Kinesiophobia Is Associated With Poor Function and Modifiable Through Interventions in People With Patellofemoral Pain: A Systematic Review With Individual Participant Data Correlation Meta-Analysis.

OBJECTIVE: The aim of this systematic review and correlation meta-analysis was to identify factors associated with kinesiophobia in individuals with patellofemoral pain (PFP) and to identify interventions that may reduce kinesiophobia in individuals with PFP. METHODS: Seven databases were searched for articles including clinical factors associated with kinesiophobia or interventions that may reduce kinesiophobia in individuals with PFP. Two reviewers screened articles for inclusion, assessed risk of bias and quality, and extracted data from each study. A mixed-effects model was used to calculate correlations of function and pain with kinesiophobia using individual participant data. Meta-analyses were performed on interventional articles; Grading of Recommendations, Assessment, Development, and Evaluation was used to evaluate certainty of evidence. Results were reported narratively when pooling was not possible. RESULTS: Forty-one articles involving 2712 individuals were included. Correlation meta-analyses using individual participant data indicated a moderate association between self-reported function and kinesiophobia (n = 499; r = -0.440) and a weak association between pain and kinesiophobia (n = 644; r = 0.162). Low-certainty evidence from 2 articles indicated that passive treatment techniques were more effective than minimal intervention in reducing kinesiophobia (standardized mean difference = 1.11; 95% CI = 0.72 to 1.49). Very low-certainty evidence from 5 articles indicated that interventions to target kinesiophobia (psychobehavioral interventions, education, and self-managed exercise) were better in reducing kinesiophobia than physical therapist treatment approaches not specifically targeting kinesiophobia (standardized mean difference = 1.64; 95% CI = 0.14 to 3.15). CONCLUSION: Higher levels of kinesiophobia were moderately associated with poorer function and weakly associated with higher pain in individuals with PFP. Taping and bracing may reduce kinesiophobia immediately after use, and specific kinesiophobia-targeted interventions may reduce kinesiophobia following the full intervention; however, the certainty of evidence is very low. IMPACT: Assessment of kinesiophobia in clinical practice is recommended, on the basis of the relationships identified between kinesiophobia and other important factors that predict outcomes in individuals with PFP.

Co-design of the web-based 'My Knee' education and self-management toolkit for people with knee osteoarthritis.

Objective: Describe the co-design process and learnings related to developing the web-based Translating Research Evidence and Knowledge (TREK) 'My Knee' education and self-management toolkit for people with knee osteoarthritis. Co-design process: Stage (i): Understand and define; systematically reviewed education interventions in published trials; appraised web-based information about knee osteoarthritis; and used concept mapping to identify education priorities of people with knee osteoarthritis and physiotherapists. Stage (ii): Prototype; created a theory-, guideline- and evidence-informed toolkit. Stage (iii): Test and iterate; completed three co-design workshops with end-users (i.e., people with knee osteoarthritis and health professionals); plus an expert review. Results: The toolkit is available at myknee.trekeducation.org. Stage (i) identified the need for more accurate and co-designed resources to address broad education needs generated during concept mapping, including guidance on surgery, dispelling common misconceptions and facilitating engagement with exercise therapy and weight management. A theory- and research-informed prototype was created in Stage (ii) to address broad learning and education needs. Stage (iii) co-design workshops (n = 15 people with osteoarthritis and n = 9 health professionals) informed further content creation and refinement, alongside improvements to optimise usability. Expert opinion review (n = 8) further refined accuracy and usability. Conclusions: The novel co-design methodology employed to create the TREK 'My Knee' toolkit facilitated the alignment of the content and usability to meet the broad education needs of people with knee osteoarthritis and health professionals. This toolkit aims to improve and facilitate engagement with guideline-recommended first-line care for people with knee osteoarthritis. Future work will determine its effectiveness in improving clinical outcomes in this population.

Trajectory of knee health in runners with and without heightened osteoarthritis risk: the TRAIL prospective cohort study protocol.

INTRODUCTION: Running is one of the most popular recreational activities worldwide, due to its low cost and accessibility. However, little is known about the impact of running on knee joint health in runners with and without a history of knee surgery. The primary aim of this longitudinal cohort study is to compare knee joint structural features on MRI and knee symptoms at baseline and 4-year follow-up in runners with and without a history of knee surgery. Secondary aims are to explore the relationships between training load exposures (volume and/or intensity) and changes in knee joint structure and symptoms over 4 years; explore the relationship between baseline running biomechanics, and changes in knee joint structure and symptoms over 4 years. In addition, we will explore whether additional variables confound, modify or mediate these associations, including sex, baseline lower-limb functional performance, knee muscle strength, psychological and sociodemographic factors. METHODS AND ANALYSIS: A convenience sample of at least 200 runners (sex/gender balanced) with (n=100) and without (n=100) a history of knee surgery will be recruited. Primary outcomes will be knee joint health (MRI) and knee symptoms (baseline; 4 years). Exposure variables for secondary outcomes include training load exposure, obtained daily throughout the study from wearable devices and three-dimensional running biomechanics (baseline). Additional variables include lower limb functional performance, knee extensor and flexor muscle strength, biomarkers, psychological and sociodemographic factors (baseline). Knowledge and beliefs about osteoarthritis will be obtained through predefined questions and semi-structured interviews with a subset of participants. Multivariable logistic and linear regression models, adjusting for potential confounding factors, will explore changes in knee joint structural features and symptoms, and the influence of potential modifiers and mediators. ETHICS AND DISSEMINATION: Approved by the La Trobe University Ethics Committee (HEC-19524). Findings will be disseminated to stakeholders, peer-review journals and conferences.

Anterior Knee Pain Following Primary Unilateral Total Knee Arthroplasty With Posterior-Stabilized Prosthesis and Patellar Resurfacing: Prevalence and Clinical Implications.

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.

People With Knee Osteoarthritis Attending Physical Therapy Have Broad Education Needs and Prioritize Information About Surgery and Exercise: A Concept Mapping Study.

OBJECTIVES: To (1) identify the education priorities of people with knee osteoarthritis, including perceived importance and confidence that a health care professional can address each, and (2) match priorities to education-specific content recommendations in knee osteoarthritis management guidelines. DESIGN: Concept mapping methodology. METHODS: Participants generated, sorted (based on themes), and rated (5-point Likert scales: importance and confidence) education priorities. Multidimensional scaling and hierarchical cluster analysis of sorting data produced a cluster map with overarching domains. Priorities were matched against education-specific content recommendations in knee osteoarthritis guidelines. RESULTS: Participants (brainstorming, n = 43; sorting and rating, n = 24) generated 76 priorities. A 4-domain, 11-cluster map was the most useful representation of sorting data: (i) understanding treatment options (relationship of education and exercise with surgery, adjunct options, treatment decision making); (ii) exercise therapy (how to exercise, why exercise); (iii) understanding and managing the condition (symptom management, understanding symptoms, understanding the condition); and (4) surgical, medical, and dietary management (surgery, medications, diet and supplements). The "relationship of education and exercise with surgery" (3.88/5), "surgery" (3.86/5), and "how to exercise" (3.78/5) clusters were rated highest for importance. Few priorities identified by participants were clearly recommended as education-specific content recommendations in the American College of Rheumatology (3%, n = 2/76), European Alliance of Associations for Rheumatology (12%, n = 9/76), National Institute for Health and Care Excellence (16%, n = 12/76), and Osteoarthritis Research Society International (1%, n = 1/76) guidelines. CONCLUSION: People with knee osteoarthritis presenting to physical therapists have broad education needs and prioritize information about surgery and exercise. J Orthop Sports Phys Ther 2022;52(9):595-606. Epub: 17 June 2022. doi:10.2519/jospt.2022.11089.

Physical Therapists Prioritize Providing Education About Exercise Therapy and to Dispel Misconceptions About Radiology for People With Knee Osteoarthritis: A Concept Mapping Study.

OBJECTIVE: To (1) identify the education priorities that physical therapists have for people with knee osteoarthritis, including perceived importance and capability to provide, and (2) match priorities to education-specific content recommendations in knee osteoarthritis guidelines. DESIGN: Concept mapping methodology. METHODS: Physical therapists generated, sorted (based on themes), and rated (5-point Likert scales: importance and capability) patient education priorities. Priorities were matched against education-specific content recommendations in knee osteoarthritis guidelines. Additional education-specific content recommendations were added from guidelines and expert opinion if necessary. Multidimensional scaling and hierarchical cluster analysis produced a cluster map with overarching domains. RESULTS: Physical therapists (brainstorming, n = 41; sorting, n = 20; rating, n = 22) generated 56 priorities, with 13 added (n = 2 from guidelines, n = 11 from expert opinion). Few priorities were clearly included as education-specific content recommendations in guidelines (ACR [2%, n = 1/56], EULAR [14%, 8/56], NICE [11%, 6/56], and OARSI [0%, 0/56]). An 8-cluster map emerged with 3 overarching domains: (i) first-line care (exercise therapy, lifestyle modification and general health, and weight management), (ii) knowledge formation and countering misconceptions (radiology misconceptions, understanding and managing pain and disability, and general beliefs and understanding about osteoarthritis), and (iii) decision making for medical management (surgery and medications). The exercise therapy cluster was rated the highest for both importance (3.84/5) and capability (4.00). The medications and weight management clusters were rated the lowest for importance (2.54) and capability (2.82), respectively. CONCLUSION: Physical therapists prioritize a range of education topics for people with knee osteoarthritis, focusing on exercise therapy. Physical therapists feel least capable of providing weight management education. J Orthop Sports Phys Ther 2022;52(9):607-619. Epub: 17 June 2022. doi:10.2519/jospt.2022.11090.

Patients and clinicians managing patellofemoral pain should not rely on general web-based information.

OBJECTIVE: To evaluate the credibility and accuracy of PFP-specific web-based content. DESIGN: Cross-sectional evaluation of web-based information. METHODS: The study protocol was registered with PROSPERO (CRD42018088671). Two search engines (Google and Bing) were used to search for websites offering information about PFP. Two reviewers assessed the websites for credibility-related and PFP-specific content. PFP-specific content was evaluated according to agreement with current international PFP consensus statements. Based on this, content was rated as (i) Accurate/Clearly described; (ii) Partially accurate/Description lacks clarity; (iii) Inaccurate/Misleading description; or (iv) Not mentioned. RESULTS: After exclusion of duplicates, forty online websites were included in our analyses. 43% of websites did not mention their source of information, and 48% did not mention if the source material was peer-reviewed. Misleading/inaccurate information was most commonly found in the definition of PFP (20% websites) and clinical examination (15%). Twenty-two percent of websites recommended surgery as treatment. The item most frequently rated as accurate/clearly described was PFP terminology (87.5%). CONCLUSION: This study highlights missing, inaccurate or poorly described web-based PFP information. Due to the commonality of PFP and potential for improving self-management, there is an urgent need to develop more accurate and comprehensive web-based patient education resources for PFP.

Higher pain level and lower functional capacity are associated with the number of altered kinematics in women with patellofemoral pain.

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/proximal, 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.

Influência da preocupação com quedas na mobilidade e na força de reação do solo em idosas durante descida de escada / Influence of concern about falls in mobility and ground reaction forcein elderly women?s during stairs descent

Objetivos: Verificar a diferença entre idosas com e sem preocupação com quedas na mobilidade e na força vertical de reação do solo durantea descida de escada.Métodos: O estudo incluiu idosas atendidas pelo Centro de Reabilitação Física da Universidade Estadual do Oeste do Paraná com idadeentre 60 e 75 anos, sem doenças neurológicas e cardiovasculares que acarretassem risco pelas atividades do estudo. Foram excluídas tambémidosas com órteses para locomoção, doenças osteoarticulares ou cirurgias de membros inferiores e histórico de queda. As participantes foramdivididas em dois grupos, com e sem preocupação com quedas em atividades diárias, identificados pela Falls Efficacy Scale Internationaltraduzida para o português. Para avaliação da mobilidade, todas as voluntárias realizaram o teste Timed Up and Go. A força de reação dosolo foi avaliada em cinco descidas de escada para coleta dos dados cinéticos (primeiro pico da força vertical de reação do solo) através deuma plataforma de força alocada no quarto degrau de uma escada de sete degraus. Após ser confirmada a normalidade dos dados, o teste t deStudent para amostras independentes foi utilizado para comparação entre os grupos.Resultados: A amostra foi composta por dezessete idosas sem preocupação com quedas (idade de 66,57±4,1 anos) e dezesseis idosas compreocupação com quedas (idade de 66,67±5,8 anos). O grupo sem preocupação com quedas desempenhou o teste Timed Up and Go de formamais veloz (9,71±1,02 segundos) comparado ao grupo preocupação com quedas (11,5±1,04 segundos) (p=0,008). Não houve diferença entreos grupos para o primeiro pico da força de reação do solo vertical (p=0,66).Conclusões: Idosas com preocupação com queda apresentaram menor desempenho no teste funcional do que idosas com ausência dessapreocupação. Entretanto, não houve diferença entre os grupos quanto à variável cinética.

Aims: To investigate the difference between elderly women with and without concern about falls in mobility and vertical ground reactionforce during stair descent.Methods: The study included older women assisted in the Centre for Physical Rehabilitation of the Universidade Estadual do Oeste do Paraná,aged between 60 and 75 years, without neurological and cardiovascular disease involving risk by the activities of the study. Women withorthoses for locomotion, osteoarticular diseases or surgery of lower limbs, and previous fall history were also excluded. The participants weredivided into two groups, with and without concern about falls in daily activities, identified by the Falls Efficacy Scale International translatedinto Portuguese. To assess mobility, all subjects performed the Timed Up and Go Test. Ground reaction force was assessed by walking stepsdown five times to collect kinetic data (first peak of the vertical ground reaction force) through a force platform allocated in the fourth step ofa staircase of seven steps. After confirmed normality of data, Student t test for independent samples was used to compare the groups.Results: The sample was composed of seventeen elderly women with no concern about falling (aged 66.57±4.1 years) and sixteen elderlywomen with concerns about falling (aged 66.67±5.8 years). The group without concern with falls performed the Timed Up and Go Test faster(9.71±1,02 seconds) than the group with concern about falls (11.5±1,04 seconds) (p=0.008). There was no difference between groups on thefirst peak of vertical ground reaction force (p=0.66).Conclusions: Elderly women with concern about falls had lower performance in the functional test than elderly women with no such concern.However, there was no difference between the groups in terms of the kinetic variable.

Efeitos de diferentes frequências da estimulação elétrica nervosa transcutânea em relação à acomodação e à agradabilidade / Effects of different transcutaneous electrical nerve stimulation frequencies regarding adaptation and pleasantness

Objetivos: Investigar os efeitos de diferentes frequ�ncias da estimula��o el�trica nervosa transcut�nea (TENS - transcutaneous electricalnerve stimulation), em rela��o � acomoda��o e agradabilidade nas diversas formas de aplica��o.M�todos: A amostra foi composta por 20 indiv�duos, divididos aleatoriamente em tr�s grupos, que foram submetidos � TENS, com tr�sfrequ�ncias diferentes: 7 Hz, 100 Hz e 255 Hz, com dura��o de pulso de 250 ?s, por 20 minutos, uma vez por semana no per�odo de tr�ssemanas. Os volunt�rios eram orientados a indicarem o momento da primeira acomoda��o e as acomoda��es subsequentes. No final do per�odode coleta de dados, os indiv�duos foram interrogados sobre a frequ�ncia que julgassem mais agrad�vel.Resultados: Para o limiar de acomoda��o, considerando todas as frequ�ncias analisadas, verificou-se que n�o houve diferen�a significativa(p>0,05), fato que tamb�m se repetiu para o n�mero de acomoda��es em 20 minutos (p>0,05). Com rela��o � agradabilidade, 11 indiv�duosindicaram a frequ�ncia de 7 Hz como a mais agrad�vel.Conclus�es: N�o houve diferen�a significativa no limiar de acomoda��o e no n�mero de acomoda��es entre as frequ�ncias utilizadas. Afrequ�ncia de 7 Hz foi apontada como a mais agrad�vel seguida da frequ�ncia de 100 Hz.

Aims: The aim of this study was to investigate the effects of different frequencies of transcutaneous electrical nerve stimulation (TENS)regarding to accommodation and pleasantness of the different forms of application.Methods: The sample consisted of 20 subjects randomly divided into 3 groups, in which they were submitted to 3 different frequencies ofTENS: 7 Hz, 100Hz, 255Hz, pulse duration of 250 ?s, for 20 minutes once a week over three weeks. The volunteers were instructed to indicatethe first and subsequent accommodation moments. At the end of the period of data collection, subjects were asked about which frequencythey thought most enjoyable.Results: For the threshold of adaptation, considering all frequencies analyzed, it was found that there was no significant difference (p>0.05),a fact that was also repeated for the number of adaptations in 20 minutes (p>0.05). With regard to pleasantness, 11 subjects indicated thefrequency of 7 Hz as the most enjoyable.Conclusions: There was no significant difference in threshold for adaptation and the number of adaptations between the frequencies used.The frequency of 7 Hz was identified as the most enjoyable then the frequency of 100 Hz.