Targeted Treatment Protocol in Patellofemoral Pain: Does Treatment Designed According to Subgroups Improve Clinical Outcomes in Patients Unresponsive to Multimodal Treatment?
Background: Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain. Hypothesis: Treatment designed according to subgroups will improve clinical outcomes in patients unresponsive to multimodal treatment. Study Design: Prospective crossover intervention....
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| Veröffentlicht in: | Sports health 2020-03, Vol.12 (2), p.170-180 |
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| creator | Yosmaoğlu, Hayri Baran Selfe, James Sonmezer, Emel Sahin, İlknur Ezgi Duygu, Senay Çerezci Acar Ozkoslu, Manolya Richards, Jim Janssen, Jessica |
| description | Background:
Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain.
Hypothesis:
Treatment designed according to subgroups will improve clinical outcomes in patients unresponsive to multimodal treatment.
Study Design:
Prospective crossover intervention.
Level of Evidence:
Level 3.
Methods:
Patients with patellofemoral pain (PFP; n = 61; mean age, 27 ± 9 years) were enrolled. Patients with PFP received standard multimodal treatment 3 times a week for 6 weeks. Patients not responding to multimodal treatment were then classified into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot) using 6 simple clinical tests. They were subsequently administered 6 further weeks of targeted intervention, designed according to subgroup characteristics. Visual analog scale (VAS), perception of recovery scale (PRS), 5-Level European Quality 5 Dimensions (EQ-5D-5L), and self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (S-LANSS) were used to assess pain, knee function, and quality of life before and after the interventions.
Results:
In total, 34% (n = 21) of patients demonstrated recovery after multimodal treatment. However, over 70% (n = 29/40) of nonresponders demonstrated recovery after targeted treatment. The VAS, PRS, S-LANSS, and EQ-5D-5L scores improved significantly after targeted intervention compared with after multimodal treatment (P < 0.001). The VAS score at rest was significantly lower in the “weak and pronated foot” and the “weak and tight” subgroups (P = 0.011 and P = 0.008, respectively). Posttreatment pain intensity on activity was significantly lower in the “strong” subgroup (P = 0.006).
Conclusion:
Targeted treatment designed according to subgroup characteristics improves clinical outcomes in patients unresponsive to multimodal treatment.
Clinical Relevance:
Targeted intervention could be easily implemented after 6 simple clinical assessment tests to subgroup patients into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot). Targeted interventions applied according to the characteristics of these subgroups have more beneficial treatment effects than a current multimodal treatment program. |
| doi_str_mv | 10.1177/1941738119883272 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7040939</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_1941738119883272</sage_id><sourcerecordid>2316785198</sourcerecordid><originalsourceid>FETCH-LOGICAL-c434t-8e6012d93fdce09be337038a381e32807a1d61a68260d14add62488c8474e89f3</originalsourceid><addsrcrecordid>eNp1kU9v1DAQxSMEoqVw54R85BKw49R2OICqLS2VilqJ7dny2pPgKvEE26nEl-Iz4tUuq4LEyX_mze_Z86rqNaPvGJPyPetaJrlirFOKN7J5Uh1vr2raNezpfr-tH1UvUrqnVLSCyefVEWfylEoljqtfaxMHyODIOoLJE4RMbiNmtDgSH8ityTCO2MOE0Yzl6MMHco6QHunPIfkhFMSZtRidDwPJSL4tmyHiMidyNc0RH4CsRh-8LZSbJVucCmNn4AskkbsQIc0Yki_S0v91GbOf0BX9werTy-pZb8YEr_brSXV38Xm9-lJf31xerc6ua9vyNtcKBGWN63jvLNBuA5xLypUpowDeKCoNc4IZoRpBHWuNc6JplbKqlS2orucn1ccdd142ExRIyOX7eo5-MvGnRuP135Xgv-sBH7SkLe14VwBv94CIPxZIWU8-2TJKEwCXpBvOhFSnJbgipTupjZhShP5gw6jexqz_jbm0vHn8vEPDn1yLoN4JkhlA3-MSQxnX_4G_AYy9tDQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2316785198</pqid></control><display><type>article</type><title>Targeted Treatment Protocol in Patellofemoral Pain: Does Treatment Designed According to Subgroups Improve Clinical Outcomes in Patients Unresponsive to Multimodal Treatment?</title><source>Access via SAGE</source><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Yosmaoğlu, Hayri Baran ; Selfe, James ; Sonmezer, Emel ; Sahin, İlknur Ezgi ; Duygu, Senay Çerezci ; Acar Ozkoslu, Manolya ; Richards, Jim ; Janssen, Jessica</creator><creatorcontrib>Yosmaoğlu, Hayri Baran ; Selfe, James ; Sonmezer, Emel ; Sahin, İlknur Ezgi ; Duygu, Senay Çerezci ; Acar Ozkoslu, Manolya ; Richards, Jim ; Janssen, Jessica</creatorcontrib><description>Background:
Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain.
Hypothesis:
Treatment designed according to subgroups will improve clinical outcomes in patients unresponsive to multimodal treatment.
Study Design:
Prospective crossover intervention.
Level of Evidence:
Level 3.
Methods:
Patients with patellofemoral pain (PFP; n = 61; mean age, 27 ± 9 years) were enrolled. Patients with PFP received standard multimodal treatment 3 times a week for 6 weeks. Patients not responding to multimodal treatment were then classified into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot) using 6 simple clinical tests. They were subsequently administered 6 further weeks of targeted intervention, designed according to subgroup characteristics. Visual analog scale (VAS), perception of recovery scale (PRS), 5-Level European Quality 5 Dimensions (EQ-5D-5L), and self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (S-LANSS) were used to assess pain, knee function, and quality of life before and after the interventions.
Results:
In total, 34% (n = 21) of patients demonstrated recovery after multimodal treatment. However, over 70% (n = 29/40) of nonresponders demonstrated recovery after targeted treatment. The VAS, PRS, S-LANSS, and EQ-5D-5L scores improved significantly after targeted intervention compared with after multimodal treatment (P < 0.001). The VAS score at rest was significantly lower in the “weak and pronated foot” and the “weak and tight” subgroups (P = 0.011 and P = 0.008, respectively). Posttreatment pain intensity on activity was significantly lower in the “strong” subgroup (P = 0.006).
Conclusion:
Targeted treatment designed according to subgroup characteristics improves clinical outcomes in patients unresponsive to multimodal treatment.
Clinical Relevance:
Targeted intervention could be easily implemented after 6 simple clinical assessment tests to subgroup patients into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot). Targeted interventions applied according to the characteristics of these subgroups have more beneficial treatment effects than a current multimodal treatment program.</description><identifier>ISSN: 1941-7381</identifier><identifier>EISSN: 1941-0921</identifier><identifier>DOI: 10.1177/1941738119883272</identifier><identifier>PMID: 31750786</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adult ; Braces ; Clinical Protocols ; Combined Modality Therapy ; Cross-Over Studies ; Current Research ; Exercise Therapy - methods ; Foot Orthoses ; Humans ; Muscle Strength ; Muscle Stretching Exercises ; Patellofemoral Pain Syndrome - classification ; Patellofemoral Pain Syndrome - therapy ; Prospective Studies ; Treatment Outcome ; Weight Loss ; Young Adult</subject><ispartof>Sports health, 2020-03, Vol.12 (2), p.170-180</ispartof><rights>2019 The Author(s)</rights><rights>2019 The Author(s) 2019 American Orthopaedic Society for Sports Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c434t-8e6012d93fdce09be337038a381e32807a1d61a68260d14add62488c8474e89f3</citedby><cites>FETCH-LOGICAL-c434t-8e6012d93fdce09be337038a381e32807a1d61a68260d14add62488c8474e89f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040939/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040939/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,21819,27924,27925,43621,43622,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31750786$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yosmaoğlu, Hayri Baran</creatorcontrib><creatorcontrib>Selfe, James</creatorcontrib><creatorcontrib>Sonmezer, Emel</creatorcontrib><creatorcontrib>Sahin, İlknur Ezgi</creatorcontrib><creatorcontrib>Duygu, Senay Çerezci</creatorcontrib><creatorcontrib>Acar Ozkoslu, Manolya</creatorcontrib><creatorcontrib>Richards, Jim</creatorcontrib><creatorcontrib>Janssen, Jessica</creatorcontrib><title>Targeted Treatment Protocol in Patellofemoral Pain: Does Treatment Designed According to Subgroups Improve Clinical Outcomes in Patients Unresponsive to Multimodal Treatment?</title><title>Sports health</title><addtitle>Sports Health</addtitle><description>Background:
Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain.
Hypothesis:
Treatment designed according to subgroups will improve clinical outcomes in patients unresponsive to multimodal treatment.
Study Design:
Prospective crossover intervention.
Level of Evidence:
Level 3.
Methods:
Patients with patellofemoral pain (PFP; n = 61; mean age, 27 ± 9 years) were enrolled. Patients with PFP received standard multimodal treatment 3 times a week for 6 weeks. Patients not responding to multimodal treatment were then classified into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot) using 6 simple clinical tests. They were subsequently administered 6 further weeks of targeted intervention, designed according to subgroup characteristics. Visual analog scale (VAS), perception of recovery scale (PRS), 5-Level European Quality 5 Dimensions (EQ-5D-5L), and self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (S-LANSS) were used to assess pain, knee function, and quality of life before and after the interventions.
Results:
In total, 34% (n = 21) of patients demonstrated recovery after multimodal treatment. However, over 70% (n = 29/40) of nonresponders demonstrated recovery after targeted treatment. The VAS, PRS, S-LANSS, and EQ-5D-5L scores improved significantly after targeted intervention compared with after multimodal treatment (P < 0.001). The VAS score at rest was significantly lower in the “weak and pronated foot” and the “weak and tight” subgroups (P = 0.011 and P = 0.008, respectively). Posttreatment pain intensity on activity was significantly lower in the “strong” subgroup (P = 0.006).
Conclusion:
Targeted treatment designed according to subgroup characteristics improves clinical outcomes in patients unresponsive to multimodal treatment.
Clinical Relevance:
Targeted intervention could be easily implemented after 6 simple clinical assessment tests to subgroup patients into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot). Targeted interventions applied according to the characteristics of these subgroups have more beneficial treatment effects than a current multimodal treatment program.</description><subject>Adult</subject><subject>Braces</subject><subject>Clinical Protocols</subject><subject>Combined Modality Therapy</subject><subject>Cross-Over Studies</subject><subject>Current Research</subject><subject>Exercise Therapy - methods</subject><subject>Foot Orthoses</subject><subject>Humans</subject><subject>Muscle Strength</subject><subject>Muscle Stretching Exercises</subject><subject>Patellofemoral Pain Syndrome - classification</subject><subject>Patellofemoral Pain Syndrome - therapy</subject><subject>Prospective Studies</subject><subject>Treatment Outcome</subject><subject>Weight Loss</subject><subject>Young Adult</subject><issn>1941-7381</issn><issn>1941-0921</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU9v1DAQxSMEoqVw54R85BKw49R2OICqLS2VilqJ7dny2pPgKvEE26nEl-Iz4tUuq4LEyX_mze_Z86rqNaPvGJPyPetaJrlirFOKN7J5Uh1vr2raNezpfr-tH1UvUrqnVLSCyefVEWfylEoljqtfaxMHyODIOoLJE4RMbiNmtDgSH8ityTCO2MOE0Yzl6MMHco6QHunPIfkhFMSZtRidDwPJSL4tmyHiMidyNc0RH4CsRh-8LZSbJVucCmNn4AskkbsQIc0Yki_S0v91GbOf0BX9werTy-pZb8YEr_brSXV38Xm9-lJf31xerc6ua9vyNtcKBGWN63jvLNBuA5xLypUpowDeKCoNc4IZoRpBHWuNc6JplbKqlS2orucn1ccdd142ExRIyOX7eo5-MvGnRuP135Xgv-sBH7SkLe14VwBv94CIPxZIWU8-2TJKEwCXpBvOhFSnJbgipTupjZhShP5gw6jexqz_jbm0vHn8vEPDn1yLoN4JkhlA3-MSQxnX_4G_AYy9tDQ</recordid><startdate>20200301</startdate><enddate>20200301</enddate><creator>Yosmaoğlu, Hayri Baran</creator><creator>Selfe, James</creator><creator>Sonmezer, Emel</creator><creator>Sahin, İlknur Ezgi</creator><creator>Duygu, Senay Çerezci</creator><creator>Acar Ozkoslu, Manolya</creator><creator>Richards, Jim</creator><creator>Janssen, Jessica</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200301</creationdate><title>Targeted Treatment Protocol in Patellofemoral Pain: Does Treatment Designed According to Subgroups Improve Clinical Outcomes in Patients Unresponsive to Multimodal Treatment?</title><author>Yosmaoğlu, Hayri Baran ; Selfe, James ; Sonmezer, Emel ; Sahin, İlknur Ezgi ; Duygu, Senay Çerezci ; Acar Ozkoslu, Manolya ; Richards, Jim ; Janssen, Jessica</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c434t-8e6012d93fdce09be337038a381e32807a1d61a68260d14add62488c8474e89f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Braces</topic><topic>Clinical Protocols</topic><topic>Combined Modality Therapy</topic><topic>Cross-Over Studies</topic><topic>Current Research</topic><topic>Exercise Therapy - methods</topic><topic>Foot Orthoses</topic><topic>Humans</topic><topic>Muscle Strength</topic><topic>Muscle Stretching Exercises</topic><topic>Patellofemoral Pain Syndrome - classification</topic><topic>Patellofemoral Pain Syndrome - therapy</topic><topic>Prospective Studies</topic><topic>Treatment Outcome</topic><topic>Weight Loss</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yosmaoğlu, Hayri Baran</creatorcontrib><creatorcontrib>Selfe, James</creatorcontrib><creatorcontrib>Sonmezer, Emel</creatorcontrib><creatorcontrib>Sahin, İlknur Ezgi</creatorcontrib><creatorcontrib>Duygu, Senay Çerezci</creatorcontrib><creatorcontrib>Acar Ozkoslu, Manolya</creatorcontrib><creatorcontrib>Richards, Jim</creatorcontrib><creatorcontrib>Janssen, Jessica</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Sports health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yosmaoğlu, Hayri Baran</au><au>Selfe, James</au><au>Sonmezer, Emel</au><au>Sahin, İlknur Ezgi</au><au>Duygu, Senay Çerezci</au><au>Acar Ozkoslu, Manolya</au><au>Richards, Jim</au><au>Janssen, Jessica</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Targeted Treatment Protocol in Patellofemoral Pain: Does Treatment Designed According to Subgroups Improve Clinical Outcomes in Patients Unresponsive to Multimodal Treatment?</atitle><jtitle>Sports health</jtitle><addtitle>Sports Health</addtitle><date>2020-03-01</date><risdate>2020</risdate><volume>12</volume><issue>2</issue><spage>170</spage><epage>180</epage><pages>170-180</pages><issn>1941-7381</issn><eissn>1941-0921</eissn><abstract>Background:
Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain.
Hypothesis:
Treatment designed according to subgroups will improve clinical outcomes in patients unresponsive to multimodal treatment.
Study Design:
Prospective crossover intervention.
Level of Evidence:
Level 3.
Methods:
Patients with patellofemoral pain (PFP; n = 61; mean age, 27 ± 9 years) were enrolled. Patients with PFP received standard multimodal treatment 3 times a week for 6 weeks. Patients not responding to multimodal treatment were then classified into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot) using 6 simple clinical tests. They were subsequently administered 6 further weeks of targeted intervention, designed according to subgroup characteristics. Visual analog scale (VAS), perception of recovery scale (PRS), 5-Level European Quality 5 Dimensions (EQ-5D-5L), and self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (S-LANSS) were used to assess pain, knee function, and quality of life before and after the interventions.
Results:
In total, 34% (n = 21) of patients demonstrated recovery after multimodal treatment. However, over 70% (n = 29/40) of nonresponders demonstrated recovery after targeted treatment. The VAS, PRS, S-LANSS, and EQ-5D-5L scores improved significantly after targeted intervention compared with after multimodal treatment (P < 0.001). The VAS score at rest was significantly lower in the “weak and pronated foot” and the “weak and tight” subgroups (P = 0.011 and P = 0.008, respectively). Posttreatment pain intensity on activity was significantly lower in the “strong” subgroup (P = 0.006).
Conclusion:
Targeted treatment designed according to subgroup characteristics improves clinical outcomes in patients unresponsive to multimodal treatment.
Clinical Relevance:
Targeted intervention could be easily implemented after 6 simple clinical assessment tests to subgroup patients into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot). Targeted interventions applied according to the characteristics of these subgroups have more beneficial treatment effects than a current multimodal treatment program.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>31750786</pmid><doi>10.1177/1941738119883272</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| source | Access via SAGE; MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Adult Braces Clinical Protocols Combined Modality Therapy Cross-Over Studies Current Research Exercise Therapy - methods Foot Orthoses Humans Muscle Strength Muscle Stretching Exercises Patellofemoral Pain Syndrome - classification Patellofemoral Pain Syndrome - therapy Prospective Studies Treatment Outcome Weight Loss Young Adult |
| title | Targeted Treatment Protocol in Patellofemoral Pain: Does Treatment Designed According to Subgroups Improve Clinical Outcomes in Patients Unresponsive to Multimodal Treatment? |
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