Treatment success of hip and core or knee strengthening for patellofemoral pain: Development of clinical prediction rules

Jennifer E. Earl-Boehm, Lori Ann Bolgla, Carolyn Emory, Karrie L. Hamstra-Wright, Sergey Tarima, Reed Ferber

Research output: Contribution to journalArticle

Abstract

Context: Patellofemoral pain (PFP) is a common injury that interferes with quality of life and physical activity. Clinical subgroups of patients may exist, one of which is caused by proximal muscle dysfunction. Objectives: To develop clinical prediction rules that predict a positive outcome after either a hip and core- or knee-focused strengthening program for individuals with PFP. Design: Secondary analysis of data from a randomized control trial. Setting: Four university laboratories. Patients or Other Participants: A total of 199 participants with PFP. Intervention(s): Participants were randomly allocated to either a hip and core-focused (n ¼ 111) or knee-focused (n ¼ 88) rehabilitation group for a 6-week program. Main Outcome Measure(s): Demographics, self-reported knee pain (visual analog scale) and function (Anterior Knee Pain Scale), hip strength, abdominal muscle endurance, and hip range of motion were evaluated at baseline. Treatment success was defined as a decrease in visual analog scale score by 2 cm or an increase in the Anterior Knee Pain Scale score by 8 points or both. Bivariate relationships between the outcome (treatment success) and the predictor variables were explored, followed by a forward stepwise logistic regression to predict a successful outcome. Results: Patients with more pain, better function, greater lateral core endurance, and less anterior core endurance were more likely to have a successful outcome after hip and core strengthening (88% sensitivity and 54% specificity). Patients with lower weight, weaker hip internal rotation, stronger hip extension, and greater trunk-extension endurance were more likely to have success after knee strengthening (82% sensitivity and 58% specificity). Conclusion: The patients with PFP who have more baseline pain and yet maintain a high level of function may experience additional benefit from hip and core strengthening. The clinical prediction rules from this study remain in the developmental phase and should be applied with caution until externally validated.

Original languageEnglish (US)
Pages (from-to)545-552
Number of pages8
JournalJournal of Athletic Training
Volume53
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Decision Support Techniques
Hip
Knee
Pain
Therapeutics
Abdominal Muscles
Sensitivity and Specificity
Pain Measurement
Articular Range of Motion
Visual Analog Scale
Rehabilitation
Logistic Models
Quality of Life
Demography
Outcome Assessment (Health Care)
Exercise
Weights and Measures
Muscles
Wounds and Injuries

Keywords

  • Exercise
  • Hip
  • Outcomes
  • PFP
  • Quadriceps
  • Rehabilitation

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Treatment success of hip and core or knee strengthening for patellofemoral pain : Development of clinical prediction rules. / Earl-Boehm, Jennifer E.; Bolgla, Lori Ann; Emory, Carolyn; Hamstra-Wright, Karrie L.; Tarima, Sergey; Ferber, Reed.

In: Journal of Athletic Training, Vol. 53, No. 6, 01.06.2018, p. 545-552.

Research output: Contribution to journalArticle

Earl-Boehm, Jennifer E. ; Bolgla, Lori Ann ; Emory, Carolyn ; Hamstra-Wright, Karrie L. ; Tarima, Sergey ; Ferber, Reed. / Treatment success of hip and core or knee strengthening for patellofemoral pain : Development of clinical prediction rules. In: Journal of Athletic Training. 2018 ; Vol. 53, No. 6. pp. 545-552.
@article{b430c6f9c3574391bfa700dfbebec87f,
title = "Treatment success of hip and core or knee strengthening for patellofemoral pain: Development of clinical prediction rules",
abstract = "Context: Patellofemoral pain (PFP) is a common injury that interferes with quality of life and physical activity. Clinical subgroups of patients may exist, one of which is caused by proximal muscle dysfunction. Objectives: To develop clinical prediction rules that predict a positive outcome after either a hip and core- or knee-focused strengthening program for individuals with PFP. Design: Secondary analysis of data from a randomized control trial. Setting: Four university laboratories. Patients or Other Participants: A total of 199 participants with PFP. Intervention(s): Participants were randomly allocated to either a hip and core-focused (n ¼ 111) or knee-focused (n ¼ 88) rehabilitation group for a 6-week program. Main Outcome Measure(s): Demographics, self-reported knee pain (visual analog scale) and function (Anterior Knee Pain Scale), hip strength, abdominal muscle endurance, and hip range of motion were evaluated at baseline. Treatment success was defined as a decrease in visual analog scale score by 2 cm or an increase in the Anterior Knee Pain Scale score by 8 points or both. Bivariate relationships between the outcome (treatment success) and the predictor variables were explored, followed by a forward stepwise logistic regression to predict a successful outcome. Results: Patients with more pain, better function, greater lateral core endurance, and less anterior core endurance were more likely to have a successful outcome after hip and core strengthening (88{\%} sensitivity and 54{\%} specificity). Patients with lower weight, weaker hip internal rotation, stronger hip extension, and greater trunk-extension endurance were more likely to have success after knee strengthening (82{\%} sensitivity and 58{\%} specificity). Conclusion: The patients with PFP who have more baseline pain and yet maintain a high level of function may experience additional benefit from hip and core strengthening. The clinical prediction rules from this study remain in the developmental phase and should be applied with caution until externally validated.",
keywords = "Exercise, Hip, Outcomes, PFP, Quadriceps, Rehabilitation",
author = "Earl-Boehm, {Jennifer E.} and Bolgla, {Lori Ann} and Carolyn Emory and Hamstra-Wright, {Karrie L.} and Sergey Tarima and Reed Ferber",
year = "2018",
month = "6",
day = "1",
doi = "10.4085/1062-6050-510-16",
language = "English (US)",
volume = "53",
pages = "545--552",
journal = "Journal of Athletic Training",
issn = "1062-6050",
publisher = "National Athletic Trainers' Association Inc.",
number = "6",

}

TY - JOUR

T1 - Treatment success of hip and core or knee strengthening for patellofemoral pain

T2 - Development of clinical prediction rules

AU - Earl-Boehm, Jennifer E.

AU - Bolgla, Lori Ann

AU - Emory, Carolyn

AU - Hamstra-Wright, Karrie L.

AU - Tarima, Sergey

AU - Ferber, Reed

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Context: Patellofemoral pain (PFP) is a common injury that interferes with quality of life and physical activity. Clinical subgroups of patients may exist, one of which is caused by proximal muscle dysfunction. Objectives: To develop clinical prediction rules that predict a positive outcome after either a hip and core- or knee-focused strengthening program for individuals with PFP. Design: Secondary analysis of data from a randomized control trial. Setting: Four university laboratories. Patients or Other Participants: A total of 199 participants with PFP. Intervention(s): Participants were randomly allocated to either a hip and core-focused (n ¼ 111) or knee-focused (n ¼ 88) rehabilitation group for a 6-week program. Main Outcome Measure(s): Demographics, self-reported knee pain (visual analog scale) and function (Anterior Knee Pain Scale), hip strength, abdominal muscle endurance, and hip range of motion were evaluated at baseline. Treatment success was defined as a decrease in visual analog scale score by 2 cm or an increase in the Anterior Knee Pain Scale score by 8 points or both. Bivariate relationships between the outcome (treatment success) and the predictor variables were explored, followed by a forward stepwise logistic regression to predict a successful outcome. Results: Patients with more pain, better function, greater lateral core endurance, and less anterior core endurance were more likely to have a successful outcome after hip and core strengthening (88% sensitivity and 54% specificity). Patients with lower weight, weaker hip internal rotation, stronger hip extension, and greater trunk-extension endurance were more likely to have success after knee strengthening (82% sensitivity and 58% specificity). Conclusion: The patients with PFP who have more baseline pain and yet maintain a high level of function may experience additional benefit from hip and core strengthening. The clinical prediction rules from this study remain in the developmental phase and should be applied with caution until externally validated.

AB - Context: Patellofemoral pain (PFP) is a common injury that interferes with quality of life and physical activity. Clinical subgroups of patients may exist, one of which is caused by proximal muscle dysfunction. Objectives: To develop clinical prediction rules that predict a positive outcome after either a hip and core- or knee-focused strengthening program for individuals with PFP. Design: Secondary analysis of data from a randomized control trial. Setting: Four university laboratories. Patients or Other Participants: A total of 199 participants with PFP. Intervention(s): Participants were randomly allocated to either a hip and core-focused (n ¼ 111) or knee-focused (n ¼ 88) rehabilitation group for a 6-week program. Main Outcome Measure(s): Demographics, self-reported knee pain (visual analog scale) and function (Anterior Knee Pain Scale), hip strength, abdominal muscle endurance, and hip range of motion were evaluated at baseline. Treatment success was defined as a decrease in visual analog scale score by 2 cm or an increase in the Anterior Knee Pain Scale score by 8 points or both. Bivariate relationships between the outcome (treatment success) and the predictor variables were explored, followed by a forward stepwise logistic regression to predict a successful outcome. Results: Patients with more pain, better function, greater lateral core endurance, and less anterior core endurance were more likely to have a successful outcome after hip and core strengthening (88% sensitivity and 54% specificity). Patients with lower weight, weaker hip internal rotation, stronger hip extension, and greater trunk-extension endurance were more likely to have success after knee strengthening (82% sensitivity and 58% specificity). Conclusion: The patients with PFP who have more baseline pain and yet maintain a high level of function may experience additional benefit from hip and core strengthening. The clinical prediction rules from this study remain in the developmental phase and should be applied with caution until externally validated.

KW - Exercise

KW - Hip

KW - Outcomes

KW - PFP

KW - Quadriceps

KW - Rehabilitation

UR - http://www.scopus.com/inward/record.url?scp=85052026430&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052026430&partnerID=8YFLogxK

U2 - 10.4085/1062-6050-510-16

DO - 10.4085/1062-6050-510-16

M3 - Article

C2 - 29893604

AN - SCOPUS:85052026430

VL - 53

SP - 545

EP - 552

JO - Journal of Athletic Training

JF - Journal of Athletic Training

SN - 1062-6050

IS - 6

ER -