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Quality Assessment Scale for Systematic Reviews on Patellofemoral Pain Syndrome

When health care professionals such as physical therapists see a large number of patients with the same problem, they look for evidence to support the best way to treat that condition. That's the case with patellofemoral pain syndrome (PFPS), a common problem for many athletes and active young adults.

PFPS causes pain around and under the patella (kneecap). Activities that increase the load on this joint aggravate the condition. For example, many patients with PFPS report that walking, running, and using stairs make their symptoms worse. Moving the knee after a long period of sitting can also cause pain.

Clear treatment guidelines based on evidence create best practice to optimize patient outcomes. These guidelines are often developed as a result of summaries from systematic reviews. In a systematic review, researchers search for all studies on a specific topic. Studies that meet the criteria for high quality methods in research are included. Treatment protocols backed by sufficient evidence are reported.

But systematic reviews must be done in such a way that they are critical and valid. Good rating scales using multiple assessors are available to assist researchers with this process. In this study, a previously validated tool called the Quality Assessment Scale for Systematic Reviews was used to look at systematic reviews already published on nonpharmacological (nondrug) treatment for PFPS.

Nonpharmacologic treatment included exercise therapy, manual therapy, and ultrasound or other physical agents. All treatments were done by a physical therapist. The use of taping and orthotics (supportive shoe inserts) was also included. Only published systematic reviews and reviews in English were selected. They were published between the years 2000 and 2007. Only those with an unbiased (acceptable) way of searching for articles were allowed.

Appropriate items for the new quality assessment scale were selected from various checklists, texts, and discussions with experts. Several teams of reviewers applied the scale to the systematic reviews on PFPS. The scale was tested and refined until it met all the criteria needed to be valid and reliable. Cutoff scores were identified to determine which reviews were high quality.

Once the reviews were analyzed and selected, then the findings were summarized for the high quality systematic reviews. In the end. three systematic reviews passed the test. They were all Cochrane Reviews, an organization known for its quality systematic reviews.

Treatment interventions studied included exercise therapy, ultrasound, and orthotics (for the foot and knee). There were no acceptable studies on the use of patellar taping (a popular treatment method). The conclusions of these reviews were as follows:

  • Exercise therapy improves pain. The type of exercise (weight-bearing and nonweight-bearing) did not seem to matter. Results were the same with either form of exercise.
  • Therapeutic ultrasound did not appear to reduce pain associated with PFPS. Further study is needed in this area.
  • No conclusion on recommendations could be made about the management of PFPS using knee and foot orthoses (due to insufficient evidence).

    However, it should be noted that sample sizes were small and in general, the evidence on these points was insufficient. And by standards set by the Cochrane organization, the studies are now considered out of date and should be updated.

    The authors conclude that their newly developed scale to assess the quality of systematic reviews specific to the topic of PFPS passed the test. It was able to identify studies of high quality that were without bias. They suggest the current 13-item scale could easily be adapted for use with other topics. Despite the many studies available on the topic of PFPS, not many passed the test to qualify as an acceptable standard for review.


    Christian J. Barton, BPhysio (Hons), PT, et al. Evaluation of the Scope and Quality of Systematic Reviews on Nonpharmacological Conservative Treatment for Patellofemoral Pain Syndrome. In Journal of Orthopaedic & Sports Physical Therapy. September 2008. Vol. 38. No.9. Pp. 529-545.

    09/25/2008

    *Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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