The comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis

Marinus Winters, Sinead Holden, Carolina Bryne Lura, Nicky J Welton, Deborah M Caldwell, Bill Vicenzino, Adam Weir, Michael Skovdal Rathleff

Research output: Contribution to journalArticle (Academic Journal)

Abstract

Objective To investigate the comparative effectiveness of all treatments for patellofemoral pain (PFP).

Design Living systematic review with network-meta analysis.

Data sources Sensitive search in 7 databases, 3 grey literature resources and 4 trial registers.

Eligibility criteria Randomised controlled trials evaluating any treatment for PFP with outcomes ‘any improvement’, and pain intensity.

Data extraction Two reviewers independently extracted data and assessed risk of bias with ROB 2. We used GRADE to appraise the strength of the evidence.

Primary outcome measure ‘Any improvement’ measured with a global rating of change scale.

Results Twenty-two trials (with 48 treatment arms) were included, of which 45% were at high risk of bias for the primary outcome. Most comparisons had a low to very low strength of the evidence. All treatments were better than wait-and-see for any improvement at 3 months (education (odds ratio (OR) 9.6, 95% Credible Interval (CrI) 2.2 to 48.8); exercise (OR 13.0, 95%CrI 2.4 to 83.5); education plus orthosis (OR 16.5, 95%CrI 4.9 to 65.8); education plus exercise plus patellar taping/mobilisations (OR 25.2, 95%CrI 5.7 to 130.3); and education plus exercise plus patellar taping/mobilisations plus orthosis (OR 38.8, 95%CrI 7.3 to 236.9)). Education plus exercise plus patellar taping/mobilisations, with (OR 4.0, 95%CrI 1.5 to 11.8) or without orthosis (OR 2.6, 95%CrI 1.7 to 4.2), were superior to education alone. At 12 months, education or education plus any combination yielded similar improvement rates.

Summary/conclusion

Education combined with a physical treatment (exercise, orthoses or patellar taping/mobilisation) is most likely to be effective at 3 months. At 12 months, education appears comparable to education with a physical treatment. There was insufficient evidence to recommend a specific type of physical treatment over another. All treatments in our NMA were superior to wait-and-see at 3 months, and we recommend avoiding a wait-and-see approach.
Original languageEnglish
JournalBritish Journal of Sports Medicine
Publication statusAccepted/In press - 4 Oct 2020

Keywords

  • knee cap
  • evidence synthesis
  • ranking
  • health technology assessment
  • bayesian

Cite this