Outcome measures in patellofemoral pain syndrome: test retest reliability and inter-relationships

doi:10.1054/ptsp.2000.0009

Physical Therapy in Sport

Volume 1, Issue 2, May 2000, Pages 32-41

https://doi.org/10.1054/ptsp.2000.0009 Get rights and content

Abstract

Objectives: Patellofemoral pain syndrome (PFPS) is common in both the sporting and general communities. With an increased demand on physiotherapists to be accountable and to justify treatment interventions, accurate and reliable measures of this condition are required. This study investigated the test retest reliability and inter-relationship of five self-report questionnaire indices used in PFPS to measure functional limitation or severity of pain, in general or during specific aggravating activities for PFPS. Design: A repeated measures and correlational design. Participants: Fifty subjects (17 male, 33 female) with PFPS aged 23·8 (±S.D. 8·9) years. Procedures: All subjects completed the questionnaires concurrently along with an evaluation form seeking their opinion about each questionnaire. A subgroup of 24 subjects completed the questionnaires again after 2 days. A Latin Square design was used to randomize the order in which the questionnaires were completed. Results: Test retest reliability was high with ICC (3,1) values ranging from 0·77 to 0·95. There were only moderate correlations between the questionnaires (Pearson r = −0·34–0·66) suggesting that they may be measuring different aspects of PFPS. Patients reported strengths and weaknesses for each questionnaire. Conclusions: Test retest reliability was good for all questionnaires. Further work is needed to establish a reliable, user friendly and clinically useful measure for the evaluation of PFPS.

References (18)

P. Bacquie et al.
Injuries presenting to an Australian sports medicine centre—a 12 month study
Clinical Journal of Sport Medicine
(1997)
B. Chesworth et al.
Validation of outcome measures in patients with patellofemoral syndrome
Journal of Orthopaedics and Sports Physical Therapy
(1989)
J. Eng et al.
Evaluation of soft shoe orthotics in the treatment of patellofemoral pain syndrome
Physical Therapy
(1993)
J. Fairbank et al.
Mechanical factors in the incidence of knee pain in adolescents and young adults
Journal of Bone and Joint Surgery
(1984)
F. Flandry et al.
Analysis of subjective knee complaints using visual analog scales
American Journal of Sports Medicine
(1991)
B. Goldberg
Chronic anterior knee pain in the adolescent
Pediatric Annuals
(1991)
E. Harrison et al.
Analysis of outcome measures used in the study of patellofemoral pain syndrome
Physiotherapy Canada
(1995)
E.L. Harrison et al.
Development of a clinical tool and patient questionnaire for evaluation of patellofemoral pain syndrome patients
Clinical Journal of Sport Medicine
(1996)

There are more references available in the full text version of this article.

Cited by (77)

What are the Outcomes of Secondary Patella Resurfacing for Dissatisfaction Following Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis of 604 Knees
2024, Journal of Arthroplasty
Secondary patella resurfacing is often performed for dissatisfaction following primary knee arthroplasty where the native patella was retained. The purpose of this meta-analysis was to evaluate outcomes of secondary patella resurfacing.
The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting on patients who underwent secondary patella resurfacing after previous primary knee arthroplasty with retention of the native patella were considered eligible. The risk of bias was assessed using the Methodological Index for Non-Randomized studies tool. A random-effects model and the inverse-variance weighting method was used for meta-analysis. There were sixteen retrospective studies including 604 knees (594 patients) with a mean follow up of 42 months (range, 2 to 197).
An overall improvement in patient-reported outcomes (PROMs) was achieved in 53% of cases from pooled data available for 293 knees [95% Confidence Interval (CI) (0.44, 0.62), I²=68% - moderate heterogeneity]. The pooled proportion of patients satisfied with the procedure was 59% [95% CI (48, 68), I² = 70% - moderate heterogeneity] in a sample size of 415. There was a minimal rate (2%) of complication incidence when performing secondary patella resurfacing and a pooled rate of revision surgery of 10%.
An improvement in pain, satisfaction, and PROMs was achieved in slightly more than half of the patients following secondary patella resurfacing. However, studies lacked standardized objective selection criteria for the procedure and the available data was predominantly retrospective, with high heterogeneity and variation in outcome reporting.
The effect of three types of exercises programs on the patella location in athletes with patellofemoral pain
2023, Knee
The aim of this study was to compare the effect of exercises focusing on the proximal and distal joints to knee and knee local exercises on the Patellar location in athletes with patellofemoral pain (PFP).
A randomized controlled, single-blinded trial was conducted. Thirty-five athletes with PFP were randomly divided into three groups; proximal (12), distal (11) and local (12). Q Angle was measured with goniometer, tilt and congruence angle were measured with digital radiology before and after the exercise programs. The exercises were performed three sessions of 70 min per week, for 8 weeks. Data were analyzed by mixed analysis of variance, post hoc test and dependent t-test.
In the pre-intervention, no significant difference was observed between the groups (P > 0.05). But in the post-intervention, Q angle, tilt angle, congruence angle and knee pain in the proximal group were significantly less than the distal and local groups (P < 0.01); while there were no significant differences between the distal and local groups (P > 0.05). Also, in the proximal group, there were significant differences between pre-intervention and post intervention in Q angle, tilt angle and congruence angle (P = 0.001), but no significant differences were observed in the distal and local groups (P > 0.05). Knee pain in all three groups showed significant differences between pre-intervention and post-intervention (P < 0.01).
The findings of the present study indicated further improvement in patellar location and knee pain in the proximal group. Accordingly, proximal group exercises can improve the pain and performance of athletes with PFP by patellar relocation to the normal position.
The association and reliability of the frontal plane projection angle during the lateral step down test on knee function in patients with patellofemoral pain
2022, Knee
The lateral step-down test is used by physical therapists (PT) to identify movement faults in patients with patellofemoral pain (PFP). The FPPA is a measure of knee valgus and PTs have access to open source video analysis software and high quality smart phones and video cameras to implement 2D video analysis into practice. The purpose of our study was to determine the reliability of PTs measuring the frontal plane projection angle (FPPA) during the lateral step-down test, and to determine if the FPPA was associated with pain, self-reported knee function and fear of movement.
Twenty-two subjects (mean age[SD] = 27.8 [6.6] years, females n = 14, males n = 8) with PFP were analyzed by six PTs using 2D video analysis software. The FPPA was measured during the lateral step down test. Numeric Pain Rating Scale (NPRS), Anterior Knee Pain Scale (AKPS) and the Tampa Scale of Kinesiophobia (TSK) were collected. Intraclass correlation (ICC) was used to assess for PT measurement reliability. Correlations between outcomes were calculated using Spearman correlation coefficient and standard error of measurement (SEM) and minimal detectable change (MDC) were reported.
Reliability amongst PTs measuring the FPPA was good (ICC [95 %CI] = 0.85 [0.72–0.93]; SEM = 3.33°, MDC = 9.20°). There were no significant correlations (p > 0.05) between FPPA and NPRS(ρ = -0.046), AKPS(ρ = 0.066), or TSK(ρ = -0.204).
Although reliability measuring FPPA was good, the large SEM and MDC associated with this measurement may limit its clinical utility in those with PFP.
Short-term effectiveness of an intervention targeting lower limb range of motion on pain and disability in patellofemoral pain patients: A randomized, non-concurrent multiple-baseline study
2021, Journal of Bodywork and Movement Therapies
Citation Excerpt :
The overall score is then normalized on a 0–100 score, where 100 indicates no problems and 0 indicates the maximum knee problems experienced (Kujala et al., 1993). Two studies report reliability with ICC3,1 = 0.81–0.90 and moderate structural validity (r = 0.58) (Bennell et al., 2000; Crossley et al., 2004). The Dutch Version of the AKPS (AKPS-DV) is reliable with a test-retest reliability comparable to the English version (ICC = 0.98) and valid with an internal consistency of r = 0.78–0.80 (Ummels et al., 2015).
Patellofemoral pain (PFP) is a common and often long-standing musculoskeletal condition. Evidence of the effectiveness of interventions addressing soft tissue flexibility is conflicting and of inconsistent scientific quality. However, reduced soft tissue flexibility can negatively affect patellofemoral joint kinematics. Lower limb range of motion (LLROM) reflects soft tissue flexibility throughout the kinetic chain. The aim was to evaluate the short-term effectiveness of an intervention targeting LLROM on pain and disability in patients with PFP.
A randomized, non-concurrent, multiple-baseline single-case design with a two-week intervention phase and baseline and postintervention phase with varying length was conducted. Eight participants (5 females, 3 males) of age 19(±1.6) years, weekly sports participation 12(±3.1) hours and 17(±14) months symptom duration were included. The Anterior Knee Pain Scale – Dutch Version (AKPS-DV) and the Patient Specific Complaint Scale (PSCS) were administered twice a week. After allocating participants to one of four subgroups of reduced LLROM the intervention was applied. The intervention consisted of soft tissue techniques (mobilization, taping, and stretching).
Participant 3 and 6 showed a medium and small but statistically significant positive effect on the AKPS-DV. Participant 2 showed a large and statistically significant positive effect on the PSCS.
This study provides moderate evidence that an intervention targeting LLROM in patients with PFP reduces pain and disability in the short-term. Further research is needed to evaluate the long-term effectiveness and optimize individual treatment outcomes.
A Meta-analysis of Surgical Versus Nonsurgical Treatment of Primary Patella Dislocation
2019, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
Another point was lost by all the outcomes owing to indirectness related to high heterogeneity in terms of surgery offered and population characteristics. The level of evidence was not downgraded for imprecision, since the difference in the Kujala score at the short-term follow-up was higher than the minimal clinically important difference of 10 points, and the risk ratios for redislocation and reintervention were <0.75.47,48 No points were lost owing to the risk of publication bias (Fig 6).
To compare outcomes after surgery versus nonsurgical treatment in the management of primary lateral patellar dislocation (LPD) through a meta-analysis of randomized controlled trials (RCTs) in terms of redislocation rate and clinical outcome, investigating both short-term (<6 years) functional recovery and overall benefit over time (>6 years).
A systematic search of the literature was performed in November 2018. Risk of bias and quality of evidence were evaluated according to the Cochrane guidelines. RCTs investigating differences between surgery and nonsurgical treatment in primary LPD were included. The outcomes evaluated were redislocation rate, reinterventions, and Kujala score at short-, mid-, and long-term follow-up, with subanalyses for the pediatric population.
We included 510 patients from 10 RCTs in the meta-analysis. Redislocation rate was 0.40 (0.25 to 0.66; P < .001) and 0.58 (0.29 to 1.15; P = .12) at the short- and mid-term follow-ups, respectively, and the risk ratio for the need for further operations at 6 to 9 months' follow-up was 0.14 (0.02 to 1.03; P = .05), all favoring surgery. Concerning the Kujala score, an advantage of the surgical approach of 10.2 points (1.6 to 18.7; P = .02) at short-term follow-up was seen, whereas long-term follow-up results were similar between the groups. The subanalysis of the pediatric population at heterogeneous follow-up confirmed a lower risk of recurrence in surgery, with a risk ratio of 0.60 (0.26 to 1.37; P = .22), although not significant.
The literature documents a low number of high-level trials. The meta-analysis of RCTs underlined that the redislocation rate is higher with the nonsurgical approach compared with the surgical one. Moreover, when looking at the clinical outcome, more favorable findings were found with the surgical approach up to 6 years, whereas results seems to be similar at a longer follow-up after either surgical or nonsurgical treatment of primary LPD.
II, meta-analysis of level I and level II randomized clinical trials.
The decline step-down test measuring the maximum pain-free flexion angle: A reliable and valid performance test in patients with patellofemoral pain
2019, Physical Therapy in Sport
Patients with patellofemoral pain (PFP) experience pain while descending stairs. To date no reliable and valid performance-test exists to assess the maximum pain-free knee flexion angle (MPFFA) as outcome measure during a step-down task. Therefore, the intra- and inter-observer reliability and construct validity of the decline step-down test (DSDT) measuring the MPFFA in patients with PFP were evaluated.
Reliability and construct validity.
Private practices in Nijmegen and Utrecht, the Netherlands.
Patients with PFP.
The reliability was assessed by repeated measurements of the MPFFA during the DSDT. The construct validity was assessed by correlating the measurements on the DSDT with the Anterior Knee Pain Scale Dutch Version (AKPS-DV) based on a pre-set hypothesis.
Thirty-two participants (forty-eight knees) were eligible for inclusion. The intraclass correlation coefficient (ICC) for intra-observer reliability was ICC_2,1 = 0.83 and ICC_2,1 = 0.85 for inter-observer reliability. The 95% limits of agreement (LoA) showed a width of 27.56° for intra-observer reliability and a width of 24.42° for inter-observer reliability. There was an average positive correlation between the DSDT and the total score on the AKPS-DV (r_s = 0.31, p = 0.030).
The DSDT measuring the MPFFA is reliable and valid in patients with PFP.

View all citing articles on Scopus

View full text

Original ArticleOutcome measures in patellofemoral pain syndrome: test retest reliability and inter-relationships

Abstract

Injuries presenting to an Australian sports medicine centre—a 12 month study

Clinical Journal of Sport Medicine

Validation of outcome measures in patients with patellofemoral syndrome

Journal of Orthopaedics and Sports Physical Therapy

Evaluation of soft shoe orthotics in the treatment of patellofemoral pain syndrome

Physical Therapy

Mechanical factors in the incidence of knee pain in adolescents and young adults

Journal of Bone and Joint Surgery

Analysis of subjective knee complaints using visual analog scales

American Journal of Sports Medicine

Chronic anterior knee pain in the adolescent

Pediatric Annuals

Analysis of outcome measures used in the study of patellofemoral pain syndrome

Physiotherapy Canada

Development of a clinical tool and patient questionnaire for evaluation of patellofemoral pain syndrome patients

Clinical Journal of Sport Medicine

Original Article
Outcome measures in patellofemoral pain syndrome: test retest reliability and inter-relationships