Author Names

Crossley KM, Vicenzino B, Lentzos J, Schache AG, Pandy MG, Ozturk H, Hinman RS.

Reviewer Name

Claire DeBoer, SPT

Reviewer Affiliation(s)

Duke University Doctor of Physical Therapy Program, Class of 2025

 

Paper Abstract

Objective: Patellofemoral joint osteoarthritis (PFJ OA) contributes considerably to knee OA symptoms. This study aimed to determine the efficacy of a PFJ-targeted exercise, education manual-therapy and taping program compared to OA education alone, in participants with PFJ OA.  Methods: A randomised, participant-blinded and assessor-blinded clinical trial was conducted in primary-care physiotherapy. 92 people aged 40 years with symptomatic and radiographic PFJ OA participated. Physiotherapists delivered the PFJ-targeted exercise, education, manual-therapy and taping program, or the OA-education (control condition) in eight sessions over 12 weeks. Primary outcomes at 3-month (primary) and 9-month follow-up: (1) patient-perceived global rating of change (2) pain visual analogue scale (VAS) (100 mm); and (3) activities of daily living (ADL) subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS).  Results: 81 people (88%) completed the 3-month follow-up and data analysed on an intention-to-treat basis. Between-group baseline similarity for participant characteristics was observed. The exercise, education, manual-therapy and taping program resulted in more people reporting much improvement (20/44) than the OA-education group (5/48) (number needed to treat 3 (95% confidence interval (CI) 2 to 5)) and greater pain reduction (mean difference: 15.2 mm, 95% CI 27.0 to 3.4). No significant effects on ADL were observed (5.8; 95% CI 0.6 to 12.1). At 9 months there were no significant effects for self-report of improvement, pain (10.5 mm, 95% CI 22.7 to 1.8) or ADL (3.0, 95% CI 3.7 to 9.7).  Conclusion: Exercise, education, manual-therapy and taping can be recommended to improve short-term patient rating of change and pain severity. However over 9-months, both options were equivalent.

 

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

  1. Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
  • Yes
  1. Was the method of randomization adequate (i.e., use of randomly generated assignment)?
  • Yes
  1. Was the treatment allocation concealed (so that assignments could not be predicted)?
  • Yes
  1. Were study participants and providers blinded to treatment group assignment?
  • Yes
  1. Were the people assessing the outcomes blinded to the participants’ group assignments?
  • Yes
  1. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
  • Yes
  1. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
  • No
  1. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
  • Yes
  1. Was there high adherence to the intervention protocols for each treatment group?
  • Yes
  1. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
  • Yes
  1. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
  • Yes
  1. Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
  • Yes
  1. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
  • Yes
  1. Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
  • Yes

 

Key Finding #1

Exercise, education, manual-therapy and taping can provide superior outcomes for patient-perceived change in condition and pain compared to physiotherapist-delivered OA-education for patients with patellofemoral joint osteoarthritis (PFJ OA).

Key Finding #2

There was no difference in physical function between two groups of individuals with PFJ OA receiving exercise, education, manual-therapy and taping vs physiotherapist-delivered OA-education.

Key Finding #3

After 9 months, both treatment options were equivalent and there were no differences between the two groups.

 

Please provide your summary of the paper

This study was used to determine the efficacy of a patellofemoral joint osteoarthritis (PFJ OA)-targeted exercise, education, manual-therapy and taping program compared to OA education alone in participants with PFJ OA. A randomized trial was conducted with both participants and assessors blinded. 92 total participants with symptomatic and radiographic PFJ OA took part in the study with one group receiveing PFJ-targeted exercise, education, manual-therapy and taping program while the control group received OA-education. Both groups received treatment during eight sessions over 12 weeks. The group who received exercise, education, manual-therapy and taping experienced superior outcomes for patient-perceived change in condition and pain. At a nine-month follow up, both treatment options were equivalent.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

On a short term basis, a targeted-exercise, education, manual therapy and taping program can provide more benefits than OA education alone for patients with patellofemoral joint osteoarthritis (PFJ OA). However, over a longer period of time both treatment options can provide equivalent otucomes. This information can be useful as a physical therapist because either treatment option can provide benefit to patients with PFJ OA depending on length of care.