A best practice guide for Patellofemoral Pain: delving deeper into our poster at Sports Kongres '23

So you've read the headlines; want to know more?

We feel strongly that best practice for any health problem should be a blend of the best available evidence, the thoughts and feelings of patients with lived experience, and the clinical reasoning of experts.

We are coming to the end of a three year mixed methods project to do just that, and have collected both quantitative data and qualitative findings that we are now synthesising.

We have published the following independent data sets from the project:

1. Six treatments have positive effects at three-months for people with patellofemoral pain: a systematic review with meta-analysis

2. Patient experience of the diagnosis and management of patellofemoral pain: a qualitative exploration

3. Clinicians' experience of the diagnosis and management of patellofemoral pain: a qualitative exploration

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We have objectively determined the agreement between these data streams by asking ourselves the following questions:

1. Are the results from the individual components supportive or contradictory?

2. Which aspects of the quantitative data are or are not explored in the qualitative data?

3. Which aspects of the qualitative data are or are not explored in the quantitative data?

We have ranked interventions eligible for meta-analysis in our systematic review or interventions advocated by both patients and expert clinicians using a consensus approach. We scored these interventions out of 4, with >3 reflecting the core approach for patellofemoral pain, and 1-2 points reflecting interventions appropriate for clinically reasoned application.

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We were able to rank 14 interventions; 11 that came from the meta-analyses from 65 high quality randomised controlled trials, and 3 that came only from patient and clinician advocacy.

The following 3 interventions should form the core approach for people with PFP:

1. Knee-targeted exercise therapy (4)

2. Hip-and-knee-targeted exercise therapy (3)

3. Foot orthoses (3)

These 6 interventions should be considered for clinically reasoned application:

1. Knee-targeted exercise therapy and perineural dextrose injection (2)

2. Lower quadrant manual therapy (2)

3. Education (2)

4. Running retraining (2)

5. Taping (2)

6. Combined interventions (exercise, stretching, VMO stimulation, taping; 1)

Both patients and clinical experts supported using symptom characteristics identified following a comprehensive assessment to guide treatment selection.

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We have since conducted two further qualitative focus groups designed to provide insight into how and when these interventions should be delivered, and are in the process of the thematic analysis of these findings. We expect to submit our finished best practice guide for peer reviewed publication before the half way point of 2023, and will then switch our focus to the impact of this project.

Please come and find us at the conference if you have any further questions, or email info@teampfp.com.

A special thanks to Ian Griffiths (AKA Sports Pod) for his help in designing our beautiful poster, check him out here.