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Cited by 34Lower Extremity Biomechanics and PathologiesClinical practice guidelines implementationMusculoskeletal pain and rehabilitation

A systematic review of clinical practice guidelines for physical therapist management of patellofemoral pain

Open access
Wallis, Jason A, Roddy, Leanne, Bottrell, Judy, Parslow, Sue, Taylor, Nicholas F·2021·Physical Therapy
DOI 10.1093/ptj/pzab021
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Abstract

OBJECTIVE: The purpose of this study was to conduct a systematic review to evaluate clinical practice guidelines for the physical therapist management of patellofemoral pain. METHODS: Five electronic databases (CINAHL, Embase, Medline, Psychinfo, Cochrane Library) were searched from January 2013 to October 2019. Additional search methods included searching websites that publish clinical practice guidelines containing recommendations for physical therapist management of patellofemoral pain. Characteristics of the guidelines were extracted, including recommendations for examination, interventions, and evaluation applicable to physical therapist practice. Quality assessment was conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, applicability of recommendations to physical therapist practice was examined using the AGREE Recommendation Excellence instrument, and convergence of recommendations across guidelines was assessed. RESULTS: Four clinical practice guidelines were included. One guideline evaluated as higher quality provided the most clinically applicable set of recommendations for examination, interventions, and evaluation processes to assess the effectiveness of interventions. Guideline-recommended interventions were consistent for exercise therapy, foot orthoses, patellar taping, patient education, and combined interventions and did not recommend the use of electrotherapeutic modalities. Two guidelines evaluated as higher quality did not recommend using manual therapy (in isolation), dry needling, and patellar bracing. CONCLUSION: Recommendations from higher-quality clinical practice guidelines may conflict with routine physical therapist management of patellofemoral pain. This review provides guidance for clinicians to deliver high-value physical therapist management of patellofemoral pain. IMPACT: This review addresses an important gap between evidence and practice in the physical therapist management of patellofemoral pain. LAY SUMMARY: If you have kneecap pain, this review offers guidance for your physical therapist to provide examination processes, treatments, and evaluation processes that are recommended by high-quality guidelines.

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Crossref · 10.1093/ptj/pzab021

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42 of 42 references verified0 citation errors · 0 not checkable

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  • Studies have reported no change or a slight decrease in hamstring activation (absolute difference: 12% MVIC) with increasing squat depth.

    “Similarly, evidence related to hamstring activity also is conflicting, as studies have reported no change1,5,35 or a slight decrease in activation (absolute difference: 12% MVIC) with increasing squat depth.36”

    From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [35]

    The Clinical Practice Guideline Examination Evaluation section mentions squatting as a diagnostic test, and the exercise-therapy table mentions resisted squats, but neither addresses hamstring activation at different squat depths. Searches for hamstring activation, squat depth, and 12% MVIC found no passage reporting the claimed result. (LLM, conf=0.76)

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  • Studies examining muscle recruitment with increasing squat depth are conflicting.

    “Apart from the influence of squat depth on hip and knee moments, studies examining muscle recruitment with increasing depth are conflicting.”

    From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [35]

    The Clinical Practice Guideline Examination Evaluation section mentions squatting as a diagnostic test, and the intervention table mentions resisted squats, but neither addresses how muscle recruitment changes with squat depth. Searches for the claim’s wording and for squat depth, muscle activation, and electromyography found no passage reporting conflicting findings. (LLM, conf=0.74)

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  • Some studies have reported an increase in quadriceps EMG activity with squat depth (29%), while others have not.

    “In regards to quadriceps activity, some studies have reported an increase in EMG activity with squat depth (29%),35 while others have not.1,5,36”

    From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [35]

    The exercise recommendations in Table 5 mention resisted squats as knee-targeted exercise, but do not report quadriceps EMG changes with squat depth. Searches for squat depth, EMG activity, and 29% found no passage supporting the finding attributed to citation 35; the paper’s 29% figure concerns patellofemoral pain prevalence (Introduction). No page numbers were available in our copy. (LLM, conf=0.76)

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Cites

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Research works printed but not linked: 1

  1. Royal Australian College of General Practitioners (RACGP). Guideline for the management of knee and hip osteoarthritis. 2018. Accessed December 20, 2020. https://www.racgp.org.au/ download/Documents/Guidelines/Musculoskeletal/guideline-for- the-management-of-knee-and-hip-oa-2nd-edition.pdf.

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Authors
Wallis, J. A., Roddy, L., Bottrell, J., Parslow, S., & Taylor, N. F.
Affiliations
  • La Trobe University (AU)
  • Eastern Health (AU)
Corresponding author
Wallis, Jason A
ORCID
Venue
Physical Therapy
Publisher
Oxford University Press (OUP)
Published
2021-02-03
Volume
101
Issue
3
ISSN
  • 0031-9023 (ISSN-L)
  • 1538-6724
DOI
10.1093/ptj/pzab021
OpenAlex
W3127772574
Cited by
34
References
42
Citations by year
2026: 7 · 2025: 12 · 2024: 8 · 2023: 5 · 2022: 1 · 2021: 1
FWCI
0.32
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • Physical Therapy (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
patellofemoral pain, exercise therapy, foot orthoses, patellar taping, patient education, manual therapy, dry needling, guideline quality, guideline applicability, knowledge-practice gap
MeSH terms
Humans, Practice Guidelines as Topic, Physical Therapy Modalities, Patellofemoral Pain Syndrome

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