Background Current multimodal approaches for the
management of non-specific patellofemoral pain a... more Background Current multimodal approaches for the management of non-specific patellofemoral pain are not optimal, however, targeted intervention for subgroups could improve patient outcomes. This study explores whether subgrouping of non-specific patellofemoral pain patients, using a series of low cost simple clinical tests, is possible. Method The exclusivity and clinical importance of potential subgroups was assessed by applying à priori test thresholds (1 SD) from seven clinical tests in a sample of adult patients with non-specific patellofemoral pain. Hierarchical clustering and latent profile analysis, were used to gain additional insights into subgroups using data from the same clinical tests. Results 130 participants were recruited, 127 had complete data: 84 (66%) female, mean age 26 years (SD 5.7) and mean body mass index 25.4 (SD 5.83), median (IQR) time between onset of pain and assessment was 24 (7–60) months. Potential subgroups defined by the à priori test thresholds were not mutually exclusive and patients frequently fell into multiple subgroups. Using hierarchical clustering and latent profile analysis three subgroups were identified using 6 of the 7 clinical tests. These subgroups were given the following nomenclature: (1) ‘strong’, (2) ‘weak and tighter’ and (3) ‘weak and pronated foot’. Conclusions We conclude that three subgroups of patellofemoral patients may exist based on the results of six clinical tests which are feasible to perform in routine clinical practice. Further research is needed to validate these findings in other data sets and, if supported by external validation, to see if targeted interventions for these subgroups improve patient outcomes.
Current multimodal approaches for the management of non-specific patellofemoral pain are not opti... more Current multimodal approaches for the management of non-specific patellofemoral pain are not optimal, however, targeted intervention for subgroups could improve patient outcomes. This study explores whether subgrouping of non-specific patellofemoral pain patients, using a series of low cost simple clinical tests, is possible. The exclusivity and clinical importance of potential subgroups was assessed by applying à priori test thresholds (1 SD) from seven clinical tests in a sample of adult patients with non-specific patellofemoral pain. Hierarchical clustering and latent profile analysis, were used to gain additional insights into subgroups using data from the same clinical tests. 130 participants were recruited, 127 had complete data: 84 (66%) female, mean age 26 years (SD 5.7) and mean body mass index 25.4 (SD 5.83), median (IQR) time between onset of pain and assessment was 24 (7-60) months. Potential subgroups defined by the à priori test thresholds were not mutually exclusive a...
ABSTRACT Purpose: This study examined relationships between vibrationsensation and joint position... more ABSTRACT Purpose: This study examined relationships between vibrationsensation and joint position sense (JPS) at the knee in healthy subjects; to establish whether vibratory perception threshold (VPT) tests may be used as an alternative to JPS testing and to establish the minimum number of trials required to attain data stability. Relevance: Proprioceptive testing methods at the knee have been criticized for their poor reliability and variability. As both vibration sense and JPS travel through similar neurological pathways, it has been suggested that a relationship exists between JPS and VPT at the knee. Similarities between these methods may open the use of VPT testing as a convenient, cheaper alternative to JPS testing in clinical and research settings. Participants: Twenty healthy adults (11 females, 9 males; aged 26.8±8.2 years) were tested for VPT and JPS. Methods: VPT was tested at five anatomical sites at the lower limb (first metatarsophalangeal joint, medial and lateral malleoli and the medial and lateral femoral condyles) using a biothesiometer (Bio-Medical Instrument, OH). JPS was measured using active angle reproduction (AAR) at target angles of 20◦ and 60◦ of knee flexion using a Cybex Norm Isokinetic Dynamometer System (CSMI Medical Solutions). Analysis: The number of required repetitions were investigated by calculating the cumulative means and standard deviations from VPT and JPS data for all subjects at each test site. The differences between the 5 testing sites for VPT and two test angles for JPS were investigated using repeated measures analysis of variance, followed by post hoc pair-wise comparisons. Pearson product–moment correlation coefficients were used to determine the relationships between the measures of proprioception from VPT and JPS. Results: Results showed no significant correlation between VPT and the two AAR test angles (r < 0.3). Intra-method assessments showed similarities in repeatability, in that VPT (all sites) and AAR 20◦ required 4 repetitions to attain data stability, whereas at AAR 60◦ five repetitions were required. There were significant differences (p < 0.005) between the joints tested for VPT and no significant differences were seen within joint for VPT or between angles for JPS. Conclusions: This study supports the notion that increased numbers of repetitions are necessary for data stabilisation. This study is the first to suggest a minimum reference standard for the number of repetitions required for VPT and JPS testing. It has shown that the JPS test of AAR at 20◦ and all VPT tests required 4 repetitions to attain data stability. However, when testing AAR at 60◦ five repetitions were required to attain data stability. The lack of correlation between VPT and JPS suggests the two modalities measure different facets of proprioception. Some disorders affect one of these sensory functions while partially or completely sparing the other. Further research is required using independent methods in clinical groups such as PFPS to allow proprioceptive subgrouping. Implications: Whilst the two testing modalities are independent of each other, these findings have implications for clinicians and researchers, encouraging the use of broader proprioceptive assessments and increased repetitions to attain consistent stable data.
The purpose of this study was to investigate the effect of increasing the number of test trials i... more The purpose of this study was to investigate the effect of increasing the number of test trials in the assessment of knee joint position sense, in a group of patellofemoral patients, and second, to investigate the effects of joint angle and type of test. Thirty-two patients with a diagnosis of patellofemoral pain syndrome were admitted to this study. Knee joint position sense was measured by performing an ipsilateral matching activity at target angles of 20 degrees and 60 degrees using two techniques; Passive Angle Reproduction (PAR), and Active Angle Reproduction (AAR). The results show that five repetitions are required for AAR and six for PAR. A two-way repeated-measures ANOVA showed that there was no significant difference (p = 0.559) in the accuracy of angle reproduction for the two angles (60 degrees and 20 degrees ); however, there was a significant difference (p = 0.001) between the two types of test (AAR and PAR). The results of this study have implications for clinicians and researchers who examine knee joint proprioception as part of functional assessment in a variety of knee joint pathologies including PFPS. A "quick" one-off assessment of knee joint position sense may give erroneous data; subjects need to have several trials before a true picture of their proprioceptive status emerges. Type of testing performed, active or passive, is also important, although the angle of testing may not be relevant.
Background Current multimodal approaches for the
management of non-specific patellofemoral pain a... more Background Current multimodal approaches for the management of non-specific patellofemoral pain are not optimal, however, targeted intervention for subgroups could improve patient outcomes. This study explores whether subgrouping of non-specific patellofemoral pain patients, using a series of low cost simple clinical tests, is possible. Method The exclusivity and clinical importance of potential subgroups was assessed by applying à priori test thresholds (1 SD) from seven clinical tests in a sample of adult patients with non-specific patellofemoral pain. Hierarchical clustering and latent profile analysis, were used to gain additional insights into subgroups using data from the same clinical tests. Results 130 participants were recruited, 127 had complete data: 84 (66%) female, mean age 26 years (SD 5.7) and mean body mass index 25.4 (SD 5.83), median (IQR) time between onset of pain and assessment was 24 (7–60) months. Potential subgroups defined by the à priori test thresholds were not mutually exclusive and patients frequently fell into multiple subgroups. Using hierarchical clustering and latent profile analysis three subgroups were identified using 6 of the 7 clinical tests. These subgroups were given the following nomenclature: (1) ‘strong’, (2) ‘weak and tighter’ and (3) ‘weak and pronated foot’. Conclusions We conclude that three subgroups of patellofemoral patients may exist based on the results of six clinical tests which are feasible to perform in routine clinical practice. Further research is needed to validate these findings in other data sets and, if supported by external validation, to see if targeted interventions for these subgroups improve patient outcomes.
Current multimodal approaches for the management of non-specific patellofemoral pain are not opti... more Current multimodal approaches for the management of non-specific patellofemoral pain are not optimal, however, targeted intervention for subgroups could improve patient outcomes. This study explores whether subgrouping of non-specific patellofemoral pain patients, using a series of low cost simple clinical tests, is possible. The exclusivity and clinical importance of potential subgroups was assessed by applying à priori test thresholds (1 SD) from seven clinical tests in a sample of adult patients with non-specific patellofemoral pain. Hierarchical clustering and latent profile analysis, were used to gain additional insights into subgroups using data from the same clinical tests. 130 participants were recruited, 127 had complete data: 84 (66%) female, mean age 26 years (SD 5.7) and mean body mass index 25.4 (SD 5.83), median (IQR) time between onset of pain and assessment was 24 (7-60) months. Potential subgroups defined by the à priori test thresholds were not mutually exclusive a...
ABSTRACT Purpose: This study examined relationships between vibrationsensation and joint position... more ABSTRACT Purpose: This study examined relationships between vibrationsensation and joint position sense (JPS) at the knee in healthy subjects; to establish whether vibratory perception threshold (VPT) tests may be used as an alternative to JPS testing and to establish the minimum number of trials required to attain data stability. Relevance: Proprioceptive testing methods at the knee have been criticized for their poor reliability and variability. As both vibration sense and JPS travel through similar neurological pathways, it has been suggested that a relationship exists between JPS and VPT at the knee. Similarities between these methods may open the use of VPT testing as a convenient, cheaper alternative to JPS testing in clinical and research settings. Participants: Twenty healthy adults (11 females, 9 males; aged 26.8±8.2 years) were tested for VPT and JPS. Methods: VPT was tested at five anatomical sites at the lower limb (first metatarsophalangeal joint, medial and lateral malleoli and the medial and lateral femoral condyles) using a biothesiometer (Bio-Medical Instrument, OH). JPS was measured using active angle reproduction (AAR) at target angles of 20◦ and 60◦ of knee flexion using a Cybex Norm Isokinetic Dynamometer System (CSMI Medical Solutions). Analysis: The number of required repetitions were investigated by calculating the cumulative means and standard deviations from VPT and JPS data for all subjects at each test site. The differences between the 5 testing sites for VPT and two test angles for JPS were investigated using repeated measures analysis of variance, followed by post hoc pair-wise comparisons. Pearson product–moment correlation coefficients were used to determine the relationships between the measures of proprioception from VPT and JPS. Results: Results showed no significant correlation between VPT and the two AAR test angles (r < 0.3). Intra-method assessments showed similarities in repeatability, in that VPT (all sites) and AAR 20◦ required 4 repetitions to attain data stability, whereas at AAR 60◦ five repetitions were required. There were significant differences (p < 0.005) between the joints tested for VPT and no significant differences were seen within joint for VPT or between angles for JPS. Conclusions: This study supports the notion that increased numbers of repetitions are necessary for data stabilisation. This study is the first to suggest a minimum reference standard for the number of repetitions required for VPT and JPS testing. It has shown that the JPS test of AAR at 20◦ and all VPT tests required 4 repetitions to attain data stability. However, when testing AAR at 60◦ five repetitions were required to attain data stability. The lack of correlation between VPT and JPS suggests the two modalities measure different facets of proprioception. Some disorders affect one of these sensory functions while partially or completely sparing the other. Further research is required using independent methods in clinical groups such as PFPS to allow proprioceptive subgrouping. Implications: Whilst the two testing modalities are independent of each other, these findings have implications for clinicians and researchers, encouraging the use of broader proprioceptive assessments and increased repetitions to attain consistent stable data.
The purpose of this study was to investigate the effect of increasing the number of test trials i... more The purpose of this study was to investigate the effect of increasing the number of test trials in the assessment of knee joint position sense, in a group of patellofemoral patients, and second, to investigate the effects of joint angle and type of test. Thirty-two patients with a diagnosis of patellofemoral pain syndrome were admitted to this study. Knee joint position sense was measured by performing an ipsilateral matching activity at target angles of 20 degrees and 60 degrees using two techniques; Passive Angle Reproduction (PAR), and Active Angle Reproduction (AAR). The results show that five repetitions are required for AAR and six for PAR. A two-way repeated-measures ANOVA showed that there was no significant difference (p = 0.559) in the accuracy of angle reproduction for the two angles (60 degrees and 20 degrees ); however, there was a significant difference (p = 0.001) between the two types of test (AAR and PAR). The results of this study have implications for clinicians and researchers who examine knee joint proprioception as part of functional assessment in a variety of knee joint pathologies including PFPS. A "quick" one-off assessment of knee joint position sense may give erroneous data; subjects need to have several trials before a true picture of their proprioceptive status emerges. Type of testing performed, active or passive, is also important, although the angle of testing may not be relevant.
Uploads
management of non-specific patellofemoral pain are not
optimal, however, targeted intervention for subgroups
could improve patient outcomes. This study explores
whether subgrouping of non-specific patellofemoral pain
patients, using a series of low cost simple clinical tests,
is possible.
Method The exclusivity and clinical importance of
potential subgroups was assessed by applying à priori
test thresholds (1 SD) from seven clinical tests in a
sample of adult patients with non-specific patellofemoral
pain. Hierarchical clustering and latent profile analysis,
were used to gain additional insights into subgroups
using data from the same clinical tests.
Results 130 participants were recruited, 127 had
complete data: 84 (66%) female, mean age 26 years
(SD 5.7) and mean body mass index 25.4 (SD 5.83),
median (IQR) time between onset of pain and
assessment was 24 (7–60) months. Potential subgroups
defined by the à priori test thresholds were not mutually
exclusive and patients frequently fell into multiple
subgroups. Using hierarchical clustering and latent
profile analysis three subgroups were identified using 6
of the 7 clinical tests. These subgroups were given the
following nomenclature: (1) ‘strong’, (2) ‘weak and
tighter’ and (3) ‘weak and pronated foot’.
Conclusions We conclude that three subgroups of
patellofemoral patients may exist based on the results of
six clinical tests which are feasible to perform in routine
clinical practice. Further research is needed to validate
these findings in other data sets and, if supported by
external validation, to see if targeted interventions for
these subgroups improve patient outcomes.
management of non-specific patellofemoral pain are not
optimal, however, targeted intervention for subgroups
could improve patient outcomes. This study explores
whether subgrouping of non-specific patellofemoral pain
patients, using a series of low cost simple clinical tests,
is possible.
Method The exclusivity and clinical importance of
potential subgroups was assessed by applying à priori
test thresholds (1 SD) from seven clinical tests in a
sample of adult patients with non-specific patellofemoral
pain. Hierarchical clustering and latent profile analysis,
were used to gain additional insights into subgroups
using data from the same clinical tests.
Results 130 participants were recruited, 127 had
complete data: 84 (66%) female, mean age 26 years
(SD 5.7) and mean body mass index 25.4 (SD 5.83),
median (IQR) time between onset of pain and
assessment was 24 (7–60) months. Potential subgroups
defined by the à priori test thresholds were not mutually
exclusive and patients frequently fell into multiple
subgroups. Using hierarchical clustering and latent
profile analysis three subgroups were identified using 6
of the 7 clinical tests. These subgroups were given the
following nomenclature: (1) ‘strong’, (2) ‘weak and
tighter’ and (3) ‘weak and pronated foot’.
Conclusions We conclude that three subgroups of
patellofemoral patients may exist based on the results of
six clinical tests which are feasible to perform in routine
clinical practice. Further research is needed to validate
these findings in other data sets and, if supported by
external validation, to see if targeted interventions for
these subgroups improve patient outcomes.