 2015 International Patellofemoral Research Network (iPFRN) retreat. An initial e-Delphi activity (n=24) generated topics and items, which were refined at the 2017 iPFRN retreat, and voted on prior to and following the 2019 iPFRN retreat (n=51 current and past retreat participants). Voting criteria included 'strongly recommended' (essential), 'recommended' (encouraged) and uncertain/unsure. An item was included in the checklist if ≥70% respondents voted 'recommended'. Items receiving ≥70% votes for 'strongly recommended' were labelled as such. The final REPORT-PFP checklist includes 31 items (11 strongly recommended, 20 recommended), covering (i) demographics (n=2,4); (ii) baseline symptoms and previous treatments (n=3,7); (iii) outcome measures (2,4); (iv) outcomes measure description (n=1,2); (v) clinical trial methodology (0,3) and (vi) reporting study results (n=3,0). The REPORT-PFP checklist is ready to be used by researchers and clinicians. Strong stakeholder engagement from clinical academics during development means consistent application by the international patellofemoral pain research community is likely. Checklist adherence will improve research accessibility for clinicians and enhance future evidence synthesis.


Assuntos
Síndrome da Dor Patelofemoral , Projetos de Pesquisa/normas , Lista de Checagem , Consenso , Técnica Delphi , Humanos , Síndrome da Dor Patelofemoral/diagnóstico
8.
J Strength Cond Res ; 35(9): 2492-2497, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31045684

RESUMO

ABSTRACT: Ferreira, AS, de Oliveira Silva, D, Barton, CJ, Briani, RV, Taborda, B, Pazzinatto, MF, and de Azevedo, FM. Impaired isometric, concentric, and eccentric rate of torque development at the hip and knee in patellofemoral pain. J Strength Cond Res 35(9): 2492-2497, 2021-The aims of this study were to compare maximal muscle strength and rate of torque development (RTD) of knee extensor and hip abductor during isometric, concentric, and eccentric contractions between women with and without patellofemoral pain (PFP). Thirty-eight women with PFP (PFPG) and 38 pain-free women (CG) participated in this study. Isometric, concentric, and eccentric maximal torque and RTD of knee extensor and hip abductor were assessed using an isokinetic dynamometer. Rate of torque development was calculated as the change in torque over the change in time from torque onset to 30, 60, and 90% of the maximal torque (RTD30%, RTD60%, and RTD90%) during isometric, concentric, and eccentric contractions. PFPG had lower isometric, concentric, and eccentric knee extensor maximal torque (29.9, 28.3, and 26.7%) compared with the CG. For knee extensor RTD, PFPG had slower isometric RTD30% (17.8%), RTD60% (21.5%), and RTD90% (23.4%); slower concentric RTD30% (35.7%), RTD60% (29.3%), and RTD90% (28.2%); and slower eccentric RTD30% (20.5%), RTD60% (25.2%), and RTD90% (22.5%) compared with the CG. PFPG had lower isometric, concentric, and eccentric hip abductor maximal torque (28.3, 21.8, and 17%) compared with the CG. For hip abductor RTD, PFPG had slower isometric RTD30% (32.6%), RTD60% (31.1%), and RTD90% (25.4%); slower concentric RTD90% (11.5%); and slower eccentric RTD30% (19.8%), RTD60% (26.4%), and RTD90% (24%) compared with the CG. In conclusion, women with PFP presented deficits in both maximal strength and RTD of knee extensor and hip abductor during isometric, concentric, and eccentric contractions, which highlight the potential importance of addressing different aspects of muscle function through exercise therapy.


Assuntos
Síndrome da Dor Patelofemoral , Feminino , Humanos , Contração Isométrica , Articulação do Joelho , Músculo Esquelético , Torque
9.
J Strength Cond Res ; 35(10): 2878-2885, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31343549

RESUMO

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.


Assuntos
Síndrome da Dor Patelofemoral , Feminino , Humanos , Contração Isométrica , Joelho , Articulação do Joelho , Força Muscular , Músculo Esquelético
10.
Arch Phys Med Rehabil ; 101(4): 613-623, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31830433

RESUMO

OBJECTIVE: 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). DESIGN: Single-blind randomized controlled trial (1:1), parallel. PARTICIPANTS: Individuals with PFP (N=50). MAIN OUTCOME MEASURES: Primary: kinesiophobia (Tampa 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 (T0), at the end of the intervention (2wk) (T1), and at 6 weeks after baseline (T2). INTERVENTION: 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). RESULTS: The knee brace reduced kinesiophobia in people with PFP compared with minimal intervention with moderate effect size at T1=mean difference (95% CI) -5.56 (-9.18 to -1.93) and T2=-5.24 (-8.58 to -1.89). There was no significant difference in self-reported and objective function and physical activity level. CONCLUSIONS: 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.


Assuntos
Braquetes , Medo , Movimento , Síndrome da Dor Patelofemoral/reabilitação , Adolescente , Adulto , Teste de Esforço , Feminino , Humanos , Masculino , Medição da Dor , Síndrome da Dor Patelofemoral/psicologia , Método Simples-Cego , Adulto Jovem
11.
Scand J Med Sci Sports ; 30(11): 2215-2221, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32645745

RESUMO

BACKGROUND: Altered patellofemoral joint (PFJ) loading and elevated kinesiophobia are commonly reported in people with patellofemoral pain (PFP). However, the relative relationship of these physical-psychological variables with pain and disability in people with PFP is unknown. AIM: To explore the relationship of PFJ loading during stair ascent and kinesiophobia, with self-reported pain and disability in women with PFP. METHODS: Fifty-seven women with PFP completed the Tampa Scale for Kinesiophobia, a Visual Analog Scale (0-100 mm) for pain during stair ascent, and the Anterior Knee Pain Scale (disability). Stair ascent mechanics were assessed via three-dimensional motion analysis while participants ascended an instrumented seven-step staircase. Peak PFJ contact force and stress, and PFJ contact force and stress loading rates were estimated using a musculoskeletal model. The relationships of PFJ kinetics during stair ascent and kinesiophobia, with the Anterior Knee Pain Scale (disability) and pain during stair ascent, were evaluated with Spearman rank correlation. Variables (kinetics and kinesiophobia) significantly correlating with the dependent variables (pain and disability) were inserted in linear regression models. RESULTS: Kinesiophobia was moderately associated with self-reported pain (rho = 0.37) and disability (rho = -0.58) in women with PFP. No PFJ loading variables were found to be associated with self-reported pain or disability (P > .05). Kinesiophobia explained 14% of the variance of participants' pain while ascending stairs and 33% of the variance of participant's self-reported disability. CONCLUSION: Addressing kinesiophobia during treatment of women with PFP may be important to reduce self-reported pain and disability.


Assuntos
Medo , Articulação Patelofemoral/fisiopatologia , Síndrome da Dor Patelofemoral/fisiopatologia , Síndrome da Dor Patelofemoral/psicologia , Fenômenos Biomecânicos , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Cinética , Medição da Dor , Autorrelato , Subida de Escada , Adulto Jovem
12.
J Med Internet Res ; 22(7): e18584, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32706674

RESUMO

BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.


Assuntos
Terapia por Exercício/métodos , Síndrome da Dor Patelofemoral/terapia , Qualidade de Vida/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
13.
Pain Med ; 20(2): 335-358, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30423181

RESUMO

OBJECTIVES: Previous reviews have reported that manifestations of pain sensitization may play an important role in the pain experienced by people with knee osteoarthritis. However, it is unknown if manifestations of pain sensitization are common features across other painful knee disorders or if sensitization requires targeted intervention. This review aims to synthesize the published research investigating manifestations of pain sensitization in painful knee disorders and to evaluate if the manifestations of pain sensitization change in response to treatment. METHODS: The systematic review protocol was registered with PROSPERO (CRD42015024211). We searched Medline, Embase, CINAHL, Web of Science, Sportsdiscus, and Cochrane Central for studies that investigated between-group differences (knee pain vs pain-free subjects) or the effect of treatment on manifestations of pain sensitization. Two reviewers independently assessed studies for inclusion and quality. Available data were synthesized via predetermined levels of evidence, meta-analysis, and metaregression where possible. RESULTS: Fifty-two studies investigating evidence related to pain sensitization distributed across four different painful knee disorders were identified. CONCLUSIONS: Our meta-analysis provides evidence of pain sensitization in people with knee osteoarthritis (strong evidence), people with patellofemoral pain (moderate evidence), and postmeniscectomy patients (very limited evidence). However, conflicting evidence exists in patellar tendinopathy. Metaregression indicates that pain is associated with pressure pain thresholds in knee osteoarthritis. In people with knee osteoarthritis and patellofemoral pain, several interventions were found to reduce manifestations of pain sensitization. This review highlights that pain sensitization may be amenable to treatment through exercise therapy, mobilization, and pharmacological and surgical intervention.


Assuntos
Hiperalgesia/epidemiologia , Hiperalgesia/etiologia , Artropatias/complicações , Articulação do Joelho , Sensibilização do Sistema Nervoso Central/fisiologia , Humanos
14.
Arch Phys Med Rehabil ; 100(3): 514-519, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30059658

RESUMO

OBJECTIVES: The aims of this study were threefold: (1) to compare the amplitude of patellar tendon reflex (T-reflex) between women with patellofemoral pain (PFP) and pain-free controls; (2) to compare the amplitude of vastus medialis Hoffmann reflex (VM H-reflex) between women with PFP and pain-free controls; (3) to investigate the association between the amplitude of patellar T-reflex and VM H-reflex in women with PFP and pain-free controls. DESIGN: Cross-sectional observational study. SETTING: Laboratory of biomechanics and motor control. PARTICIPANTS: Thirty women with PFP and 30 pain-free women aged 18 to 35 years (N=60). MAIN OUTCOME MEASURES: Peak-to-peak amplitudes 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. RESULTS: Women with PFP had significant lower amplitude 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). CONCLUSIONS: 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.


Assuntos
Reflexo H/fisiologia , Síndrome da Dor Patelofemoral/diagnóstico , Reflexo Anormal/fisiologia , Reflexo de Estiramento/fisiologia , Adolescente , Adulto , Estudos de Casos e Controles , Estudos Transversais , Estudos de Viabilidade , Feminino , Humanos , Patela/inervação , Patela/fisiopatologia , Síndrome da Dor Patelofemoral/fisiopatologia , Músculo Quadríceps/inervação , Músculo Quadríceps/fisiopatologia , Adulto Jovem
15.
J Ultrasound Med ; 38(10): 2685-2693, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30815915

RESUMO

OBJECTIVES: 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. METHODS: Forty-four women were recruited and divided 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. RESULTS: 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. CONCLUSIONS: 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 individuals with PFP and the mechanisms by which interventions targeting trunk muscle strength are beneficial to individuals with PFP.


Assuntos
Músculos Abdominais/anatomia & histologia , Músculos Abdominais/diagnóstico por imagem , Síndrome da Dor Patelofemoral/fisiopatologia , Ultrassonografia/métodos , Adolescente , Adulto , Feminino , Humanos , Adulto Jovem
16.
Br J Sports Med ; 52(16): 1031-1038, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29549150

RESUMO

OBJECTIVE: 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 individuals with knee osteoarthritis (OA). DESIGN: Systematic review with meta-analysis. DATA SOURCES: Medline, Embase, SPORTDiscus, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from inception to November 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included RCTs investigating the effect of conservative interventions on QoL or psychosocial factors in individuals with knee OA. Only RCTs considering these outcomes as primary were included. RESULTS: 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. SUMMARY/CONCLUSION: 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 individuals 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 individuals with knee OA. PROSPERO REGISTRATION NUMBER: CRD42016047602.


Assuntos
Osteoartrite do Joelho/psicologia , Osteoartrite do Joelho/reabilitação , Qualidade de Vida , Terapia Cognitivo-Comportamental , Depressão/prevenção & controle , Terapia por Exercício , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoeficácia , Yoga
17.
Br J Sports Med ; 52(18): 1170-1178, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29925502

RESUMO

Patellofemoral pain affects a large proportion of the population, from adolescents to older adults, and carries a substantial personal and societal burden. An international group of scientists and clinicians meets biennially at the International Patellofemoral Research Retreat to share research findings related to patellofemoral pain conditions and develop consensus statements using best practice methods. This consensus statement, from the 5th International Patellofemoral Research Retreat held in Australia in July 2017, focuses on exercise therapy and physical interventions (eg, orthoses, taping and manual therapy) for patellofemoral pain. Literature searches were conducted to identify new systematic reviews and randomised controlled trials (RCTs) published since the 2016 Consensus Statement. The methodological quality of included systematic reviews and RCTs was graded using AMSTAR and PEDro, respectively. Evidence-based statements were developed from included papers and presented to a panel of 41 patellofemoral pain experts for consensus discussion and voting. Recommendations from the expert panel support the use of exercise therapy (especially the combination of hip-focused and knee-focused exercises), combined interventions and foot orthoses to improve pain and/or function in people with patellofemoral pain. The use of patellofemoral, knee or lumbar mobilisations in isolation, or electrophysical agents, is not recommended. There is uncertainty regarding the use of patellar taping/bracing, acupuncture/dry needling, manual soft tissue techniques, blood flow restriction training and gait retraining in patients with patellofemoral pain. In 2017, we launched the International Patellofemoral Research Network (www.ipfrn.org) to consolidate and grow our patellofemoral research community, facilitate collaboration and disseminate patellofemoral pain knowledge to clinicians and the general public. The 6th International Patellofemoral Research Retreat will be held in Milwaukee, Wisconsin, USA, in October 2019.


Assuntos
Terapia por Exercício , Síndrome da Dor Patelofemoral/terapia , Modalidades de Fisioterapia , Fita Atlética , Austrália , Congressos como Assunto , Consenso , Órtoses do Pé , Humanos , Manipulações Musculoesqueléticas , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Arch Phys Med Rehabil ; 98(1): 114-119, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27422350

RESUMO

OBJECTIVE: To determine the association between the amplitude 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). DESIGN: Cross-sectional study. SETTING: Laboratory of biomechanics and motor control. PARTICIPANTS: Women diagnosed with PFP (N=15) aged 18 to 35 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: 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 amplitudes 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 amplitude of VM H-reflex and worst pain during the previous month, self-reported function, and chronicity of pain. RESULTS: Strong negative correlations were found between the amplitude 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 amplitude of VM H-reflex and self-reported physical function (r=.62; P=.012). CONCLUSIONS: 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.


Assuntos
Síndrome da Dor Patelofemoral/fisiopatologia , Músculo Quadríceps/fisiopatologia , Reflexo Anormal/fisiologia , Adolescente , Adulto , Doença Crônica , Estudos Transversais , Estimulação Elétrica , Eletromiografia , Feminino , Nervo Femoral , Humanos , Medição da Dor , Síndrome da Dor Patelofemoral/reabilitação , Autorrelato , Adulto Jovem
20.
Pain Med ; 17(10): 1953-1961, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27113220

RESUMO

OBJECTIVE: 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. DESIGN: Cross-sectional study SETTING: Participants were recruited via advertisements in fitness centers, public places for physical activity and universities. SUBJECTS: Thirty-eight females with patellofemoral pain, and 33 female pain-free controls. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.


Assuntos
Hiperalgesia/diagnóstico , Medição da Dor/métodos , Limiar da Dor/fisiologia , Articulação Patelofemoral/patologia , Articulação Patelofemoral/fisiologia , Suporte de Carga/fisiologia , Adulto , Estudos Transversais , Feminino , Humanos , Hiperalgesia/fisiopatologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA