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2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017
Collins NJ, Barton CJ, van Middelkoop M, et al
Br J Sports Med Published Online First: 20 June 2018.
One of the most common sources of knee pain is from patellofemoral pain and is a common condition that family physicians have to manage. Patients often report significant burden due to a limitation in activity and daily tasks, hence it is imperative to have a firm grasp of the evidence behind current treatment. This past year, the 5th International Patellofemoral Research Retreat gathered in Australia to review the interventions for patellofemoral pain and published the 2018 consensus statement for patellofemoral pain treatment.
6 systematic reviews and 13 RCTs that were published since the last meeting were reviewed and used to update the 2016 consensus statement. No significant changes were made from the previous consensus statements but several new statements were added to address new modalities.
Some highlights of the consensus-based recommendations are as follows
- Exercise therapy is recommended and reduces pain in the short, medium, and long terms. It also improves function in the medium and long-term.
- Combining hip and knee exercises is superior to knee exercises alone
- Combined interventions are recommended to reduce pain in the short and medium term. This means exercise therapy in conjunction with other therapies such as foot orthoses, patellar taping, or manual therapy
- Foot orthoses are recommended to reduce pain in the short term
- Electrophysical agents (ultrasound, phonophoresis, laser therapy) are not recommended
- Patellofemoral, knee and lumbar mobilisations are not recommended
- in isolation
- It is uncertain whether patellar taping and bracing are helpful with pain in the short, medium, or long term.
- It is uncertain whether acupuncture or dry needling reduces pain in the short and medium term
- It is uncertain whether manual soft tissue techniques are beneficial in the short term
- It is uncertain whether blood flow restriction training is superior to exercise therapy with regards to reducing pain in the short term
- It is uncertain whether gait retraining is effective in reducing pain and improving function in the short term
Given there are many areas of uncertainty, it is important for the family physician to be aware of these treatment modalities and how they may apply to the individual seeking treatment. However, there remains a lot of questions to be answered and will require physicians to continually update themselves on the latest available evidence.
Jim Niu MD, CCFP
Sport and Exercise Medicine Fellow, University of Ottawa
Advisor Dr. Taryn Taylor BKIN, MSC, MD, CCFP (SEM), Dip Sport Med
CME Certified Fall Prevention module
In a cross Canada review, there were few certified Fall Prevention programs targeted towards Primary Care physicians and their healthcare professional teams. Dr. Frank Molnar, Geriatrician, and his team have changed that! The Champlain Fall Prevention Steering Committee, Dr. Molnar and the Regional Geriatric Program of Eastern Ontario have worked together to deliver an interactive Fall Prevention module which utilizes the Champlain Fall Prevention tools. This online group learning program meets the certification criteria of the College of Family Physicians of Canada and has been certified by the University of Ottawa’s Office of Continuing Professional Development for up to 2 MainPro+ credits.
The sequential modules focus on education, client self-screening using the Staying Independent Checklist, and delivery of the appropriate and evidence-based follow up assessment and diagnosis to determine the root cause of the fall. Selecting the right intervention and referral is also covered in the module.
A complement to this CME program includes access for non-registered health care workers to an online PSW Fall Prevention module. It can be useful for volunteers, receptionists and other non-registered team members as it provides information to enable them to act as a coach and guide for their older clients and to understand the importance of self-screening and the use of the Staying Independent Checklist as part of the Champlain Fall Prevention Algorithm.
These two modules are components of the Fall Prevention education framework to reinforce the delivery of the best practices in Fall Prevention across the continuum. Work is now being undertaken to provide other registered healthcare professionals with similar support,
All of these resources and the link to sign up for the CME module can be found through the www.stopfalls.ca website