The 'Best Practice Guide to Conservative Management of Patellofemoral Pain': incorporating level 1 evidence with expert clinical reasoning.

IMPORTANCE: Patellofemoral pain (PFP) is both chronic and prevalent; it has complex aetiology and many conservative treatment options. OBJECTIVE: Develop a comprehensive contemporary guide to conservative management of PFP outlining key considerations for clinicians to follow. DESIGN: Mixed methods. METHODS: We synthesised the findings from six high-quality systematic reviews to September 2013 with the opinions of 17 experts obtained via semistructured interviews. Experts had at least 5 years clinical experience with PFP as a specialist focus, were actively involved in PFP research and contributed to specialist international meetings. The interviews covered clinical reasoning, perception of current evidence and research priorities. RESULTS: Multimodal intervention including exercise to strengthen the gluteal and quadriceps musculature, manual therapy and taping possessed the strongest evidence. Evidence also supports use of foot orthoses and acupuncture. Interview transcript analysis identified 23 themes and 58 subthemes. Four key over-arching principles to ensure effective management included-(1) PFP is a multifactorial condition requiring an individually tailored multimodal approach. (2) Immediate pain relief should be a priority to gain patient trust. (3) Patient empowerment by emphasising active over passive interventions is important. (4) Good patient education and activity modification is essential. Future research priorities include identifying risk factors, testing effective prevention, developing education strategies, evaluating the influence of psychosocial factors on treatment outcomes and how to address them, evaluating the efficacy of movement pattern retraining and improving clinicians' assessment skills to facilitate optimal individual prescription. CONCLUSIONS AND RELEVANCE: Effective management of PFP requires consideration of a number of proven conservative interventions. An individually tailored multimodal intervention programme including gluteal and quadriceps strengthening, patellar taping and an emphasis on education and activity modification should be prescribed for patients with PFP. We provide a 'Best Practice Guide to Conservative Management of Patellofemoral Pain' outlining key considerations.

Cardiovascular disease risk factors in adolescent British South Asians and whites: a pilot study.

BACKGROUND: Cardiovascular disease (CVD) and associated mortality are more common in British South Asians than in the British white population. Most of the aspects of the cardiovascular risk profile are modifiable, and are thought to be established in childhood. However, the role of genetics and ethnicity has not been fully elucidated. OBJECTIVES: This pilot study compared cardiovascular risk profiles in British South Asian and British white adolescents, and investigated the relationships between physical activity, cardiorespiratory fitness, nutrition, and CVD risk profile in both ethnic groups. METHODS: Cardiovascular risk factors included systolic and diastolic blood pressure, body composition, fasting glucose, cholesterol, and triglycerides. Physical activity was measured using 7-day accelerometry; diet was measured from a 3-day dietary record. Fitness was assessed from running economy, submaximal exercise lactate response, and peak oxygen uptake. Body composition was determined through a bioelectrical impedance analyzer (BIA). Finger-prick blood samples were taken for fasting glucose, cholesterol, and triglycerides. RESULTS: Twelve British South Asian males (aged 15.2 ± 0.3 years) and 11 British white males (aged 15.1 ± 0.3 years) were recruited. Mean systolic blood pressure in British South Asian adolescents was 6.9 mm Hg higher (95% confidence interval [CI], -13.4 to 0.4 mm Hg) than in their British white counterparts. Following multifactorial adjustment, this increased to 12.4 mm Hg. Fasting blood triglycerides were 1.04 mmol/L (0.52-1.57 mmol/L) higher in Asians; this was nonsignificant following adjustment for dietary factors. The British South Asian adolescents' diet contained 42 g (23-61 g) more fat per day. CONCLUSIONS: Differences in cardiovascular risk profile between British South Asian and British white males are present in adolescence, with higher fasting blood triglycerides in British South Asian adolescent males being attributed to a higher proportion of dietary fat. Interventions may thus be developed to influence dietary choices during childhood, and therefore potentially reduce CVD in adulthood.