Department of Kinesiology, University of Wisconsin-Milwaukee.
Department of Physical Therapy, Augusta University, GA.
J Athl Train. 2018 Jun;53(6):545-552. doi: 10.4085/1062-6050-510-16. Epub 2018 Jun 12.
Patellofemoral pain (PFP) is a common injury that interferes with quality of life and physical activity. Clinical subgroups of patients may exist, one of which is caused by proximal muscle dysfunction.
To develop clinical prediction rules that predict a positive outcome after either a hip and core- or knee-focused strengthening program for individuals with PFP.
Secondary analysis of data from a randomized control trial.
Four university laboratories.
A total of 199 participants with PFP.
INTERVENTION(S): Participants were randomly allocated to either a hip and core-focused (n = 111) or knee-focused (n = 88) rehabilitation group for a 6-week program.
MAIN OUTCOME MEASURE(S): Demographics, self-reported knee pain (visual analog scale) and function (Anterior Knee Pain Scale), hip strength, abdominal muscle endurance, and hip range of motion were evaluated at baseline. Treatment success was defined as a decrease in visual analog scale score by ≥2 cm or an increase in the Anterior Knee Pain Scale score by ≥8 points or both. Bivariate relationships between the outcome (treatment success) and the predictor variables were explored, followed by a forward stepwise logistic regression to predict a successful outcome.
Patients with more pain, better function, greater lateral core endurance, and less anterior core endurance were more likely to have a successful outcome after hip and core strengthening (88% sensitivity and 54% specificity). Patients with lower weight, weaker hip internal rotation, stronger hip extension, and greater trunk-extension endurance were more likely to have success after knee strengthening (82% sensitivity and 58% specificity).
The patients with PFP who have more baseline pain and yet maintain a high level of function may experience additional benefit from hip and core strengthening. The clinical prediction rules from this study remain in the developmental phase and should be applied with caution until externally validated.
髌股疼痛（PFP）是一种常见的损伤，会影响生活质量和身体活动。患者可能存在临床亚组，其中之一是由近端肌肉功能障碍引起的。
为 PFP 患者制定临床预测规则，预测其在接受髋关节和核心或膝关节聚焦强化计划后获得积极结果的可能性。
随机对照试验数据的二次分析。
四所大学的实验室。
共有 199 名髌股疼痛患者。
参与者被随机分配到髋关节和核心聚焦（n = 111）或膝关节聚焦（n = 88）康复组，进行为期 6 周的方案。
基线时评估人口统计学资料、自我报告的膝关节疼痛（视觉模拟评分）和功能（前膝痛量表）、髋关节力量、腹部肌肉耐力和髋关节活动范围。治疗成功定义为视觉模拟评分下降≥2cm 或前膝痛量表评分增加≥8 分或两者兼而有之。探索结局（治疗成功）与预测变量之间的二元关系，然后进行向前逐步逻辑回归以预测成功结局。
疼痛程度较高、功能较好、外侧核心耐力较好且前侧核心耐力较差的患者，在接受髋关节和核心强化治疗后更有可能取得成功（88%的敏感性和 54%的特异性）。体重较轻、髋关节内旋较弱、髋关节伸展较强且躯干伸展耐力较好的患者，在接受膝关节强化治疗后更有可能取得成功（82%的敏感性和 58%的特异性）。
髌股疼痛患者的基线疼痛程度较高，但功能仍保持较高水平，可能会从髋关节和核心强化中获得额外的益处。本研究的临床预测规则仍处于发展阶段，在外部验证之前应谨慎应用。
