title: Exercise, education, manual-therapy and taping compared to education for patellofemoral osteoarthritis: a blinded, randomised clinical trial.
abstract: OBJECTIVE
  Patellofemoral joint osteoarthritis (PFJ OA) contributes considerably to knee OA symptoms. This study aimed to determine the efficacy of a PFJ-targeted exercise, education manual-therapy and taping program compared to OA education alone, in participants with PFJ OA.
  
  
  METHODS
  A randomised, participant-blinded and assessor-blinded clinical trial was conducted in primary-care physiotherapy. 92 people aged ≥40 years with symptomatic and radiographic PFJ OA participated. Physiotherapists delivered the PFJ-targeted exercise, education, manual-therapy and taping program, or the OA-education (control condition) in eight sessions over 12 weeks. Primary outcomes at 3-month (primary) and 9-month follow-up: (1) patient-perceived global rating of change (2) pain visual analogue scale (VAS) (100 mm); and (3) activities of daily living (ADL) subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS).
  
  
  RESULTS
  81 people (88%) completed the 3-month follow-up and data analysed on an intention-to-treat basis. Between-group baseline similarity for participant characteristics was observed. The exercise, education, manual-therapy and taping program resulted in more people reporting much improvement (20/44) than the OA-education group (5/48) (number needed to treat 3 (95% confidence interval (CI) 2 to 5)) and greater pain reduction (mean difference: -15.2 mm, 95% CI -27.0 to -3.4). No significant effects on ADL were observed (5.8; 95% CI -0.6 to 12.1). At 9 months there were no significant effects for self-report of improvement, pain (-10.5 mm, 95% CI -22.7 to 1.8) or ADL (3.0, 95% CI -3.7 to 9.7).
  
  
  CONCLUSIONS
  Exercise, education, manual-therapy and taping can be recommended to improve short-term patient rating of change and pain severity. However over 9-months, both options were equivalent.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (ACTRN12608000288325): https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=82878.
authors.affiliation: Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia; Department of Mechanical Engineering, The University of Melbourne, Parkville, Victoria, Australia; School of Allied Health, College of Science, Health and Engineering La Trobe University, Bundoora, Victoria 3086, Australia. Electronic address: k.crossley@uq.edu.au.
authors.forename: K M
authors.initials: KM
authors.lastname: Crossley
authors.affiliation: Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Vicenzino
authors.affiliation: Department of Mechanical Engineering, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Lentzos
authors.affiliation: Department of Mechanical Engineering, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: A G
authors.initials: AG
authors.lastname: Schache
authors.affiliation: Department of Mechanical Engineering, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: M G
authors.initials: MG
authors.lastname: Pandy
authors.affiliation: Department of Mechanical Engineering, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Ozturk
authors.affiliation: Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: R S
authors.initials: RS
authors.lastname: Hinman
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D055052:Athletic Tape; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010147:Pain Measurement; D010353:Patient Education as Topic; D063868:Patient Outcome Assessment
keywords: Exercise-therapy; Knee; Patella; Physiotherapy; Rehabilitation