Physiotherapy for anterior knee pain: a randomised controlled trial.
OBJECTIVE
To determine the efficacy of the individual components of physiotherapy in subjects with anterior knee pain.


METHODS
An observer blind, prospective, factorial design randomised controlled trial. 81 young adults with anterior knee pain were randomly allocated to one of four treatment groups: (1) exercise, taping, and education; (2) exercise and education; (3) taping and education; and (4) education alone. Each group received six physiotherapist-led treatments over three months. Follow up took place at three months using the following outcome measures: patient satisfaction (discharge/refer for further treatment); a visual analogue pain score; the WOMAC lower limb function score; the Hospital Anxiety and Depression scale (HAD); and quadriceps strength. At 12 months the WOMAC and HAD were assessed by postal questionnaire.


RESULTS
All groups showed significant improvements in WOMAC, visual analogue, and HAD scores; these improvements did not vary significantly between the four groups or between exercising/non-exercising and taped/non-taped patients at three and 12 months. However, patients who exercised were significantly more likely to be discharged at three months than non-exercising patients (chi(2), p<0.001). Taping was not significantly associated with discharge. Significantly greater improvements in WOMAC, visual analogue, and the anxiety score (but not the depression score) were seen in patients who were discharged than in those who were referred.


CONCLUSIONS
The proprioceptive muscle stretching and strengthening aspects of physiotherapy have a beneficial effect at three months sufficient to permit discharge from physiotherapy. These benefits are maintained at one year. Taping does not influence the outcome.
Clark
D I
DI
Department of Orthopaedics, City Hospital Nottingham, UK. davidclark@compuserve.com
Downing
N
N
Mitchell
J
J
Coulson
L
L
Syzpryt
E P
EP
Doherty
M
M
D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000209:etiology; D018771:Arthralgia / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D003866:Depressive Disorder / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D010147:Pain Measurement; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities / Q000379:methods*; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome