Predictors of short and long term outcome in patellofemoral pain syndrome: a prospective longitudinal study

Abstract

BackgroundPatellofemoral pain syndrome (PFP) is a common musculoskeletal condition that has a tendency to become chronic and problematic in a proportion of affected individuals. The objective of this study was to identify prognostic factors that may have clinical utility in predicting poor outcome on measures of pain and function in individuals with PFP.MethodsA prospective follow-up study was conducted of 179 participants in a randomised clinical trial. Nine baseline factors (age, gender, body mass index, arch height, duration of knee pain, worst pain visual analogue scale, Kujala Patellofemoral Score (KPS), functional index questionnaire (FIQ), step down repetitions) were investigated for their prognostic ability on outcome assessed at six, 12 and 52 weeks (worst pain, KPS and FIQ). Factors with significant univariate associations were entered into multivariate linear regression models to identify a group of factors independently associated with poor outcome.ResultsLong symptom duration was the most consistent predictor of poor outcome over 52 weeks rated on the KPS and the FIQ (β-0.07, 95% confidence interval -0.1 to -0.03, p < 0.000; and -0.02, -0.03 to -0.01, p < 0.000, respectively). Worse KPS at baseline was predictive of outcome at six, 12 and 52 weeks. Gender, body mass index and arch height were generally not associated with outcome (univariate analysis), while age, worst pain, FIQ and step downs were excluded during multivariate analyses.ConclusionsPatients presenting with PFP of long duration who score worse on the KPS have a poorer prognosis, irrespective of age, gender and morphometry. These results suggest that strategies aimed at preventing chronicity of more severe PFP may optimise prognosis.

Outcome Predictors for Conservative Patellofemoral Pain Management: A Systematic Review and Meta-Analysis

“…Two studies included data from the same PFP population [26,31], however they reported findings from different follow-up durations and were both therefore included in the review. Two further studies, one that presented short-and long-term predictors of outcome without differentiating predictors for specific interventions [39], and the other that reported post hoc baseline foot mobility measures [40], could not be used within this review.…”

“…Consistent with prognosis following physiotherapy intervention including foot orthoses application [39], limited evidence showed patient height and weight was not predictive of a successful outcome following foot orthoses intervention [19,20]. In contrast with prognostic data, a trend towards older age was identified as a predictor of foot orthoses success [20,23], and younger age significantly predictive of exercise intervention success [31].…”

Efficacy of Nonsurgical Interventions for Anterior Knee Pain

“…This is particularly important considering the role that early effective intervention, aimed at reducing pain severity and duration, may play in limiting the longer-term impact of AKP. [14] Despite the strengths of this systematic review, there are limitations that need to be considered when interpreting findings. Studies were not considered eligible for inclusion if they were published in non-English languages.…”

“…[12] Despite its prevalence, chronicity and impact, AKP remains one of the most challenging musculoskeletal conditions managed by practitioners. [13] Since greater pain severity and longer symptom duration are predictive of poor prognosis, [14] early effective management may be the key to limiting the longer-term impact of the condition. Considering the multifactorial nature of patellofemoral pain [15,16], the management approach should consider individual presentation and the contribution of local knee factors, as well as potential proximal (hip) and distal (foot) factors.…”

Lower Mechanical Pressure Pain Thresholds in Female Adolescents With Patellofemoral Pain Syndrome

“…Even though we excluded female adolescents who were currently under medical treatment, the baseline demographics of worst pain last week and symptom duration showed that our sample of female adolescents with PFPS was comparable to previous patient-based studies in slightly older patients of mixed genders. 6,7,33 The investigation of the association between symptom duration and localized and distal hyperalgesia may be limited, as the PFPS in the current study represented a chronic pain condition, defined as PFPS more than 3 months in duration. None of the adolescents had a symptom duration less than 3 months, even though 1 of our inclusion criteria was pain for more than 6 weeks.…”