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Abstract
Objective To compare the effectiveness of adjunct treatments combined with exercise to exercise alone in people with patellofemoral pain (PFP) and explore the quality of intervention descriptions in randomised controlled trials (RCTs).
Design Systematic review.
Data sources Seven databases were searched in November 2023.
Eligibility RCTs that evaluated the effectiveness of any adjunct treatment combined with exercise to exercise alone on self-reported pain and function in people with PFP.
Results We included 45 RCTs (2023 participants), with 25 RCTs (1050 participants) contributing to meta-analyses. Pooled analysis indicated very low-certainty evidence that neuromuscular electrical stimulation or monopolar dielectric diathermy combined with exercise leads to small and large improvements in self-reported pain when compared with exercise alone (standardised mean difference (95% CI)=−0.27 (−0.53 to −0.02) and −2.58 (−4.59 to −0.57), respectively) in the short-term. For self-reported pain and function, very low-certainty evidence indicates that knee taping, whole-body vibration, electromyographic biofeedback and knee brace combined with exercise do not differ from exercise alone. Interventions are poorly described in most RCTs, adjunct treatments scored on average 14/24 and exercise therapy 12/24 in the Template for Intervention Description and Replication checklist.
Conclusion Neuromuscular electrical stimulation and monopolar dielectric diathermy combined with exercise seem to improve self-reported pain in people with PFP compared with exercise alone. Knee taping, whole-body vibration, electromyographic biofeedback and knee brace do not offer additional benefits to exercise alone. Most interventions are poorly described, which is detrimental to translating research knowledge into clinical practice.
PROSPERO registration number CRD42020197081.
- exercise
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Footnotes
DDOS and FVS are joint senior authors.
X @LarissaRSouto, @DrDanilo_Silva, @M_Pazzinatto
Contributors LRS, DOS, RFCM and FVS designed the study. LRS wrote the first draft of the manuscript and all authors provided critical feedback. LRS ran the searches. LRS and MSS conducted the study screening and data extraction. LRS, DOS and MFP conducted the risk of bias assessment and grading of evidence. LRS and DOS conducted the data analysis and synthesis. All authors have read and confirmed that they meet ICMJE criteria for authorship. All authors read and approved the final manuscript. LRS is the guarantor of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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