Critical appraisal tools designed for clinical medicine have limitations for use in the context of public health. The meta-tool structure of the MetaQAT allows for rigorous appraisal, while allowing users to simultaneously appraise the multitude of study designs relevant to public health research and assess non-standard domains, such as applicability.
BackgroundPatellar tendinopathy (PT) is a common chronic pathology of the knee, with a high prevalence in athletes and the general population.ObjectivesThe objectives of this article were to systematically investigate all the evidence applicable to the intrinsic and extrinsic causative factors and rehabilitation of PT, and then integrate and link rehabilitation with the main causative factors identified.MethodThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Various tools were used to evaluate the methodological quality of the eligible articles. Data were interpreted descriptively, and the causative factors and rehabilitation of PT were analysed.ResultsTwenty studies were included in the review. The distinctive factor responsible for PT is the mechanical theory. Seven intrinsic and four extrinsic risk factors were identified, with the main intrinsic risk factors being muscle flexibility and strength, and extrinsic risk factors being acquisition and level of skills. PT can be treated with numerous different therapeutic modalities, although eccentric muscle training showed exceptional results. The intrinsic and extrinsic risk factors can only be transformed and reduced by rehabilitation, which is inevitable to improve PT pain and function.ConclusionThe essence of an integrated management protocol for PT is to identify the dominant contributing factors, whether intrinsic or extrinsic, and to reduce the load on the patellar tendon by modifying these factors by either rehabilitation intervention or direct modification of the equipment or environment to obtain a positive outcome towards pain management and function.
BackgroundPatellar tendinopathy (PT) is an overuse injury of the knee. The mechanism of injury is associated with repetitive stress on the patellar tendon of the knee as a result of explosive movement. Patellar tendinopathy is prevalent in all populations and is associated with intrinsic and extrinsic risk factors.ObjectivesPrimarily, the objective was to report on the intrinsic and extrinsic risk factors for PT, entailing a systematic review of the literature; the secondary objective was to use these risk factors to compile a proposed PT screening tool from the review and standard outcome measures.MethodA systematic review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Elimination criteria of the articles included duplicates, titles, abstracts and methodological quality. The evidence was collected, characterised with regard to the intrinsic and extrinsic risk factors and summarised descriptively.ResultsThe search yielded 157 feasible articles prior to commencement of article elimination. Six articles were included with a mean methodological quality score of 69%. Eight intrinsic and five extrinsic risk factors were identified. These identified risk factors are all relevant to the pathology and formed the basis for a proposed PT screening tool. The Victorian Institute of Sports Assessment for Patellar Tendinopathy Questionnaire, Visual Analog Scale and the Pain Provocation Test are also included in the proposed test.ConclusionIntrinsic and extrinsic risk factors for PT were identified, and consequently, the proposed PT screening tool was formulated for possible future testing in appropriate studies.Clinical implicationsPrevention of PT through intrinsic and extrinsic risk factor identification, and implementation in the clinical setup as a possible outcome measurement tool with which to verify functional improvement in PT rehabilitation.
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