Keays Susan L, Mason Marjon, Newcombe Peter A
*Sue Keays Physiotherapy, Private Practice, Nambour, Australia; †School of Health and Sports Sciences, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Australia; and ‡School of Psychology, The University of Queensland, Brisbane, Australia.
Clin J Sport Med. 2016 May;26(3):190-8. doi: 10.1097/JSM.0000000000000226.
The main aim of this study was to assess whether improvements after a 1-month patellofemoral pain (PFP) program addressing local and global deficits were maintained for 3 years.
This prospective cohort study comprised 4 treatment phases including a randomized trial during week 1.
The study was conducted in a private physiotherapy practice.
Thirty-seven patients (55 knees) from an original cohort of 41 patients (60 knees) with PFP were followed for 3 years after referral by doctors to participate in this study.
Patients received 4 treatments: local treatment focusing on quadriceps strengthening, quadriceps stretching, and taping for fortnight 1, supplemented with individualized global treatment focusing on lower limb posture and movement patterns for fortnight 2, followed by ongoing self-management.
Seven outcome measures, assessed at 4 time points, were quadriceps strength, quadriceps length, eccentric knee control, and 4 pain measures. Long-term measures included return to sporting activity, pain recurrence, exercise compliance, and Kujala score.
Improvements after fortnight 1 (P < 0.001) and fortnight 2 (P < 0.05) were maintained over 3 years for 6 of 7 measures. On testing, 73% were pain free and the remaining 27% had less pain than pretreatment. Kujala scores improved 27%. Eighty-two percent resumed any sport stopped and 54% of patients started new sports/activities. Patellofemoral pain recurred in 7% and 89% of patients was still exercising 3 years posttreatment.
Significant improvements after physiotherapy, incorporating local and individually targeted treatment, were maintained for 3 years in a compliant cohort.
本研究的主要目的是评估针对局部和整体功能缺陷的为期1个月的髌股疼痛（PFP）治疗方案所带来的改善是否能持续3年。
这项前瞻性队列研究包括4个治疗阶段，其中第1周为随机试验阶段。
研究在一家私人物理治疗诊所进行。
最初的41例PFP患者（60膝）中有37例患者（55膝）经医生转诊后参与本研究并随访3年。
患者接受4种治疗：第1个两周阶段进行以股四头肌强化、股四头肌拉伸和贴扎为主的局部治疗，第2个两周阶段辅以针对下肢姿势和运动模式的个体化整体治疗，之后是持续的自我管理。
在4个时间点评估的7项观察指标为股四头肌力量、股四头肌长度、膝关节离心控制能力和4项疼痛指标。长期指标包括恢复体育活动情况、疼痛复发情况、运动依从性和库贾拉评分。
7项指标中的6项在第1个两周（P<0.001）和第2个两周（P<0.05）后的改善情况在3年中得以维持。测试时，73%的患者无痛，其余27%的患者疼痛程度低于治疗前。库贾拉评分提高了27%。82%的患者恢复了之前停止的任何运动，54%的患者开始了新的运动/活动。7%的患者出现髌股疼痛复发，89%的患者在治疗后3年仍在进行锻炼。
在一个依从性良好的队列中，结合局部和个体化针对性治疗的物理治疗后取得的显著改善持续了3年。
