Developing Clinical and Research Priorities for Pain and Psychological Features in People With Patellofemoral Pain:An International Consensus Process With Health Care Professionals

OBJECTIVE: To decide clinical and research priorities on pain features and psychological factors in persons with patellofemoral pain. DESIGN: Consensus development process. METHODS: We undertook a 3-stage process consisting of (1) updating 2 systematic reviews on quantitative sensory testing of pain features and psychological factors in patellofemoral pain, (2) an online survey of health care professionals and persons with patellofemoral pain, and (3) a consensus meeting with expert health care professionals. Participants responded that they agreed, disagreed, or were unsure that a pain feature or psychological factor was important in clinical practice or as a research priority. Greater than 70% participant agreement was required for an item to be considered important in clinical practice or a research priority. RESULTS: Thirty-five health care professionals completed the survey, 20 of whom attended the consensus meeting. Thirty persons with patellofemoral pain also completed the survey. The review identified 5 pain features and 9 psychological factors—none reached 70% agreement in the patient survey, so all were considered at the meeting. Afte the meeting, pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy were the only factors considered clinically important. All but the therma pain tests and 3 psychological factors were consid ered research priorities. CONCLUSION: Pain catastrophizing, pain self-efficacy, and fear-avoidance beliefs were factors considered important in treatment planning, clinical examination, and prognostication. Quantitative sensory tests for pain were not regarded as clinically important but were deemed to be research priorities, as were most psychological factors.</p

A prospective investigation of biomechanical risk factors for anterior knee pain

Anterior knee pain is one of the most common chronic knee conditions in the United States; however, little research has been done to determine the risk factors for this injury. The main objective of this investigation was to determine the biomechanical risk factors for anterior knee pain in a military population. We assessed lower extremity kinematics, kinetics, muscle strength, and postural measures as risk factors for the development of anterior knee pain. A total of 1597 participants were enrolled in this investigation. Each participant underwent baseline data collection during their first summer of enrollment at the United States Naval Academy. Baseline data collection included three-dimensional motion analysis during a jump-landing task, six lower extremity isometric strength tests, and measurement of navicular drop and Q-angle. Following baseline data collection participants were followed from their date of enrollment to January 15, 2008. Due to the enrollment of participants over the summers of 2005, 2006, and 2007, the follow up time for participants varied. Forty (females=24, males=16) of the enrolled participants were diagnosed with anterior knee pain over the course of the follow up period. Due to incomplete data collection for some of the participants, the cohort of non-injured subjects reduced to 1279. Poisson regression analyses were performed to determine the risk factors for the development of anterior knee pain. We also performed a 2x2 (gender x group) ANOVA to determine if there was a difference between genders for the risk factors for anterior knee pain. Poisson and logistic regression analyses were performed to determine if gender significantly predicted the incidence rate or prevalence of anterior knee pain. Risk factors for the development of anterior knee pain included decreased knee flexion angle and vertical ground reaction force and increased hip internal rotation angle during the jump-landing task. Additionally, decreased knee flexion and extension strength, increased hip external rotation strength, and increased navicular drop were risk factors for the development of anterior knee pain. There were no significant differences between males and females who developed anterior knee pain for the risk factor variables. The incidence rate of anterior knee pain in females was significantly greater than males, with females having 2.23 times (95% CI: 1.19, 4.20) the rate of anterior knee pain compared to males. There was no difference in the prevalence of anterior knee pain between males and females. Decreased strength, increased hip internal rotation angle, and increased navicular drop may be predisposing individuals to the development of anterior knee pain due to these muscle imbalances and malalignments leading to patellar malalignment. This suggests that prevention programs should focus on increasing strength of the lower extremity musculature along with instructing proper mechanics during dynamic movements in order to decrease the incidence of anterior knee pain. Additionally, targeting prevention programs towards females may help to decrease the incidence rate of anterior knee pain

Y-balance test performance and BMI are associated with ankle sprain injury in collegiate male athletes

Objectives: To determine if static balance, dynamic balance, ankle range of motion, body mass index (BMI), or history of an ankle sprain were associated with ankle sprain injuries within male and female collegiate athletes. Design: Prospective cohort. Methods: Three hundred and eighty-four male (age = 19.79 ± 1.80 years, height = 178.02 ± 10.39 cm, mass = 85.71 ± 17.59 kg) and one hundred and sixty seven female (age = 19.80 ± 1.52 years, height = 165.61 ± 7.08 cm, mass = 66.16 ± 10.53 kg) collegiate athletes involved in a variety of sports at a NCAA Division II or NAIA institution participated. Baseline measures of the Y-Balance (YBT), modified Balance Error Scoring System (mBESS), weight-bearing lunge test (WBLT), BMI, and history of ankle sprain were recorded. Participants were followed prospectively for two years and incidence of ankle sprain injury was documented. The average of the WBLT, mBESS, and YBT measures were used for analysis. Male and female participants were analyzed separately. Mann–Whitney U tests were utilized to identify variables which may be significantly associated with ankle sprain injury for logistic regression analysis. Results: A total of 59 (38 males and 21 females) individuals sustained an ankle sprain during the follow up period. The binary logistic regression revealed BMI (Nagelkerke R2 = 0.069; X2 = 12.89; p \u3c 0.001; OR = 3.85; 95% CI, 1.90–7.79; p \u3c 0.001) and anterior reach of the YBT (Nagelkerke R2 = 0.074; X2 = 13.70, p \u3c 0.001; OR = 3.64; 95% CI = 1.83–7.23; p = 0.01) were significantly associated with ankle sprain injury in male athletes. No variables were associated with ankle sprain injury within female athletes. Conclusions: Male collegiate athletes with greater BMI and lesser YBT anterior reach were at a greater risk of sustaining an ankle sprain injury

Anterior knee pain risk in male and female military tactical athletes

Context: Anterior knee pain (AKP) is ubiquitous in early career military members and exacerbated during functional tasks required during military duties. Therefore, it is important to understand the risk of this condition among male and female tactical athletes in diverse military occupations. Objective: To assess sex and occupation with respect to the AKP risk in military members. Design: Descriptive epidemiology study. Setting: United States Armed Forces. Patients or Other Participants: All military members diagnosed with anteropatellar or retropatellar pain, patellar instability, or knee tendinopathy on their initial encounter from 2006 to 2015. Main Outcome Measure(s): The Defense Medical Epidemiology Database was queried for the number of individuals with AKP. Relative risk (RR) and χ2 statistics were calculated in the assessment of sex and occupational category. Regressions were calculated to determine associations between service branch, sex, and AKP across time. Results: From 2006 to 2015, a total of 151 263 enlisted and 14 335 officer service members were diagnosed with AKP. Enlisted females had an incidence rate of 16.7 per 1000 person-years compared with enlisted males\u27 incidence rate of 12.7 per 1000 person-years (RR = 1.32; 95% CI = 1.30, 1.34; P\u3c.001) across all AKP diagnoses. Female officers had an incidence rate of 10.7 per 1000 person-years; male officers had an incidence rate of 5.3 per 1000 person-years (RR = 2.01; 95% CI = 1.94, 2.09). Differences in risk were also noted across military occupations for both enlisted and officer service members (P values,.05). Conclusions: Sex and military occupation were salient factors for the AKP risk. Evaluating training requirements and developing intervention programs across military occupations could serve as a focus for future research aiming to decrease the incidence of chronic knee pain

Pain severity during functional activities in individuals with patellofemoral pain: A systematic review with meta-analysis

OBJECTIVES: Patellofemoral pain (PFP) is a common lower extremity condition that results in pain during functional tasks. Currently, it is unknown the extent to which differences in pain levels exist in individuals with PFP compared to asymptomatic controls during functional task and if pain differ across various functional tasks. The purpose of this systematic review and meta-analysis is to evaluate pain levels between individuals with PFP and asymptomatic controls and compare pain severity across various functional tasks. DESIGN: Systematic review. METHODS: OVID, SPORTSDiscus, CINAHL, Web of Science and Embase were searched for studies that included PFP and asymptomatic controls with pain assessed during a functional task. Pooled pain scores mean with 95% confidence intervals were calculated between groups across 11 functional tasks. Standardized mean differences (SMD) were calculated based on Hedge\u27s g effect sizes. Tasks whose SMD 95% confidence intervals were non-overlapping were considered significantly different. RESULTS: 28 articles were included for data analysis. Pain was greater across 10 tasks (SMD = 1.52-6.08) in individuals with PFP compared to the asymptomatic controls with an average SMD of 2.45. Running and star excursion balance testing resulted in greater pain than walking. Limited evidence showed greater pain in sitting than seven other tasks. CONCLUSIONS: Moderate evidence exists for greater pain levels in individuals with PFP compared to asymptomatic controls in functional tasks. Pain was greater during running and star excursion balance compared to walking. Clinicians should assess knee pain before and after functional tasks to improve our understanding of patient specific pain experiences