title: A systematic review of the effects of therapeutic taping on patellofemoral pain syndrome. Prognostic factors for patellofemoral pain: a multicentre observational analysis A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works? Patellofemoral Pain Syndrome: Validity of Clinical and Radiological Features Comparison of symptoms and clinical findings in subgroups of individuals with patellofemoral pain Diagnostic value of five clinical tests in patellofemoral pain syndrome. Intrinsic Risk Factors for the Development of Anterior Knee Pain in an Athletic Population: A Two-Year Prospective Study * Diagnostic accuracy and association to disability of clinical test findings associated with patellofemoral pain syndrome.
abstract: OBJECTIVE To investigate the efficacy of patellar taping on pain control , patellar alignment , and neuromuscular control ( ie , vastus medialis oblique activation , knee extensor moment , etc ) in subjects with patellofemoral pain syndrome . DATA SOURCES We search ed MEDLINE , SPORT Discus , PEDro , and CINAHL through December 2004 , using the key words patellar taping , therapeutic taping , McConnell taping , taping , chronic injury , patellofemoral pain , and knee . STUDY SELECTION Criteria for inclusion criteria were studies that exclusively recruited patients diagnosed with patellofemoral pain syndrome or anterior knee pain and outcome measures specific to pain reduction , neuromuscular control , and patellar positioning . DATA EXTRACTION We identified and review ed 16 studies with an average PEDro score of 4.25/10 . Articles were divided into 3 categories based on primary outcome measures : 4 r and omized controlled trials on treatment methods and pain , 9 studies on neuromuscular control , and 3 on patellar positioning . DATA SYNTHESIS Although patellar taping seems to reduce pain and improve function in people with patellofemoral pain syndrome during activities of daily living and rehabilitation exercise , strong evidence to identify the underlying mechanisms is still not available Objectives Describe proportions of individuals with patellofemoral pain ( PFP ) with an unfavourable recovery over 12 months ; identify clinical predictors of poor recovery at 3 and 12 months ; and determine baseline values of predictors that identify those with poor 12-month prognosis . Methods An observational analysis utilised data from 310 individuals with PFP enrolled in two r and omised clinical trials . Thirteen baseline variables ( participant , PFP , study characteristics ) were investigated for their prognostic ability . Pain , function and global recovery were measured at 3 and 12 months . Multivariate backward stepwise regression analyses ( treatment-adjusted , p<0.10 ) were performed for each follow-up measure . Receiver operator characteristic curves identified cut-points associated with unfavourable recovery at 12 months . Results 55 % and 40 % of participants had an unfavourable recovery at 3 and 12 months , respectively . Longer baseline pain duration was significantly associated with poor 3-month and 12-month recovery on measures of pain severity ( β 11.36 to 24.94 ) , Anterior Knee Pain ( AKP ) Scale ( −4.44 to −11.33 ) and global recovery ( OR : 2.32 to 6.11 ) . Greater baseline pain severity and lower AKP Scale score were significantly associated with poor recovery on multiple measures ( p<0.05 ) . Baseline duration > 2 months and AKP Scale score < 70/100 were associated with unfavourable 12-month recovery . Conclusions A substantial number of individuals with PFP have an unfavourable recovery over 12 months , irrespective of intervention . Knee pain duration > 2 months is the most consistent prognostic indicator , followed by AKP Scale score < 70 . Sports medicine practitioners should utilise interventions with known efficacy in reducing PFP , and promote early intervention to maximise prognosis . Trial registration Australian study : Australian Clinical Trials Registry ( ACTRN012605000463673 ) , Clinical Trials.gov ( NCT00118521 ) ; Dutch study : International St and ard R and omised Controlled Trial Number Register ( IS RCT N83938749 Purpose There is research evidence which supports the effectiveness of exercise in reducing pain and increasing function in patients with patellofemoral pain syndrome . However , what is unclear are the parameters underpinning this intervention . This has led to uncertainty when operationalizing exercises for patients with patellofemoral pain syndrome in clinical practice . The aim of this review was to evaluate the parameters of exercise programs reported in primary research , to provide clinicians with evidence -based recommendations for exercise prescription for patellofemoral pain . Methods A systematic review of r and omized controlled trials was undertaken . Only trials that identified exercise to be effective in treating patellofemoral pain were included . Appropriate data bases and reference lists were search ed using established keywords . Data relating to common exercise parameters such as the type of exercise , length , and frequency of intervention , intensity , repetitions , sets , and specific technique were extracted , along with details of co- interventions that may have been used . Results A total of ten r and omized controlled trials were included in this review and from these trials 14 interventions arms were evaluated . All 14 interventions focused on active exercises , all but two of which also included a passive stretching component . The current body of evidence demonstrates positive results with exercise interventions such as  knee extension , squats , stationary cycling , static quadriceps , active straight leg raise , leg press , and step-up and down exercises  for patients with patellofemoral pain syndrome . A progressive regime of daily exercises of two to four sets of ten or more repetitions over an intervention period of 6 weeks or more , combined with exercises to address flexibility of the lower limb musculature was commonly used . Conclusion Currently , the primary research on this topic supports the use of closed kinetic chain , strengthening exercises for musculature of the lower limb , combined with flexibility options . The current evidence base supports a prescription of daily exercises of two – four sets of ten or more repetitions over a period of 6 weeks or more Data regarding validity of clinical and radiographic findings in diagnosing patellofemoral pain syndrome are inconclusive . We prospect ively assessed how sensitive and specific key patellofemoral physical examination tests are , and evaluated the prevalence of physical examination and radiographic findings . Sixty-one infantry soldiers with patellofemoral pain syndrome and 25 control subjects were evaluated . The sensitivity of the patellar tilt , active instability , patella alta , and apprehension tests was low ( less than 50 % ) ; specificity ranged between 72 % and 100 % . Although the prevalence of positive patellar tilt and active instability tests was significantly greater in subjects with patellofemoral pain syndrome , there were no significant differences between the groups in the results of the other two tests . Soldiers with patellofemoral pain syndrome presented with increased quadriceps angle , lateral and medial retinacular tenderness , patellofemoral crepitation , squinting patella , and reduced mobility of the patella . There were no differences between the groups in the prevalence of lower limb and foot posture alignment and knee effusion .  Plain radiography showed increased patellar subluxation in soldiers with patellofemoral pain syndrome . Other radiographic measures ( sulcus angle , Laurin angle , Merchant angle , and Insall-Salvati index ) were similar in both groups . We provide evidence regarding the validity of clinical and radiographic features commonly used for diagnosing patellofemoral pain syndrome . Physical examinations were more useful than plain radiography . Level of Evidence : Diagnostic study , Level I. See the Guidelines for Authors for a complete description of levels of evidence Patellofemoral pain syndrome ( PFPS ) is one of the most common musculoskeletal disorders . However , no consensus on the definition , classification , assessment , diagnosis , or management has been reached . We evaluated symptoms and clinical findings in subgroups of individuals with PFPS , classified on the basis of the findings in radiological examinations and compared the findings with knee-healthy subjects . An orthopedic surgeon and a physical therapist consecutively examined 80 patients clinical ly diagnosed as having PFPS and referred for physical therapy .  The examination consisted of taking a case history and clinical tests . Radiography revealed pathology in 15 patients , and scintigraphic examination revealed focal uptake in 2 patients indicating pathology ( group C ) . Diffusely increased uptake was present in 29 patients ( group B ) . In the remaining 29 patients radiographic and scintigraphic examinations were normal ( group A ) . Knee-healthy controls ( group D ) reported no clinical symptoms . No symptom could be statistically demonstrated to differ between the three patient groups . Knee-healthy subjects differed significantly from the three patient groups in all clinical tests measuring pain in response to the provocations ; compression test , medial and lateral tenderness , passive gliding of the patella , but they also differed in Q angle . Differences in clinical tests between the patient groups were nonsignificant . The main finding in our study on patients clinical ly diagnosed with PFPS is that possible pathologies can not be detected from the patient 's history or from commonly used clinical tests The current study is aim ed at examining the validity of five clinical patellofemoral tests used in the diagnosis of patellofemoral pain syndrome ( PFPS ) . Forty-five knee patients were divided into either the PFPS or the non-PFPS group , based on the fulfilment of the diagnostic criteria for PFPS . An investigator , blinded to the group assignment , performed the vastus medialis coordination test , patellar apprehension test , Waldron 's test , Clarke 's test , and the eccentric step test . The positive likelihood ratio was 2.26 for both the vastus medialis coordination test and the patellar apprehension test . For the eccentric step test , the positive likelihood ratio was 2.34 . A positive outcome on either the  vastus medialis coordination test , the patellar apprehension test , or the eccentric step test increases the probability of PFPS to a small , but sometimes important , degree . For the remaining tests , the positive likelihood ratios were below the threshold value of 2 , indicating that given a positive test result , the probability that the patient has PFPS is altered to a small , and rarely important degree . The negative likelihood ratios for all tests exceeded the threshold value of 0.5 , suggestive of clinical ly irrelevant information . These data question the validity of clinical tests for the diagnosis of PFPS Many variables have retrospectively been associated with the presence of anterior knee pain . Very few prospect i ve data exist , however , to determine which of these variables will lead to the development of anterior knee pain . It was our purpose in this study to determine the intrinsic risk factors for the development of anterior knee pain in an athletic population over a 2-year period . Before the start of training , 282 male and female students enrolled in physical education classes  were evaluated for anthropometric variables , motor performance , general joint laxity , lower leg alignment characteristics , muscle length and strength , static and dynamic patellofemoral characteristics , and psychological parameters . During this 2-year follow-up study , 24 of the 282 students developed  patellofemoral pain . Statistical analyses revealed a significant difference between those subjects who developed patellofemoral pain and those who did not concerning quadriceps and gastrocnemius muscle flexibility , explosive strength , thumb-forearm mobility , reflex response time of the vastus medialis obliquus and vastus lateralis muscles , and the psychological parameter of seeking social support . However , only a shortened quadriceps muscle , an altered vastus medialis obliquus muscle reflex response time , a decreased explosive strength , and a hypermobile patella had a significant correlation with the incidence of patellofemoral pain . We concluded that the latter four parameters play a dominant role in the genesis of anterior knee pain and we therefore deem them to be risk factors for this syndrome PURPOSE To investigate the diagnostic accuracy and association to disability of selected functional findings or physical examination tests for patellofemoral pain syndrome ( PFPS ) in patients with anterior knee pain . METHODS A sample of 76 consecutive patients with anterior knee pain was further subdivided into PFPS and other diagnoses . Routine physical examination tests were examined in a prospect i ve , consecutive-subjects design for a cohort of patients with anterior knee pain . Diagnostic accuracy findings , including sensitivity , specificity , positive ( PPV ) and negative ( NPV ) predictive value , and positive ( LR+ ) and negative ( LR- ) likelihood ratios , were calculated for each test . PPV and NPV reflect the percentage of time of positive or a negative test ( respectively ) accurately captures the diagnosis of the condition . LR+ and LR- reflect alterations in post-test probability when the test is positive or negative ( respectively ) . Lastly , associations to disability ( International Knee Documentation Committee ( IKDC ) subjective form ) were calculated for each clinical finding . RESULTS Diagnostic accuracy analyses of individual functional assessment and situational phenomena suggest that the strongest diagnostic test is pain encountered during resisted muscle contraction of the knee ( PPV=82 % ; LR+=2.2 ; 95 % CI : 0.99 - 5.2 ) . Clusters of test findings were substantially more diagnostic , with any two of three positive findings of muscle contraction , pain during squatting , and pain during palpation yielding the following values : PPV=89 % ; LR+=4.0 ( 95 % CI : 1.8 - 10.3 ) . No individual or clustered test findings were significantly associated with the IKDC score . CONCLUSION Combinations of functional assessment tests and situational phenomena are diagnostic for PFPS and may serve to rule in and rule out the presence of PFPS . Single findings are not related to disability scores ( IKDC )
target: Of the functional tests , squatting demonstrated the highest sensitivity .
  Other useful tests include pain during stair climbing and prolonged sitting .
  Conclusion A diagnostic checklist is useful as it provides a structured method for diagnosing AKP in a clinical setting .
background: Background  Anterior knee pain ( AKP ) or patellofemoral pain syndrome is common and may limit an individual 's ability to perform common activities of daily living such as stair climbing and prolonged sitting .
  The diagnosis is difficult as there are multiple definitions for this disorder and there are no accepted criteria for diagnosis .
  It is therefore most commonly a diagnosis that is made once other pathologies have been excluded .
  Objectives The aim of this study was to create an evidence -based checklist for research ers and clinicians to use for the diagnosis of AKP .