Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia.
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Phys Ther. 2021 Mar 3;101(3). doi: 10.1093/ptj/pzab021.
The purpose of this study was to conduct a systematic review to evaluate clinical practice guidelines for the physical therapist management of patellofemoral pain.
Five electronic databases (CINAHL, Embase, Medline, Psychinfo, Cochrane Library) were searched from January 2013 to October 2019. Additional search methods included searching websites that publish clinical practice guidelines containing recommendations for physical therapist management of patellofemoral pain. Characteristics of the guidelines were extracted, including recommendations for examination, interventions, and evaluation applicable to physical therapist practice. Quality assessment was conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, applicability of recommendations to physical therapist practice was examined using the AGREE Recommendation Excellence instrument, and convergence of recommendations across guidelines was assessed.
Four clinical practice guidelines were included. One guideline evaluated as higher quality provided the most clinically applicable set of recommendations for examination, interventions, and evaluation processes to assess the effectiveness of interventions. Guideline-recommended interventions were consistent for exercise therapy, foot orthoses, patellar taping, patient education, and combined interventions and did not recommend the use of electrotherapeutic modalities. Two guidelines evaluated as higher quality did not recommend using manual therapy (in isolation), dry needling, and patellar bracing.
Recommendations from higher-quality clinical practice guidelines may conflict with routine physical therapist management of patellofemoral pain. This review provides guidance for clinicians to deliver high-value physical therapist management of patellofemoral pain.
This review addresses an important gap between evidence and practice in the physical therapist management of patellofemoral pain.
If you have kneecap pain, this review offers guidance for your physical therapist to provide examination processes, treatments, and evaluation processes that are recommended by high-quality guidelines.
本研究旨在进行系统评价，评估针对髌股疼痛的物理治疗管理的临床实践指南。
从 2013 年 1 月至 2019 年 10 月，检索了 5 个电子数据库（CINAHL、Embase、Medline、Psychinfo、Cochrane Library）。此外，还搜索了发布包含物理治疗师管理髌股疼痛建议的临床实践指南的网站。提取指南的特征，包括适用于物理治疗师实践的检查、干预和评估建议。使用评估研究和评估指南（AGREE）II 工具进行质量评估，使用 AGREE 建议卓越工具检查建议对物理治疗师实践的适用性，并评估指南之间建议的一致性。
纳入了 4 项临床实践指南。一项评估为高质量的指南提供了最具临床适用性的检查、干预和评估流程建议，以评估干预措施的有效性。指南推荐的干预措施在运动疗法、足矫形器、髌骨贴扎、患者教育和联合干预方面是一致的，不推荐使用电疗方法。另外 2 项评估为高质量的指南不建议单独使用手法治疗、干针和髌骨支撑。
高质量临床实践指南的建议可能与髌股疼痛的常规物理治疗师管理相冲突。本综述为临床医生提供了指导，以提供高价值的髌股疼痛物理治疗师管理。
本综述解决了物理治疗师管理髌股疼痛方面证据与实践之间的重要差距。
如果您有膝盖疼痛，本综述为您的物理治疗师提供了检查流程、治疗和评估流程的建议，这些建议是由高质量的指南推荐的。
