Physiotherapy effectiveness on muscle strength, flexibility, pain and function in patients with patellofemoral pain syndrome

Study objectives: To evaluate the effectiveness on muscle strength, flexibility, pain and function of a six-week physiotherapy treatment for patients with Patellofemoral Pain Syndrome delivered in a district North-West Wales National Health Service Hospital. Methods: 26 patients with Patellofemoral Pain Syndrome (9 males, 16 females) who were referred to the NHS physiotherapy department where asked to complete an AKP Scale and two VASs along with a series of clinical tests that measure lower limb isometric strength and flexibility in two different occasions; The first occasion took place directly after the first treatment session with the physiotherapist; the second occasion took place directly after the last physiotherapy visit which was approximately after 5-8 weeks. Results: The data showed that physiotherapy treatment in patients with PFPS did not improve strength (measured by the lower limb isometric strength tests or flexibility (measured by the modified Thomas and hamstrings flexibility test) however; pain measured by two VASs (one for usual pain and one for pain on the day of the assessment) and function measured by the AKP Scale function, were significantly improved (VASs p<0.02 & AKP Scale p<0.01 ). Conclusions: This study reported that physiotherapy treatment in patients with PFPS works, not through strength and flexibility but through other components. There are several possible explanations for the results of this study. Future studies should aim to identify the different treatment components and which of these really work for patients with PFPS

Reproducibility of lower strength tests using a new portable dynamometer; measurement comparisons with a non-portable dynamometer

Objectives: Hand-held dynamometers have been used to assess lower limb muscle strength. However, they have been reported to have various reliability and be dependent on the strength of the participant and that of the examiner. A new way to assess lower limb muscle strength using a portable load cell is being introduced in assessing knee extensors, hip abductors, hip external rotators and combined hip abductors and external rotators (‘clam’ position). The study aimed to identify the test-retest reliability, intra-rater reliability and validity of the new assessment method. Method: Twenty healthy controls took part in this study which took place in a physiology lab and performed four isometric strength tests on the portable dynamometer at two times. The first time the tests were also performed in an isokinetic dynamometer to assess validity. Results: The new assessment method was found have high reliability (knee extension ICC=0.99; hip abduction ICC=0.94; hip external rotation=0.97; ‘clam’=0.95) and high validity (knee extension ICC=0.99; hip abduction ICC=0.98; hip external rotation=0.90; ‘clam’=0.98) when compared to a gold standard isokinetic dynamometer. Conclusion: The new method is reliable and valid. It is more time-consuming than a hand-held dynamometer however it provides precise results without being dependent on the examiner

A model of applied physiotherapy in patellofemoral pain

Patellofemoral Pain (PFP) is a very common knee condition with various aetiologies. This short communication facilitates a ‘collective’ case study approach that draws together a range of evidence from different ‘cases’. These cases are defined as areas of evidence underpinning PFP management as an applied physiotherapy phenomenon. This communication reports the complexity of PFP in terms of the (i) evidence-base, (ii) the application of clear guidance, (iii) the actions of physiotherapists in the applied field context and (iv) and the fundamental dissonance rather than bridging of the evidence-base and applied practice. A model of applied physiotherapy is presented that articulates how PFP should be viewed as a complex intervention and that a modified Promoting Action on Research Implementation (PARIHS) framework should be utilised to address the deficits of clinical practice

Quantitative risk analysis for road tunnels complying with EU regulations

Tunnels have improved the connection of regions within the European Commission (EC) and have been used lately as a catalyst for economic development of previously isolated regions. However, the increasing number of these important infrastructures is raising upfront an endogenous problem, which is the severity of accidents that may occur. These risks have much greater impact when heavy goods vehicles (HGVs) or dangerous goods (DGs) are involved in the accident. As a result, the EC launched the EC Directive 2004/54/EC. In order to achieve a minimum acceptable level of safety, the EC Directive 2004/54/EC suggests, apart from the measures imposed based on tunnel characteristics, the implementation of a risk analysis in cases such as the opening of the road tunnel to DGs. The most widely accepted method for such quantitative risk analysis (QRA) is the OECD/PIARC QRA Model. This research exploits the QRA Model to perform a QRA for five illustrative cases in order to explore the sufficiency of the minimum tunnel safety measures imposed by the Directive when transportation of HGVs and DGs is allowed through the tunnel. The research concludes that, at least for tunnels with marginal values of the EC Directive classes for length and traffic, the risk exposure (F/N curves) lays over the acceptable safety limits of ALARP (as low as reasonably practicable) models. Thus, the manager of the tunnel should take seriously into account the provision of the Directive for further risk analysis and consider more safety measures as well as take into account the risk associated with the alternative routes

A simplified mathematical model for thrombin generation

A new phenomenological mathematical model based directly on laboratory data for thrombin generation and having a patient-specific character is described. A set of the solved equations for cell-based models of blood coagulation that can reproduce the temporal evolution of thrombin generation is proposed; such equations are appropriate for use in computational fluid dynamic (CFD) simulations. The initial values for the reaction rates are either taken from already existing model or experimental data, or they can obtained from simple reasoning under certain assumptions; it is shown that coefficients can be adjusted in order to fit a range of different thrombin generation curves as derived from thrombin generation assays. The behaviour of the model for different platelet concentration seems to be in good agreement with reported experimental data. It is shown that the reduced set of equations used represents to a good approximation a low-order model of the detailed mechanism and thus it can represent a cost-effective and-case specific mathematical model of coagulation reactions up to thrombin generation

Perceptions of physiotherapists of their role in reducing pain and increasing, function, strength and flexibility in patients with Patellofemoral Pain Syndrome

Study objectives: The purpose of this focus group study was to establish the physiotherapy treatment of Patellofemoral Pain Syndrome in North-West Wales. In addition the study aimed to report the barriers that stopped physiotherapists from increasing strength and flexibility and the contradictions of physiotherapists’ beliefs regarding their practice. Methods: The investigation was based on specific and priori designed questions. Two focus groups were conducted, where physiotherapists discussed the results of a feasibility study conducted in their department. 11 hypotheses discussed whilst 13 evidence statements reported by the merger of the answers to the hypotheses. A level of consensus was described using the moderator’s notes. Results: Patellofemoral Pain Syndrome physiotherapy works; not through strength and flexibility but through pain and function improvement. However, this practice often only has a short-term effect. Conclusions: Group classes and better education on the importance of specific exercises and self-managing should be researched whilst the long-term effect of these treatment components should also be assessed

A systematic review of reviews on patellofemoral pain syndrome. Exploring the risk factors, diagnostic tests, outcome measurements and exercise treatment

Abstract: Background: Literature has shown a growing number of published studies on Patellofemoral Pain Syndrome every year. The increasing evidence base has revealed a significant number of reviews which makes it confusing for clinicians and researchers to choose from the best evidence. This study aimed to gather the reviews on Patellofemoral Pain Syndrome and provide information about the most common clinical tests, risk factors, exercise treatment and outcome measures. In addition, secondary questions aimed to report the study settings and patient characteristics of the primary included studies. Methods: Studies eligible for this Review of Reviews were those published from 1993 to July 2013. Databases searched included PubMed, CINAHL, SPORTDiscus, Pedro and the Cochrane Library. Four key areas were searched using the words: PFPS, Anterior Knee Pain (AKP) or Chondromalacia patella (CP), plus a keyword. The keywords for the four research topics were a) risk factors; b) exercise treatment; c) diagnostic clinical tests and d) psychometric outcome measurements. Only reviews with clear methodological strategy were included. A two-stage evaluation was performed ineach review assessment. At first, the level of evidence was graded and then the methodological quality of each review was assessed. Results: Full text screening revealed that only 18 reviews were eligible for use. The selected reviews included 213 primary studies. After excluding duplicates, 144 primary studies were screened to answer the secondary questions. A gold standard clinical test for PFPS assessment cannot be reached and the use of functional tasks should be considered. The quadriceps strength deficits are still the only evidence based risk factors along with the dynamic malalignment of the lower limb. More research is still required on strength and flexibility deficits of other lower limb muscles. The quadriceps-based exercises are still the only ones to have strong evidence together with hamstrings, quadriceps, gastrocnemius and anterior hip muscles stretching. Finally, the usage of Activities of Daily Living Scale is recommended as the best outcome measure. Conclusion: There is no evidence on whether the above treatment and assessment methods should be used in sedentarypeople or differently across population groups or gender. More RCTs with large populations, powered correctly, inclinical environments are called for in further research