effectiveness of conservative treatment for patellofemoral pain syndrome: a systematic review and meta-analysis

Objective: To evaluate the evidence regarding the effectiveness of conservative treatment in reducing patellofemoral pain. Data sources: CENTRAL, MEDLINE, CINAHL, and PEDro databases. Study selection: Adults with patellofemoral pain, randomized controlled trials only, any conservative treatment compared with placebo, sham, other conservative treatment, or no treatment. Two independent reviewers. Data extraction: Data were extracted from the full-text of the articles, based on Cochrane Collaboration recommendations. The outcome of interest was the difference between groups regarding change in pain severity. Data synthesis: The majority of studies were underpowered. More than 80% of the 37 trials did not show a clinically significant benefit. Clinically significant effects of different sizes were found for 7 trials (6 studies out of 7 had short follow-ups). These effects were found for: (i) pulsed electromagnetic fields combined with home exercise –33.0 (95% CI –45.2 to –20.8); (ii) hip muscle strengthening –65.0 (95% CI –87.7 to –48.3) and –32.0 (–37.0 to –27.0); (iii) weight-bearing exercise –40.0 (95% CI –49.4 to –30.6); (iv) neuromuscular facilitation combined with aerobic exercise and stretching –60.1 (95% CI –66.9 to –54.5); (v) postural stabilization –24.4 (95% CI –33.5 to –15.3); and (vi) patellar bracing –31.6 (95% CI –35.2 to –28.0). Conclusion: There is no evidence that a single treat-ment modality works for all patients with patellofemoral pain. There is limited evidence that some treatment modalities may be beneficial for some subgroups of patients with patellofemoral pain.