title: The Effectiveness of Multimodal Care for Soft Tissue Injuries of the Lower Extremity: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
abstract: OBJECTIVE
  The purpose of this systematic review was to evaluate the effectiveness of multimodal care for the management of soft tissue injuries of the lower extremity.
  
  
  METHODS
  We systematically searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Random pairs of independent reviewers screened studies for relevance and critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. We included studies with a low risk of bias in our best evidence synthesis.
  
  
  RESULTS
  We screened 6794 articles. Six studies had a low risk of bias and addressed the following: plantar heel pain (n = 2), adductor-related groin pain (n = 1), and patellofemoral pain (n = 3). The evidence suggests that multimodal care for the management of persistent plantar heel pain may include mobilization and stretching exercise. An intensive, clinic-based, group exercise program (strengthening, stretching, balance, agility) is more effective than multimodal care for the management of adductor-related groin pain in male athletes. There is inconclusive evidence to support the use of multimodal care for the management of persistent patellofemoral pain. Our search did not identify any low risk of bias studies examining multimodal care for the management of other soft tissue injuries of the lower extremity.
  
  
  CONCLUSIONS
  A multimodal program of care for the management of persistent plantar heel pain may include mobilization and stretching exercise. Multimodal care for adductor-related groin pain is not recommended based on the current evidence. There is inconclusive evidence to support the use of multimodal care for the management of persistent patellofemoral pain.
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada. Electronic address: deborah.sutton@uoit.ca.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Sutton
authors.affiliation: Professor, Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York, NY; Professor, Department of Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York, NY.
authors.forename: Margareta
authors.initials: M
authors.lastname: Nordin
authors.affiliation: Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, ON, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
authors.forename: Kristi
authors.initials: K
authors.lastname: Randhawa
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Hainan
authors.initials: H
authors.lastname: Yu
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Associate Clinical Research Scientist, Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Instructor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Wong
authors.affiliation: Director, Graduate Education Program, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Assistant Clinical Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
authors.forename: Paula
authors.initials: P
authors.lastname: Stern
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
authors.forename: Sharanya
authors.initials: S
authors.lastname: Varatharajan
authors.affiliation: Research Coordinator, Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Southerst
authors.affiliation: Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Clinical Research Manager, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Senior Clinical Research Scientist, Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Shearer
authors.affiliation: Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Postdoctoral Fellow, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Maja
authors.initials: M
authors.lastname: Stupar
authors.affiliation: Assistant Professor, Division of Clinical Education, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Chadwick
authors.initials: C
authors.lastname: Chung
authors.affiliation: Graduate Student, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: Goldgrub
authors.affiliation: Professor, Injury Prevention Centre and School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Carroll
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Taylor-Vaisey
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D035002:Lower Extremity / Q000293:injuries*; D063868:Patient Outcome Assessment; D026741:Physical Therapy Modalities; D017695:Soft Tissue Injuries / Q000628:therapy*; D000078202:Systematic Reviews as Topic
keywords: Combined Modality Therapy; Fasciitis; Lower Extremity; Pain; Patellofemoral Pain Syndrome; Plantar; Review Literature as Topic; Soft Tissue Injuries; Sprains and Strains