RESUMEN

OBJECTIVE: The aim of this systematic review and correlation meta-analysis was to identify factors associated with kinesiophobia in individuals with patellofemoral pain (PFP) and to identify interventions that may reduce kinesiophobia in individuals with PFP. METHODS: Seven databases were searched for articles including clinical factors associated with kinesiophobia or interventions that may reduce kinesiophobia in individuals with PFP. Two reviewers screened articles for inclusion, assessed risk of bias and quality, and extracted data from each study. A mixed-effects model was used to calculate correlations of function and pain with kinesiophobia using individual participant data. Meta-analyses were performed on interventional articles; Grading of Recommendations, Assessment, Development, and Evaluation was used to evaluate certainty of evidence. Results were reported narratively when pooling was not possible. RESULTS: Forty-one articles involving 2712 individuals were included. Correlation meta-analyses using individual participant data indicated a moderate association between self-reported function and kinesiophobia (n = 499; r = -0.440) and a weak association between pain and kinesiophobia (n = 644; r = 0.162). Low-certainty evidence from 2 articles indicated that passive treatment techniques were more effective than minimal intervention in reducing kinesiophobia (standardized mean difference = 1.11; 95% CI = 0.72 to 1.49). Very low-certainty evidence from 5 articles indicated that interventions to target kinesiophobia (psychobehavioral interventions, education, and self-managed exercise) were better in reducing kinesiophobia than physical therapist treatment approaches not specifically targeting kinesiophobia (standardized mean difference = 1.64; 95% CI = 0.14 to 3.15). CONCLUSION: Higher levels of kinesiophobia were moderately associated with poorer function and weakly associated with higher pain in individuals with PFP. Taping and bracing may reduce kinesiophobia immediately after use, and specific kinesiophobia-targeted interventions may reduce kinesiophobia following the full intervention; however, the certainty of evidence is very low. IMPACT: Assessment of kinesiophobia in clinical practice is recommended, on the basis of the relationships identified between kinesiophobia and other important factors that predict outcomes in individuals with PFP.

Asunto(s)

RESUMEN

BACKGROUND: There is a scarcity of evidence describing how physical therapists use data from clinical examinations to inform the treatment of runners with knee pain. OBJECTIVE: Our purpose was to examine the between physical therapist agreement on the selection of perceived impairments in runners with knee pain. METHODS: Twelve physical therapists reviewed two cases of runners with knee pain. The cases included clinical subjective information, objective data, and review of videos of each participant running. Each rater selected up to three perceived impairments (from a list of eight) that each physical therapist would address at the next physical therapy session. Percent agreement was calculated to determine the between rater agreement on each individual perceived impairment selection and Fleiss Kappa was calculated for each unique combination of three perceived impairments per case. RESULTS: Twelve raters with 51 (18-156) months of clinical experience participated. Percent agreement ranged from 8%-100% for both cases for individual impairments. When assessing the unique combination of three impairments selected, inter-rater agreement was less than what is expected due to chance alone (κ = -0.09, p = .92; κ = -0.09, p = .98) for both cases. CONCLUSION: The 12 physical therapists demonstrated poor to excellent levels of agreement when selecting an individual perceived impairment. Agreement was worse than chance when selecting a combination of three unique impairments.

Asunto(s)

RESUMEN

BACKGROUND AND PURPOSE: Differentiating between cervical nerve root and peripheral nerve injuries can be challenging. A phenomenon known as double crush syndrome may increase the susceptibility to injury and symptoms at other locations along the course of the nerve. The purpose of this case report is to describe the physical therapy differential diagnosis and management of a cyclist with upper extremity pain, weakness, and paresthesia. CASE DESCRIPTION: The subject was referred to physical therapy with a diagnosis of cervical disc disease. His chief complaints were chronic neck and right shoulder pain as well as a recent onset of right hand numbness and weakness following 100-mile bike ride one month prior. Diagnostic imaging revealed multi-level degenerative changes of the cervical spine. Initial electromyography and nerve conduction studies (EMG/NCS) indicated right ulnar neuropathy at the elbow. The ultimate incorporation of ulnar nerve mobilizations in various positions immediately decreased symptoms. In light of the subject's improvement after ulnar nerve mobilizations, imaging findings, and EMG/NCS findings, the subject's presentation was consistent with a double crush syndrome with C8 nerve root compression and distal ulnar nerve compression at the elbow. OUTCOMES: The subject demonstrated full resolution of all symptoms, 0% disability on the Neck Disability Index, 8.3% disability of the Disabilities of the Arm, Shoulder, and Hand questionnaire, normal EMG/NCV findings, and unrestricted return to work and endurance cycling at three months and maintained at one year. He did not require hand surgery. DISCUSSION: This case report highlights the importance of continual clinical re-examination and re-assessment with ancillary diagnostic testing, especially if chosen interventions are not eliciting desired responses. The identification of key risk factors, such as occupation and recreational activities is imperative in achieving the most efficacious clinical treatment. In this case, the recognition of a double crush syndrome assisted in optimizing the physical therapy plan of care and the subject ultimately achieving full recovery. LEVEL OF EVIDENCE: Level 4.