Exercise for treating patellofemoral pain syndrome: an abridged version of Cochrane Systematic Review

BACKGROUND: Patellofemoral pain syndrome (PFPS) is a common knee problem characterised by retropatellar or peripatellar pain, which particularly affects adolescents and young adults. Exercise therapy is often prescribed. AIM: To assess the effects of exercise therapy in people with PFPS. DESIGN: Systematic review. SETTING: All settings. POPULATION: Adolescents and adults with PFPS. METHODS: A search was performed in nine databases up to May 2014, including the Cochrane Register, MEDLINE and EMBASE. Randomised and quasi-randomised trials evaluating the effect of exercise therapy in adolescents and adults with PFPS were considered for inclusion. Two review authors independently selected trials, extracted data and assessed risk of bias. RESULTS: In total, 31 trials including 1690 participants were included in this review, of which most were at high risk of performance bias and detection bias due to lack of blinding. The included studies provided evidence for: exercise therapy versus control; exercise therapy versus other conservative interventions (e.g. taping); and different exercises or exercise programmes. Pooled data favoured exercise therapy over control for pain during activity (short term MD -1.46 [-2.39, -0.54]), usual pain (short term estimated MD -1.44 [-2.48,-0.39]), functional ability; (short term estimated MD 12.21 [6.44, 18.09] and long term recovery (RR 1.35 [0.99, 1.84]). Pooled data favoured hip and knee exercise over knee exercises alone for pain during activity (short-term MD -2.20 [3.80, -0.60]) and usual pain (short term MD -1.77 [-2.78,-0.76]). CONCLUSION: This review found very low quality but consistent evidence that exercise therapy for PFPS may result in clinically important reduction in pain and improvement in functional ability, as well as enhancing long-term recovery. There is some very low quality evidence that hip plus knee exercises may be more effective in reducing pain than knee exercise alone. CLINICAL REHABILITATION IMPACT: Very low quality evidence but consistent evidence indicates that exercise therapy benefits patients with PFP. However, there is insufficient evidence to determine the best form of exercise therapy and it is unknown whether this result would apply to all people with PFPS.