title: Cold legs: a potential indicator of negative outcome in the rehabilitation of patients with patellofemoral pain syndrome.
abstract: OBJECTIVE
  The purpose of this paper is to explore the link between a poor outcome in response to an exercise based approach to physiotherapy, in patients with patellofemoral dysfunction and a self-report of legs feeling cold even in warm surroundings.
  
  
  METHODS
  The study was carried out in the physiotherapy outpatients department of Burnley General Hospital, Lancashire, UK with 87 consecutively referred patients with a diagnosis of patellofemoral pain syndrome being assessed for suitability for entry into the study. Of these 77 entered the study with 14 (18%), of these responding 'Yes' to the question 'Do your legs feel cold even in warm surroundings?' All patients were assessed using four outcome measures prior to the commencement of a standardised rehabilitation programme consisting of lower limb biarticular muscle stretching, vastus medialis training and patella taping or biofeedback. The patients were reassessed using the same outcome measures 3 months after completing their course of treatment.
  
  
  CONCLUSIONS
  Patients who responded 'Yes' to the question 'Do your legs feel cold even in warm surroundings?' reported higher pain levels and tolerated less physical activity than non-cold sufferers at initial assessment, these differences were statistically significant. The cold sufferers showed less improvement on all of the outcome measures although the differences between the two groups only reached statistical significance for one of the outcome measures. The implications of this in relation to clinical practice are discussed.
authors.affiliation: Division of Physiotherapy, SOHS, University of Bradford, 25 Trinity Road, Bradford BD5 0BB, UK. j.selfe@bradford.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Selfe
authors.forename: L
authors.initials: L
authors.lastname: Harper
authors.forename: I
authors.initials: I
authors.lastname: Pedersen
authors.forename: J
authors.initials: J
authors.lastname: Breen-Turner
authors.forename: J
authors.initials: J
authors.lastname: Waring
authors.forename: D
authors.initials: D
authors.lastname: Stevens
mesh_terms: D000293:Adolescent; D000328:Adult; D018771:Arthralgia / Q000503:physiopathology* / Q000534:rehabilitation*; D002648:Child; D003080:Cold Temperature; D005260:Female; D006801:Humans; D007719:Knee Joint; D007866:Leg; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D013577:Syndrome