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Physical therapy is probably effective for patellofemoral pain

BMJ 2003; 326 doi: (Published 01 March 2003) Cite this as: BMJ 2003;326:g

Question Is physical therapy effective in treating patellofemoral pain?

Synopsis These authors took patients with knee pain due to patellofemoral dysfunction and randomly assigned them (masked allocation) to receive physical therapy (n=36) or sham physical therapy (n=35). They set up the study to detect a difference of 1.5 cm on a 10 cm pain scale; others have suggested that a 2 cm difference is clinically important. They followed the patients for six weeks. At the end of the study, they asked the patients to guess which treatment they actually received. In the group receiving physical therapy, 25 (76%) thought they had received physical therapy, while only 11 (35%) of those receiving sham treatment thought they had received physical treatment. The authors used an intention to treat approach to analysing their data. At the end of the six week period, the difference in the mean change of the patients' worst pain was 2 cm while the difference in their usual pain was 1.5 cm. The authors also found a 10 point decline in anterior knee pain on a 100 point scale (so 20 would be clinically meaningful). They found no difference in ratings of functional disability.

Bottom line The authors of this reasonably well done study say that physical therapy improves pain in patients with patellofemoral pain. However, the blinding was flawed, and the differences detected, while statistically significant, may not be clinically significant. It is possible that physical therapy has no real effect.

Level of evidence Individual cohort study or low quality randomised controlled trials (<80% follow up).



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