close

Вход

Забыли?

вход по аккаунту

?

Patellar taping and bracing for the treatment of chronic knee painA systematic review and meta-analysis.

код для вставкиСкачать
Arthritis & Rheumatism (Arthritis Care & Research)
Vol. 59, No. 1, January 15, 2008, pp 73– 83
DOI 10.1002/art.23242
© 2008, American College of Rheumatology
ORIGINAL ARTICLE
Patellar Taping and Bracing for the Treatment of
Chronic Knee Pain: A Systematic Review and
Meta-Analysis
STUART J. WARDEN,1 RANA S. HINMAN,2 MARK A. WATSON, JR.,3 KEITH G. AVIN,3
ANDREA E. BIALOCERKOWSKI,2 AND KAY M. CROSSLEY2
Objective. To evaluate the evidence for patellar taping and bracing in the management of chronic knee pain.
Methods. Randomized or quasi-randomized studies assessing patellar taping or bracing effects on chronic knee pain
were sourced from 7 electronic databases (to November 2006), and assessed using the Physiotherapy Evidence Database
scale. Weighted mean differences were determined, and pooled estimates of taping and bracing effects were obtained
using random-effects models.
Results. Of 16 eligible trials, 13 investigated patellar taping or bracing effects in individuals with anterior knee pain, and
3 investigated taping effects in individuals with knee osteoarthritis (OA). The methodologic quality of the taping studies
was significantly higher than the bracing studies (mean ⴞ SD 4.8 ⴞ 2.1 versus 2.8 ⴞ 0.8; P < 0.05). On a 100-mm scale,
tape applied to exert a medially-directed force on the patella decreased chronic knee pain compared with no tape by 16.1
mm (95% confidence interval [95% CI] ⴚ22.2, ⴚ10.0; P < 0.001) and sham tape by 10.9 mm (95% CI ⴚ18.4, ⴚ3.4; P <
0.001). For anterior knee pain and OA, medially-directed tape decreased pain compared with no tape by 14.7 mm (95%
CI ⴚ22.8, ⴚ6.9; P < 0.001) and 20.1 mm (95% CI ⴚ26.0, ⴚ14.3; P < 0.001), respectively. There was disputable evidence
from low-quality studies for patellar bracing benefits.
Conclusion. There was evidence that tape applied to exert a medially-directed force on the patella produces a clinically
meaningful change in chronic knee pain. There was limited evidence to demonstrate the efficacy of patellar bracing.
These outcomes were limited by the presence of high heterogeneity between study outcomes and significant publication
bias.
INTRODUCTION
Chronic knee pain is a leading cause of disability, and
accounts for a large proportion of visits to health professionals. The most frequent presentation in younger people
(age ⬍50 years) is anterior knee pain, characterized by a
gradual onset of poorly-localized pain under or around the
1
Stuart J. Warden, PT, PhD, FACSM: School of Health and
Rehabilitation Sciences, Indiana University, Indianapolis,
and Centre for Health, Exercise and Sports Medicine, School
of Physiotherapy, The University of Melbourne, Melbourne,
Victoria, Australia; 2Rana S. Hinman, PT, PhD, Andrea E.
Bialocerkowski, PT, PhD, Kay M. Crossley, PT, PhD: The
University of Melbourne, Melbourne, Victoria, Australia;
3
Mark A. Watson, Jr., DPT, Keith G. Avin, DPT: School of
Health and Rehabilitation Sciences, Indiana University, Indianapolis.
Address correspondence to Stuart J. Warden, PT, PhD,
FACSM, Department of Physical Therapy, School of Health
and Rehabilitation Sciences, Indiana University, Indianapolis, IN 46202. E-mail: stwarden@iupui.edu.
Submitted for publication March 2, 2007; accepted in
revised form June 11, 2007.
patellofemoral joint. It is aggravated by activities including
squatting, stair climbing and descent, and prolonged sitting with the knee bent (1). In contrast, the most common
cause of knee pain in older individuals (age ⬎50 years) is
osteoarthritis (OA). Knee OA is a chronic disease affecting
articular cartilage and subchondral bone, typically affecting the patellofemoral and tibiofemoral joints concurrently
(2). Pain associated with knee OA is insidious in onset,
usually aggravated by movement or weight bearing, and
relieved by rest.
The mainstay of treatment for chronic knee pain is management of symptoms (3,4). Two frequently-used treatments are therapeutic taping and bracing of the patella.
Taping involves applying adhesive, rigid, strapping tape to
glide, tilt, and/or rotate the patella, whereas bracing involves applying an external, nonadhesive device that also
aims to modify patella position (the latter is distinct from
valgus and varus bracing used to treat tibiofemoral joint
OA). Both treatments aim to reduce pain by increasing the
patellofemoral contact area, thereby decreasing joint
stress. They are ideal treatments for chronic knee pain as
they are simple, inexpensive, and associated with negligi73
74
ble adverse effects. This type of treatment decreases the
burden associated with treating chronic knee pain because
patients can be taught to self-tape or self-brace, increasing
their responsibility in management.
Although they are clinically popular and recommended
(3,5), the effectiveness of patellar taping and bracing in the
management of chronic knee pain is still debated (4,6,7). It
is not currently known whether patellar taping and bracing effects differ: 1) with the direction of force applied to
the patella, 2) between anterior knee pain and OA, 3) from
sham effects, or 4) between the 2 respective interventions.
This study addresses these questions. Studies of anterior
knee pain and knee OA were both included because they
are the most common causes of chronic knee pain treated
by patellar taping and bracing, and because patellar taping
and bracing are thought to produce similar effects across
these 2 diagnoses.
MATERIALS AND METHODS
Inclusion and exclusion criteria. The protocol was established a priori. Randomized or quasi-randomized studies assessing patellar taping or bracing effects on chronic
knee pain were sourced. There were no restrictions on the
cause, severity, or history of knee pain, nor on the underlying pathology. There were no restrictions on followup
duration; studies reporting both immediate (same-day)
and longer-term effects of patellar taping and bracing were
included. Studies evaluating combined effects of taping or
bracing with a concurrent intervention were included if
the isolated effects of taping or bracing could be elucidated. Dissertations, conference proceedings, and studies
in non-English languages were excluded. Experts in the
field were not contacted to obtain possible unpublished
studies, as these may be subject to bias.
Search strategy. Relevant studies were identified by sequentially searching the following databases: Medline
(1980 to November 2006); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to November 2006); Evidence Based Medicine (EBM) Reviews
(to November 2006); the ISI Web of Knowledge CrossSearch (1980 to November 2006); SPORTDiscus (1980 to
November 2006); Expanded Academic ASAP (1980 to November 2006); and the Physiotherapy Evidence Database
(PEDro) (to November 2006). Our search dates began at
1980, or as soon as possible thereafter if the database was
launched after 1980, because patellar taping and bracing
for chronic knee pain were not used prior to this date. For
all databases except PEDro, the following search strategy
was used with database-specific truncation terms: (knee$
OR patell$) AND pain AND (tape$ OR taping OR brace$
OR bracing). PEDro was searched with the terms “patell*
AND tap*”, “patell* AND brac*”, “knee* AND tap*”, and
“knee* AND brac*” in the abstract and title field. Bibliographies of potentially eligible studies were searched recursively until no other potentially eligible studies were identified.
Warden et al
Inclusion determination. Eligibility was assessed by 2
independent reviewers (SJW and KMC), with consensus
reached by discussing conflicts with a third investigator
(RSH). Assessments were performed in 2 stages. First,
titles and abstracts were assessed, then potentially eligible
studies and studies whose titles and abstracts provided
insufficient information to determine inclusion suitability
were obtained in full text and assessed.
Assessment of study quality. Studies were blindly evaluated for methodologic quality by 2 independent reviewers (MAW and KGA), with disagreements resolved by a
third assessor (SJW). Quality was assessed using the PEDro
scale, which is an 11-item checklist where 1 point is
awarded for each of the following satisfied items (except
for the first item, which pertains to external validity and is
not counted towards the final score): 1) eligibility criteria
were specified, 2) subjects were randomly allocated to
groups or treatment order, 3) allocation was concealed, 4)
groups were similar at baseline, 5) subjects were blinded,
6) therapists who administered the treatment were
blinded, 7) assessors were blinded, 8) measures of key
outcomes were obtained from more than 85% of subjects,
9) data were analyzed by intention to treat, 10) statistical
comparisons were conducted between groups, and 11)
point measures and measures of variability were provided
(8). Only studies scoring ⱖ3 points out of 10 were considered to be of sufficient quality to warrant data extraction
(9,10).
Data extraction. Study design, number of participants,
participant characteristics and diagnoses, interventions investigated, and method of pain assessments were abstracted from each study by a single reviewer (SJW). The
same reviewer abstracted in duplicate the quantitative
pain outcome data. When a study provided data from more
than 1 pain scale, the data used for analysis were selected
according to the hierarchy of pain-related outcomes in OA
(11,12). In this hierarchy, global pain (measured on a visual analog scale [VAS] or Likert scale) takes precedence
over pain during walking (VAS or Likert scale), which in
turn takes precedence over the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale
and pain during activities other than walking (VAS or
Likert scale). For crossover studies, it was assumed that
subjects completed all arms of the study as allocated. This
is a valid assumption because typically these studies involved within-day testing between groups, thus allowing
for followup and maintenance of group allocation. Similarly, it was assumed in crossover study designs that there
were minimal carry-over effects for successive interventions, being that cutaneous sensibility following tape removal returns to baseline within 5 minutes (13). Included
studies used longer periods than this between successive
interventions and, consequently, data from all periods of
eligible crossover trials were included in our analyses.
Data synthesis. Pain scores were converted to percentages of the maximum possible score and reported as millimeters on a 100-mm analog scale. The normalization of
Effect of Patellar Taping and Bracing on Chronic Knee Pain
Figure 1. Flow of studies through selection process. PFJ ⫽ patellofemoral joint.
data to a 100-point scale is a frequent approach in metaanalyses of intervention effects on pain (10,14 –16). The
mean difference and SEM difference between comparison
interventions were determined. As crossover studies typically did not report variation of paired differences, the
standard errors of their difference scores were calculated
assuming a conservative correlation of 0.5 in order to
ensure appropriate weighting in analyses (17). Effect sizes
for comparative interventions were derived by dividing
the mean differences by the pooled SD (18).
Data were entered in Cochrane Collaboration’s Review
Manager program (RevMan version 4.2, Cochrane Collaboration, Oxford, UK), and results of comparable studies
were pooled in meta-analyses. Weighted mean differences
between interventions and 95% confidence intervals (95%
CIs) expressed as millimeters on a 100-mm analog scale
were determined, weighted by the inverse of the variance
for each study. Weighted mean differences on a 100-mm
analog scale were used for the primary analysis because of
the relative uniformity of the pain measures across studies,
and to facilitate clinical interpretation. Weighted mean
differences between interventions and 95% CIs for unitless effect sizes were also determined, weighted by the
inverse of the variance for each study. Pooled estimates of
the effects of patellar taping and bracing were obtained
using random-effects models in order to minimize the
influences of heterogeneity (17). The I2 quantity was used
to test heterogeneity between trials in each analysis (19).
Moderate-to-high heterogeneity (I2 ⱖ 50%) was explored
using sensitivity analyses. Publication bias was determined by assessing funnel plot asymmetry using a linear
regression approach (20,21).
RESULTS
Search results. Searching retrieved 462 unique articles,
of which 16 fufilled the inclusion criteria (Figure 1)
(11,22–36). These 16 articles were retrieved from the first 3
databases searched (Medline [n ⫽ 12], CINAHL [n ⫽ 1],
EBM Reviews [n ⫽ 3]). No additional eligible studies were
retrieved from succeeding electronic database or bibliography searches.
The 16 eligible studies are described in Table 1. Seven of
the studies were randomized controlled trials and 9 were
randomized crossover trials. Thirteen studies investigated
patellar taping or bracing effects in anterior knee pain, and
3 investigated taping effects in knee OA. Diagnoses were
75
primarily made by physicians, orthopedists, rheumatologists, and physical therapists. Consistent with clinical
practice, diagnosis of anterior knee pain was always based
on clinical examination, whereas knee OA diagnosis was
determined both clinically and radiologically according to
the American College of Rheumatology criteria (37). Criteria for the clinical diagnosis of anterior knee pain predominantly included an insidious onset of retropatellar or
peripatellar pain aggravated by palpation of the patellar
facets (28,31), external compression of the patellofemoral
joint (27,28,33), and/or activities that stress the patellofemoral joint (i.e., stair ascent and descent, running, and
prolonged sitting with the knee bent) (22,25,28,31,34 –36).
The age of participants in the studies reflected clinical
presentations, with studies on anterior knee pain and knee
OA including participants who were ⬍50 and ⬎50 years of
age, respectively.
Most studies (11 [69%] of 16) investigated independent
taping or bracing effects (13,22,24 –29,33,34,36). The remaining studies (5 [31%] of 16) investigated taping or
bracing effects with ⱖ1 cointerventions, including exercise (23,30,31,35) and other physical therapy treatments
(23,32). Only 1 study directly compared patellar taping
effects with bracing effects (24).
All taping studies included a group in which tape with
a medially-directed force was applied to the patella (medially-directed tape). Tape was used to exert a medial glide
and/or tilt force on the patella, with or without an anterior
tilt or rotation force, and with or without tape to unload
the infrapatellar fat pad. Comparative groups in taping
studies included groups in which tape was applied without exerting appreciable force on the patella (sham tape);
tape with a laterally-directed force was applied to the
patella (laterally-directed tape); or no tape was applied (no
tape).
All bracing studies included a group in which the brace
was designed to generate a medially-directed force on the
patella (medially-directed brace). Comparative groups included groups in which either an elastic knee sleeve or a
simple infrapatellar knee strap was used (sham brace) or
no brace was applied (no brace).
Methodologic quality of included studies. The 2 reviewers scored 176 quality criteria and agreed on 138
(78%). The intraclass correlation coefficient (2,1) for the
total PEDro score for each study was 0.73. All disagreements were resolved by discussion with the third assessor.
The methodologic quality of the studies was moderate,
ranging from 2– 8 points out of 10 (mean ⫾ SD score 4.4 ⫾
2.0) (Table 2). Taping studies scored significantly higher
than bracing studies (mean ⫾ SD score 4.8 ⫾ 2.1 versus
2.8 ⫾ 0.8, respectively; P ⬍ 0.05 by Mann-Whitney U test).
Most studies (11 [69%] of 16) clearly defined their selection criteria and the source of their participants. However,
not all criteria on the PEDro scale could be satisfied for the
chosen interventions and study designs. Although it is
possible to achieve subject and assessor blinding when
studying patellar taping and bracing effects, it is not possible to achieve therapist blinding, because treatments for
these conditions require therapist skill and/or instruction.
76
Warden et al
Table 1. Description of included studies*
Study (ref.)
Trial
design
Diagnosis†
Participants
Intervention groups
Christou (22)
Crossover
AKP, by physician
15 female patients
Mean ⫾ SD age 26.3 ⫾
1.5
Symptom duration NR
Medially-directed
tape
Laterally-directed
tape
Sham tape
No tape
Medially-directed
tape, education,
and exercise
Medially-directed
tape and
education
No tape; education
and exercise
No tape; education
Medially-directed
tape
Medially-directed
brace
No tape or brace
Clark et al
(23)
Controlled
AKP, by orthopedist,
rheumatologist, or
GP
81 patients (45 men, 36
women)
Age range 6–40 years
Symptom duration ⱖ3
months
Conway et al
(24)
Crossover
AKP, by orthopedist
and/or
physiotherapist
30 Air Force cadets (21
men, 9 women)
Mean age 20.1 years
Symptom duration NR
Cowan et al
(25)
Crossover
AKP, by physical
therapist
Medially-directed
tape
Sham tape
No tape
Cushnaghan
et al (26)
Crossover
OA, by
rheumatologist
Finestone et
al (27)
Controlled
AKP, by orthopedist
and physician
10 patients (3 men, 7
women)
Mean age ⫾ SD 22.7 ⫾
8.0
Symptom duration NR
14 patients (4 men, 10
women)
Mean age (range) years
70.4 (55–84)
Mean (range) symptom
duration 8.3 (1–20)
years
59 male infantry
recruits (84 knees)
Ages NR
Symptom duration NR
Handfield and
Kramer (28)
Crossover
AKP, by physical
therapist
36 patients (10 men, 26
women)
Mean age ⫾ SD 29 ⫾
12 years
Symptom duration NR
Medially-directed
tape
Sham tape
Hinman et al
(29)
Controlled
OA, by physical
therapist
87 patients (30 men, 57
women)
Mean age ⫾ SD 69 ⫾
8
Mean ⫾ SD symptom
duration 9 ⫾ 10
years
Medially-directed
tape
Sham tape
No tape
Pain outcome‡
Modified McGill
analog (0–5) pain
questionnaire
during isokinetic
leg press exercise
VAS (2 10-cm
horizontal lines
with anchors of no
pain and ‘extreme
pain’) during
climbing stairs and
walking on flat
area after 12 weeks
of intervention
Category rating scale
1–8 (1 ⫽ no pain,
8 ⫽ excruciating
pain) during
maximal
concentric and
eccentric isokinetic
quadriceps
contractions
VAS (10 cm) for
average pain
during stairstepping task
Medially-directed
tape
Laterally-directed
tape
Sham tape
VAS (10 cm) for
overall pain after 4
days of
intervention
Medially-directed
brace
Sham-brace
No brace
Category rating scale
1–4 (1 ⫽
discomfort, 4 ⫽
activity-limiting
pain) during
infantry training
VAS (10-cm
horizontal line
with anchors of no
pain and worst
pain ever
experienced)
during isokinetic
knee extensor
strength test at 60
degrees/second
VAS (10-cm
horizontal line
numbered in 1-cm
increments) for
pain on movement
after 3 weeks of
intervention
(continued)
Effect of Patellar Taping and Bracing on Chronic Knee Pain
77
Table 1. Description of included studies* (Continued)
Study (ref.)
Trial
design
Diagnosis†
Participants
Hinman et al
(13)
Crossover
OA, by physical
therapist
18 patients (6
men, 12 women)
Mean age ⫾ SD
66.9 ⫾ 6.5 years
Symptom duration
⫽ knee pain on
most days of
previous month
(average pain
⬎3/10)
25 patients (8
men, 17 women)
Mean age (range)
29 (14–40) years
Mean (range)
symptom
duration 2.5
(0.1–15) years
129 patients (53
men, 76 women)
Mean age (range)
35 (18–60) years
Symptom duration
ⱖ3 weeks
Kowall et al
(30)
Controlled
AKP, by orthopedist
and/or physical
therapist
Lun et al (31)
Controlled
AKP, by physician
Miller et al
(32)
Controlled
AKP, by physician
59 Air Force
cadets (48 men,
11 women)
Ages NR
Symptom duration
NR
Ng and Cheng
(33)
Crossover
AKP, by physician
and physical
therapist
15 patients (8
men, 7 women)
Mean age ⫾ SD 32
⫾ 6.6
Symptom duration
NR
Powers et al
(34)
Crossover
AKP, by physical
therapist
15 female patients
Mean age ⫾ SD
31.1 ⫾ 7.5
Symptom duration
NR
Because more than half of the studies (9 [56%] of 16) used
a crossover (within-subject) study design, these studies
were not able to satisfy concealed allocation because it was
known a priori that all eligible participants would be exposed to each intervention. Similarly, crossover study designs could not meet the criterion of baseline comparability because the repeated testing of participants in these
studies theoretically influenced pain outcomes for succeeding interventions. We assumed minimal carry-over
Intervention groups
Pain outcome‡
Medially-directed
tape
Sham tape
No tape
VAS (10-cm
horizontal line) for
pain during
walking
Medially-directed
tape and physical
therapy
No tape; physical
therapy
VAS (10-point scale)
for pain during
activity after 4
weeks of
intervention
Medially-directed
brace
Medially-directed
brace and
exercise
Sham brace and
exercise
No brace; exercise
Medially-directed
brace and
physical therapy
Sham brace and
physical therapy
No brace; physical
therapy
Medially-directed
tape
No tape
VAS (10 cm) for pain
during sport
activity after 12
weeks of
intervention
Medially-directed
brace 1
Medially-directed
brace 2
No brace
VAS (horizontal line
with anchors of no
pain and worst
pain in life) for
pain with activity
after 2–3 weeks
intervention
VAS (10-cm
horizontal line
with anchors of no
pain and
maximum pain)
immediately
following singleleg stand for 5
seconds with
additional 20%
body weight added
VAS (10-point scale)
for pain during
aggravating activity
(unilateral squat or
deep knee bend)
(continued)
effects for successive interventions in crossover studies
(see data extraction in Materials and Methods); however,
their potential presence negated the ability of crossover
studies to meet the PEDro criterion of baseline comparability. Many crossover studies also did not satisfy the
criteria for adequate followup (6 [67%] of 9) or intent-totreat (8 [89%] of 9). It is expected that these criteria were
met; study periods were conducive with both followup
and the maintenance of group allocation because same-day
78
Warden et al
Table 1. Description of included studies* (Continued)
Study (ref.)
Trial
design
Diagnosis†
Participants
Intervention groups
Pain outcome‡
VAS (10-cm
horizontal line
with anchors of no
pain and worst
pain possible) for
average pain over
previous 24 hours
after 3 weeks of
intervention
11-point numerical
pain-rating scale (0
⫽ no pain, 10 ⫽
worst pain
imaginable) for
pain during single
step-down
Whittingham
et al (35)
Controlled
AKP, by physical
therapist
30 Army recruits (24
men, 6 women)
Mean age ⫾ SD 18.7 ⫾
1.2
Symptom duration NR
Medially-directed
tape and exercise
Sham tape and
exercise
No tape; exercise
Wilson et al
(36)
Crossover
AKP, by physical
therapist, hospital
consultant, or
physician
71 patients (39 men, 32
women)
Mean age ⫾ SD 33.8 ⫾
10.2
Symptom duration ⱖ1
month
Medially-directed
tape
Sham tape
No tape
* AKP ⫽ anterior knee pain; NR ⫽ not reported; GP ⫽ general practitioner; VAS ⫽ visual analog scale; OA ⫽ osteoarthritis.
† Diagnosis of AKP was determined clinically, whereas diagnosis of OA was determined clinically and radiologically according to the American
College of Rheumatology criteria (37).
‡ Pain outcome used for data extraction and meta-analyses in the current review.
testing was employed. However, the reports typically did
not specify that ⬎85% of subjects completed the tasks nor
that participants were analyzed according to their initial
group allocation.
Effect of patellar taping on chronic knee pain. One
taping study (24) was of insufficient quality to warrant
data extraction, and another (30) did not provide a means
of determining variability for its pain outcome measures.
The remaining 10 studies investigated the immediate
(same-day; 6 studies) and short-term (3–12 weeks; 4 studies) effects of patellar taping. As there was relative homogeneity between studies in terms of interventions and pain
outcome measures (Table 1), similar studies were combined for meta-analyses.
Medially-directed tape compared with no tape (8 studies, 288 participants) and sham tape (8 studies, 242 participants) decreased reported pain by 16.1 mm (95% CI
⫺22.2, ⫺10.0; P ⬍ 0.001; I2 ⫽ 79%) (Figure 2A) and 10.9
mm (95% CI ⫺18.4, ⫺3.4; P ⬍ 0.001; I2 ⫽ 87%) (Figure
2B), respectively. Sensitivity analyses revealed that 2 studies (23,36) with opposing findings to the pooled outcomes
accounted for the statistical heterogeneities. Removal of
these studies did not alter the outcomes of the analyses.
Outcomes and statistical heterogeneities were not influenced by the inclusion of studies investigating taping effects with cointerventions, or by elevation of the PEDro
score inclusion criterion to 5. However, there was a publication bias, as evident by significant funnel plot asymmetries (all P ⬍ 0.02).
For anterior knee pain, medially-directed tape compared
with no tape (6 studies, 212 participants) decreased reported pain by 14.7 mm (95% CI ⫺22.8, ⫺6.9; P ⬍ 0.001)
(Figure 2C). There was no difference between mediallydirected tape and sham tape in this population (5 studies,
152 participants), although effects did favor medially-di-
rected tape (⫺9.1 mm, 95% CI ⫺19.9, 1.8; P ⫽ 0.10) (Figure
2D). For OA, medially-directed tape compared with no
tape (2 studies, 76 participants) decreased reported pain
by 20.1 mm (95% CI ⫺26.0, ⫺14.3; P ⬍ 0.001) (Figure 2C),
and medially-directed tape compared with sham tape (3
studies, 90 participants) decreased reported pain by 13.3
mm (95% CI ⫺18.1, ⫺8.4; P ⬍ 0.001) (Figure 2D).
Sham tape compared with no tape (6 studies, 192 participants) decreased reported pain by 10.4 mm (95% CI
⫺15.7, ⫺5.1; P ⬍ 0.001; I2 ⫽ 67%) (Figure 3A). For anterior
knee pain (4 studies, 116 participants) and OA (2 studies,
76 participants), sham tape compared with no tape decreased reported pain by 12.0 mm (95% CI ⫺19.7, ⫺4.3;
P ⬍ 0.01) and 7.2 mm (95% CI ⫺11.9, ⫺2.5; P ⬍ 0.01),
respectively (Figure 3B). Laterally-directed tape did not
differ from medially-directed tape (3 studies, 100 participants) or from sham tape (3 studies, 100 participants), with
effects favoring medially-directed tape (6.9 mm, 95% CI
⫺10.2, 24.0; P ⫽ 0.43) (Figure 3C) and sham tape (5.5 mm,
95% CI ⫺1.6, 12.6; P ⫽ 0.13) (Figure 3D). No studies
compared laterally-directed tape with no tape.
Effect of patellar bracing on anterior knee pain. Two
patellar bracing studies (24,27) were of insufficient quality
to warrant data extraction. The remaining 3 studies investigated immediate (same-day; 1 study) and short-term
(3–12 weeks; 2 studies) effects of patellar bracing on anterior knee pain. No studies investigated patellar bracing
effects on pain associated with knee OA. Medially-directed brace compared with no brace (3 studies, 119 participants) decreased reported pain associated with anterior
knee pain by 14.6 mm (95% CI ⫺25.5, ⫺3.8; P ⬍ 0.01; I2 ⫽
76%) (Figure 4A). Sensitivity analyses revealed that the
differences between immediate and short-term effects accounted for the statistical heterogeneity. Medially-directed
brace did not differ from sham brace (2 studies, 94 partic-
Effect of Patellar Taping and Bracing on Chronic Knee Pain
79
Table 2. Quality scores for eligible studies*
PEDro scale item†
Author (ref.)
Christou (22)
Clark et al (23)
Conway et al (24)
Cowan et al (25)
Cushnaghan et al (26)
Finestone et al (27)
Handfield and Kramer (28)
Hinman et al (29)
Hinman et al (13)
Kowall et al (30)
Lun et al (31)
Miller et al (32)
Ng and Cheng (33)
Powers et al (34)
Whittingham et al (35)
Wilson et al (36)
1
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
2
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
3
4
5
⫹
6
7
8
9
10
11
Total score‡
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
5
7
2
3
4
2
4
3
8
4
3
4
3
3
8
7
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
⫹
* PEDro ⫽ Physiotherapy Evidence Database; ⴙ ⴝ the item was clearly satisfied.
† Column numbers correspond to the following items on the PEDro scale: 1, eligibility criteria were specified; 2, subjects were randomly allocated to
groups or treatment order; 3, allocation was concealed; 4, groups were similar at baseline; 5, subjects were blinded; 6, therapists who administered the
treatment were blinded; 7, assessors were blinded; 8, measures of key outcomes were obtained from more than 85% of subjects; 9, data were analyzed
by intention to treat; 10, statistical comparisons were conducted between groups; and 11, point measures and measures of variability were provided.
‡ Total score (out of a possible 10) was determined by counting the number of items that were satisfied, except for the first item, which pertains to
external validity.
ipants) (1.3 mm, 95% CI ⫺9.8, 7.2; P ⫽ 0.76; I2 ⫽ 0%)
(Figure 4B). Similarly, sham brace did not differ from no
brace (2 studies, 98 participants) (2.5 mm, 95% CI ⫺10.6,
5.7; P ⫽ 0.55; I2 ⫽ 0%) (Figure 4C). Only 1 eligible study
(24) directly compared patellar taping and bracing effects;
however, it was of insufficient quality to warrant data
extraction.
DISCUSSION
This systematic review and meta-analysis provides evidence for the benefits of patellar taping, disputable evidence for the benefits of patellar bracing, and no evidence
of the comparative efficacies of patellar taping and bracing
in the management of chronic knee pain. Some acknowledged liberties in pooling data were taken in acquiring
these outcomes, such as the inclusion of studies investigating multiple diagnoses (anterior knee pain and knee
OA) and the inclusion of data from all periods of eligible
crossover trials. This approach may have contributed to
the elevated levels of heterogeneity observed in the outcomes, which, combined with the presence of significant
publication bias, indicates the need for additional highquality trials in this area of inquiry. However, the current
review provides the most up-to-date and detailed analysis
of the effects of patellar taping and bracing on chronic
knee pain.
Following its initial description in 1986 (38), patellar
taping has become clinically accepted as an intervention
for the management of chronic knee pain. This systematic
review and meta-analysis provides evidence for this use.
The results of 10 moderate-quality studies (mean ⫾ SD
PEDro score 5.2 ⫾ 2.1) demonstrate that on a 100-mm
scale, medially-directed patellar tape reduces chronic
knee pain by 16 mm compared with no tape. This effect
was irrespective of the time course of tape application;
pain reductions were observed both immediately (sameday) following tape application and after repeated applications over the short term (3–12 weeks), with reductions
in pain of 17 mm and 14 mm, respectively. Similarly, the
reduction in pain with tape use was irrespective of diagnosis; medially-directed tape reduced pain associated
with anterior knee pain and knee OA by 15 mm and 20
mm, respectively.
Approximately 50% of the benefit of medially-directed
tape on chronic knee pain was explained by sham treatment effects. Tape that does not exert appreciable force on
the patella (sham tape) reduced chronic knee pain by 10
mm compared with no tape. This effect was not influenced
by the duration of tape application or diagnosis, and it
suggests that sensory and/or placebo effects associated
with tape are sufficient to modify chronic knee pain. However, medially-directed tape reduced chronic knee pain by
11 mm compared with sham tape, irrespective of the duration of tape application. This indicates that while sham
tape does benefit chronic knee pain, greater benefits are
gained if tape exerts a medially-directed force on the patella.
Medially-directed patellar tape is commonly applied
clinically to treat chronic knee pain. This fits with the
accepted theory of patellar malalignment in both anterior
knee pain and knee OA, where there is lateral displacement of the patella relative to the femoral trochlear groove,
resulting in increased peak patellofemoral contact pressures and loading of the lateral facet (39,40). Reflecting the
clinical popularity of medially-directed tape, all taping
80
Warden et al
Figure 2. Effects of medially-directed patellar tape on chronic knee pain. Immediate and short-term effects of medially-directed tape
compared with A, no tape and B, sham tape. Effects of medially-directed tape on anterior knee pain and knee osteoarthritis compared with
C, no tape and D, sham tape. WMD ⫽ weighted mean difference; 95% CI ⫽ 95% confidence interval.
Figure 3. Effects of sham and laterally-directed patellar tape on chronic knee pain. A, Immediate and short-term effects of sham tape
compared with no tape. B, Effects of sham tape on anterior knee pain and knee osteoarthritis compared with no tape. Effects of
laterally-directed tape on anterior knee pain and knee osteoarthritis compared with C, medially-directed tape and D, sham tape. WMD ⫽
weighted mean difference; 95% CI ⫽ 95% confidence interval.
studies in the current review included a group in which
medially-directed tape was used, whereas only 3 studies
investigated laterally-directed tape. Due to the small number of studies investigating laterally-directed tape, no de-
finitive conclusions can be made regarding its benefits or
its effects compared with medially-directed tape.
The reduction in chronic knee pain with medially-directed tape is clinically significant. Medially-directed tape
Effect of Patellar Taping and Bracing on Chronic Knee Pain
Figure 4. Effects of patellar bracing on anterior knee pain. Immediate and short-term effects of medially-directed bracing compared with A, no brace and B, sham brace. C, Short-term effects of
sham bracing versus no bracing. WMD ⫽ weighted mean difference; 95% CI ⫽ 95% confidence interval.
reduced the pain associated with anterior knee pain and
OA by 15 mm and 20 mm, respectively. These effect sizes
compare favorably with the minimal clinically important
differences of 15–20 mm and 17.5 mm required to detect
treatment effects on pain in individuals with anterior knee
pain and OA, respectively (41,42). Thus, medially-directed tape used in isolation may generate clinically important changes in chronic knee pain. However, these
changes have only been investigated in a limited number
of short-term studies (ⱕ12 weeks) with relatively small
sample sizes, and the long-term effects of tape on chronic
knee pain have not been established. Nevertheless, this
short-term investigation fits with the clinical use of tape as
a temporary pain-relieving technique for the management
of chronic knee pain.
In contrast to the evidence for the benefits of patellar
tape, there was disputable evidence from 3 low-quality
studies (mean ⫾ SD PEDro score 3.3 ⫾ 0.6) for the benefits
of patellar bracing. Bracing designed to generate a medially-directed force on the patella reduced anterior knee pain
by 15 mm on a 100-mm scale compared with no brace.
This outcome was attributable to the immediate effects
reported for 2 braces in 1 study (34), with no differences
being found in 2 studies (31,32) on the short-term effects of
medially-directed bracing. These latter 2 studies also
found no difference between medially-directed bracing
and sham bracing. To our knowledge, no studies have
assessed the immediate sham effects of bracing, or compared patellar bracing and taping effects in chronic knee
pain. Therefore, there is a need for further well-designed
studies on the effects of patellar bracing on chronic knee
pain, particularly in knee OA, for which no studies are
currently available.
81
Our conclusions differ from previous systematic reviews
that have reported inconclusive evidence for patellar taping efficacy in the management of chronic knee pain (43–
46). However, previous studies were not specific to patellar taping and bracing, did not perform meta-analyses,
were limited to only anterior knee pain, did not include all
eligible controlled studies, and were published prior to
more recent controlled studies on the effects of patellar
taping and bracing on chronic knee pain.
We used a systematic methodology to eliminate potential sources of bias; however, our conclusions are influenced by publication bias, as is indicated by significant
funnel plot asymmetry. This asymmetry indicates that
negative studies investigating patellar taping and bracing
effects are less likely to be published, and that small studies are more likely to produce larger effect sizes. Potentially contributing to this publication bias was our noninclusion of dissertations and conference proceedings;
however, these are infrequently subjected to extensive
peer review, and there is no systematic and comprehensive method of searching for these sources. The presence
of publication bias in the current review indicates the need
for additional high-quality trials of patellar taping and
bracing effects on chronic knee pain.
In addition to publication bias, the outcomes of our analyses may have been influenced by the inclusion of studies
reported only in English (21). However, our original search
found only 3 studies published in non-English languages
(47– 49). Based on their English abstracts, these studies
would not have altered the conclusions reached in this review, as their findings support those of our pooled results.
Our meta-analysis found that tape applied to exert a
medially-directed force on the patella produces a clinically meaningful change in chronic knee pain resulting
from either anterior knee pain or knee OA. This effect
occurs immediately and persists at least short term (ⱕ12
weeks). Placebo and/or other effects (possibly including
sensory effects) contribute to beneficial tape effects, but
these only explain approximately half of the reduction in
pain associated with medially-directed tape. There is insufficient evidence to make definitive conclusions regarding in which direction forces should be applied to the
patella to optimally reduce pain (medially or laterally), or
to establish the efficacy of patellar bracing. Similarly, there
is insufficient evidence from quality studies directly comparing patellar taping and bracing effects to establish their
comparative benefits in the management of chronic knee
pain. These conclusions need to be considered in light of
significant limitations, including low numbers of studies
investigating relatively small numbers of participants,
high heterogeneity between study outcomes, and publication bias, all of which indicate the need for additional
high-quality studies of taping and bracing effects on
chronic knee pain.
AUTHOR CONTRIBUTIONS
Dr. Warden had full access to all of the data in the study and
takes responsibility for the integrity of the data and the accuracy
of the data analysis.
Study design. Warden, Hinman, Watson, Avin, Bialocerkowski,
Crossley.
82
Acquisition of data. Warden, Watson, Avin.
Analysis and interpretation of data. Warden, Hinman, Watson,
Avin, Bialocerkowski, Crossley.
Manuscript preparation. Warden, Hinman, Watson, Avin, Bialocerkowski, Crossley.
Statistical analysis. Warden, Hinman, Bialocerkowski, Crossley.
REFERENCES
1. Gerbino PG II, Griffin ED, d’Hemecourt PA, Kim T, Kocher
MS, Zurakowski D, et al. Patellofemoral pain syndrome: evaluation of location and intensity of pain. Clin J Pain 2006;22:
154 –9.
2. Duncan RC, Hay EM, Saklatvala J, Croft PR. Prevalence of
radiographic osteoarthritis: it all depends on your point of
view. Rheumatology (Oxford) 2006;45:757– 60.
3. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update.
Arthritis Rheum 2000;43:1905–15.
4. Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician 2007;75:194 –
202.
5. Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med 2002;30:447–56.
6. Crossley K, Cowan SM, Bennell KL, McConnell J. Patellar
taping: is clinical success supported by scientific evidence?
Man Ther 2000;5:142–50.
7. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW,
Dieppe P, et al, and the Standing Committee for International
Clinical Studies Including Therapeutic Trials. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis. Report of a Task Force of the
Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003;62:
1145–55.
8. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M.
Reliability of the PEDro scale for rating quality of randomized
controlled trials. Phys Ther 2003;83:713–21.
9. Ferreira PH, Ferreira ML, Maher CG, Herbert RD, Refshauge K.
Specific stabilisation exercise for spinal and pelvic pain: a
systematic review. Aust J Physiother 2006;52:79 – 88.
10. Herbert RD, Gabriel M. Effects of stretching before and after
exercising on muscle soreness and risk of injury: systematic
review. BMJ 2002;325:468.
11. McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a
systematic quality assessment and meta-analysis. JAMA 2000;
283:1469 –75.
12. Reichenbach S, Sterchi R, Scherer M, Trelle S, Burgi E, Burgi
U, et al. Meta-analysis: chondroitin for osteoarthritis of the
knee or hip. Ann Intern Med 2007;146:580 –90.
13. Hinman RS, Bennell KL, Crossley KM, McConnell J. Immediate effects of adhesive tape on pain and disability in individuals with knee osteoarthritis. Rheumatology (Oxford) 2003;
42:865–9.
14. Bjordal JM, Ljunggren AE, Klovning A, Slordal L. Nonsteroidal antiinflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials. BMJ 2004;329:1317.
15. Eisenberg E, McNicol ED, Carr DB. Efficacy and safety of
opioid agonists in the treatment of neuropathic pain of nonmalignant origin: systematic review and meta-analysis of randomized controlled trials. JAMA 2005;293:3043–52.
16. Lee C, Straus WL, Balshaw R, Barlas S, Vogel S, Schnitzer TJ.
A comparison of the efficacy and safety of nonsteroidal antiinflammatory agents versus acetaminophen in the treatment
of osteoarthritis: a meta-analysis. Arthritis Rheum 2004;51:
746 –54.
17. Higgins JP, Green S, editors. Cochrane handbook for systematic reviews of interventions 4.2.6 (updated September 2006).
In: The Cochrane Library. IV. Chichester (UK): John Wiley &
Sons; 2006.
Warden et al
18. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale (NJ): Lawrence Erlbaum; 1988.
19. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring
inconsistency in meta-analyses. BMJ 2003;327:557– 60.
20. Egger M, Davey Smith G, Schneider M, Minder C. Bias in
meta-analysis detected by a simple, graphical test. BMJ 1997;
315:629 –34.
21. Sterne JA, Egger M, Smith GD. Systematic reviews in health
care: investigating and dealing with publication and other
biases in meta-analysis. BMJ 2001;323:101–5.
22. Christou EA. Patellar taping increases vastus medialis oblique
activity in the presence of patellofemoral pain. J Electromyogr
Kinesiol 2004;14:495–504.
23. Clark DI, Downing N, Mitchell J, Coulson L, Syzpryt EP,
Doherty M. Physiotherapy for anterior knee pain: a randomised controlled trial. Ann Rheum Dis 2000;59:700 – 4.
24. Conway A, Malone TR, Conway P. Patellar alignment/tracking alteration: effect on force output and perceived pain.
Isokinet Exerc Sci 1992;2:9 –17.
25. Cowan SM, Bennell KL, Hodges PW. Therapeutic patellar
taping changes the timing of vasti muscle activation in people
with patellofemoral pain syndrome. Clin J Sport Med 2002;
12:339 – 47.
26. Cushnaghan J, McCarthy C, Dieppe P. Taping the patella
medially: a new treatment for osteoarthritis of the knee joint?
BMJ 1994;308:753–5.
27. Finestone A, Radin EL, Lev B, Shlamkovitch N, Wiener M,
Milgrom C. Treatment of overuse patellofemoral pain: prospective randomized controlled clinical trial in a military
setting. Clin Orthop Relat Res 1993;293:208 –10.
28. Handfield T, Kramer J. Effect of McConnell taping on perceived pain and knee extensor torques during isokinetic exercise performed by patients with patellofemoral pain syndrome. Physiother Can 2000;52:39 – 44.
29. Hinman RS, Crossley KM, McConnell J, Bennell KL. Efficacy
of knee tape in the management of osteoarthritis of the knee:
blinded randomised controlled trial. BMJ 2003;327:135.
30. Kowall MG, Kolk G, Nuber GW, Cassisi JE, Stern SH. Patellar
taping in the treatment of patellofemoral pain: a prospective
randomized study. Am J Sports Med 1996;24:61– 6.
31. Lun VM, Wiley JP, Meeuwisse WH, Yanagawa TL. Effectiveness of patellar bracing for treatment of patellofemoral pain
syndrome. Clin J Sport Med 2005;15:235– 40.
32. Miller MD, Hinkin DT, Wisnowski JW. The efficacy of orthotics for anterior knee pain in military trainees: a preliminary
report. Am J Knee Surg 1997;10:10 –3.
33. Ng GY, Cheng JM. The effects of patellar taping on pain and
neuromuscular performance in subjects with patellofemoral
pain syndrome. Clin Rehabil 2002;16:821–7.
34. Powers CM, Ward SR, Chan LD, Chen YJ, Terk MR. The effect
of bracing on patella alignment and patellofemoral joint contact area. Med Sci Sports Exerc 2004;36:1226 –32.
35. Whittingham M, Palmer S, Macmillan F. Effects of taping on
pain and function in patellofemoral pain syndrome: a randomized controlled trial. J Orthop Sports Phys Ther 2004;34:
504 –10.
36. Wilson T, Carter N, Thomas G. A multicenter, single-masked
study of medial, neutral, and lateral patellar taping in individuals with patellofemoral pain syndrome. J Orthop Sports
Phys Ther 2003;33:437– 43.
37. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et
al. Development of criteria for the classification and reporting
of osteoarthritis: classification of osteoarthritis of the knee.
Arthritis Rheum 1986;29:1039 – 49.
38. McConnell J. The management of chondromalacia patellae: a
long-term solution. Aust J Physiother 1986;32:215–33.
39. MacIntyre NJ, Hill NA, Fellows RA, Ellis RE, Wilson DR.
Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome. J Bone Joint Surg Am
2006;88:2596 – 605.
40. Niu J, Zhang YQ, Nevitt M, Xu L, Felson DT, Zhu YY, et al.
Effect of Patellar Taping and Bracing on Chronic Knee Pain
41.
42.
43.
44.
45.
Patella malalignment is associated with prevalent patellofemoral osteoarthritis: the Beijing Osteoarthritis Study [abstract]. Arthritis Rheum 2005;52 Suppl 9:S456 –7.
Bellamy N, Carette S, Ford PM, Kean WF, le Riche NG, Lussier A, et al. Osteoarthritis antirheumatic drug trials. III. Setting the delta for clinical trials: results of a consensus development (Delphi) exercise. J Rheumatol 1992;19:451–7.
Crossley KM, Bennell KL, Cowan SM, Green S. Analysis of
outcome measures for persons with patellofemoral pain:
which are reliable and valid? Arch Phys Med Rehabil 2004;
85:815–22.
Aminaka N, Gribble PA. A systematic review of the effects of
therapeutic taping on patellofemoral pain syndrome. J Athl
Train 2005;40:341–51.
Bizzini M, Childs JD, Piva SR, Delitto A. Systematic review of
the quality of randomized controlled trials for patellofemoral
pain syndrome. J Orthop Sports Phys Ther 2003;33:4 –20.
Crossley K, Bennell K, Green S, McConnell J. A systematic
83
46.
47.
48.
49.
review of physical interventions for patellofemoral pain syndrome. Clin J Sport Med 2001;11:103–10.
D’hondt NE, Struijs PA, Kerkhoffs GM, Verheul C, Lysens R,
Aufdemkampe G, et al. Orthotic devices for treating patellofemoral pain syndrome. Cochrane Database Syst Rev 2002;
2:CD002267.
Abeillon G, Dubois T, Auclair J, Calmels P, Domenach M,
Minaire P. Patellar syndromes: efficacy of a knee-brace with
patellar window in the therapeutic programme. J Traumatol
Sport 1991;8:121–7. In French.
Nafstad GL, Tronstad A, Aune AK. Patellofemoral pain: a
comparative study of patella stabilizing orthosis versus tape
as an adjuvant to exercise-therapy. Norsk Tidsskrift For
Idrettsmedisin 1996;11:26 –38.
Park YS, Kim HJ. Effects of a taping method on pain and ROM
of the knee joint in the elderly. Taehan Kanho Hakhoe Chi
2005;35:372– 81. In Korean.
Документ
Категория
Без категории
Просмотров
1
Размер файла
179 Кб
Теги
pain, systematic, meta, treatment, taping, knee, analysis, review, bracing, chronic, patella
1/--страниц
Пожаловаться на содержимое документа