Comparative effectiveness of treatments for patellofemoral pain:a living systematic review with network meta-analysis
| Autor: | Marinus Winters, Sinéad Holden, Carolina Bryne Lura, Nicky J Welton, Deborah M Caldwell, Bill T Vicenzino, Adam Weir, Michael Skovdal Rathleff |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
evidence synthesis
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| Zdroj: | Winters, M, Holden, S, Lura, C B, Welton, N J, Caldwell, D M, Vicenzino, B T, Weir, A & Rathleff, M S 2021, ' Comparative effectiveness of treatments for patellofemoral pain : a living systematic review with network meta-analysis ', British Journal of Sports Medicine, vol. 55, no. 7, pp. 369-377 . https://doi.org/10.1136/bjsports-2020-102819 Winters, M, Holden, S, Lura, C B, Welton, N J, Caldwell, D M, Vicenzino, B, Weir, A & Skovdal Rathleff, M 2020, ' The comparative effectiveness of treatments for patellofemoral pain : a living systematic review with network meta-analysis ', British Journal of Sports Medicine . https://doi.org/10.1136/bjsports-2020-102819 British Journal of Sports Medicine |
| DOI: | 10.1136/bjsports-2020-102819 |
| Popis: | ObjectiveTo investigate the comparative effectiveness of all treatments for patellofemoral pain (PFP).DesignLiving systematic review with network meta-analysis (NMA).Data sourcesSensitive search in seven databases, three grey literature resources and four trial registers.Eligibility criteriaRandomised controlled trials evaluating any treatment for PFP with outcomes ‘any improvement’, and pain intensity.Data extractionTwo reviewers independently extracted data and assessed risk of bias with Risk of Bias Tool V.2. We used Grading of Recommendations, Assessment, Development and Evaluation to appraise the strength of the evidence.Primary outcome measure‘Any improvement’ measured with a Global Rating of Change Scale.ResultsTwenty-two trials (with forty-eight treatment arms) were included, of which approximately 10 (45%) were at high risk of bias for the primary outcome. Most comparisons had a low to very low strength of the evidence. All treatments were better than wait and see for any improvement at 3 months (education (OR 9.6, 95% credible interval (CrI): 2.2 to 48.8); exercise (OR 13.0, 95% CrI: 2.4 to 83.5); education+orthosis (OR 16.5, 95% CrI: 4.9 to 65.8); education+exercise+patellar taping/mobilisations (OR 25.2, 95% CrI: 5.7 to 130.3) and education+exercise+patellar taping/mobilisations+orthosis (OR 38.8, 95% CrI: 7.3 to 236.9)). Education+exercise+patellar taping/mobilisations, with (OR 4.0, 95% CrI: 1.5 to 11.8) or without orthosis (OR 2.6, 95% CrI: 1.7 to 4.2), were superior to education alone. At 12 months, education or education+any combination yielded similar improvement rates.Summary/conclusionEducation combined with a physical treatment (exercise, orthoses or patellar taping/mobilisation) is most likely to be effective at 3 months. At 12 months, education appears comparable to education with a physical treatment. There was insufficient evidence to recommend a specific type of physical treatment over another. All treatments in our NMA were superior to wait and see at 3 months, and we recommend avoiding a wait-and-see approach.PROSPERO registeration numberPROSPERO registration CRD42018079502. |
| Databáze: | OpenAIRE |
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