INTRODUCTION

Knee pain is a common ailment among a variety of age-groups.1,2 While 3.9% of children between 9 and 10 years of age reported chronic knee pain, the prevalence increases to 18.5% by the age of 15 years, and 20.8% by age 60.1,2 These studies suggest that the prevalence of knee pain continues to increase as the population ages.

Knee pain is typically classified as either traumatic or non-traumatic. Non-traumatic knee pain includes but is not limited to patellofemoral pain syndrome (PFPS), osteoarthritis (OA), and lateral knee pain.

Although extensive research has been conducted on a variety of knee disorders including many randomized trials, there is currently insufficient data from studies that monitor intervention choices and resulting outcomes in patients treated by student physical therapists and their clinical instructors.

Practice Patterns and Outcomes of Care for Patients with Non-Traumatic Knee DisordersJessica B. Albers, Alison M. Nading, Chelsea M. O’Driscoll, Jeremy W. Schmidt, Charlene M. Sheaman, Shannon B. StrimpleJessica B. Albers, Alison M. Nading, Chelsea M. O’Driscoll, Jeremy W. Schmidt, Charlene M. Sheaman, Shannon B. Strimple

School of Physical Therapy, Regis University, Denver, CO

DISCUSSION Nearly 50% of subjects achieved a successful outcome as defined by changes in pain and function, although patients with OA experienced less success. Interventions appeared to match the impairments identified. Although this was an initial exploratory study, interventions have been identified that are associated with outcomes and could be used in future prospective study designs.

METHODS

Procedures:

•Data collected by Regis University Doctor of Physical Therapy students during three clinical affiliations on patients with non-traumatic knee pain.

•Data collection included baseline, weekly, and discharge measurements using the Lower Extremity Functional Scale (LEFS) and the Numeric Pain Rating Scale (NPRS).

•Patients were classified as successful if they met the minimal clinically important difference (MCID) values for both of the following criteria:

•NPRS > 2 point decrease•LEFS > 9 point increase

•Data was coded and statistically analyzed with SPSS 17.0 version primarily consisting of descriptive and correlative statistics.

•Statistical significance set at an alpha < .10 for Chi-square testing.

RESULTS

•Total Subjects: 65 (F = 36, M = 29)

•Average age: 37.8 years ± 18.1

•Most Common Diagnoses:

•PFPS (n=26; 48.1%)

•Osteoarthritis (n=11; 20.4%)

•Lateral Knee Pain (n=13; 24.1%)

Purpose:

The purpose of this analysis of practice was to identify the physical therapy interventions and practice patterns implemented by student physical therapists in the treatment of PFPS, OA, and lateral knee pain.

References:1. Anderson R, Crespo C, Ling S, Batham J, Bartlett S. Prevalence of significant knee pain among older americans: results from the third national health and nutrition examination survery. J Am Geriatr Soc. 1999;47:1435-1438.

2.Vanasarja V. Prevalence of chronic knee pain in children and adolescence in northern Finland. Acta Pediatric. 1995;84:803-805.

3. Lowry C, Cleland J, Dyke K. Management of patients with patellofemoral pain syndrome using a multimodal approach: a case series. J Orthop Sport Phys Ther. 2008; 38: 691-702

CLINICAL RELEVANCE Monitoring patient demographics, outcome

measures and prioritized interventions can inform clinical practice. The use of both the LEFS and NPRS appear to be appropriate measures in tracking changes in patients with non-traumatic knee pain. Assessment of a multimodal approach to treating PFPS, yielded similar results in changes in NPRS (4 point change from baseline to discharge) and the LEFS (14 point change from baseline to discharge).3

Diagnosis#1

Intervention#2

Intervention#3

Intervention#4

Intervention

PFPSStretching

(n=23)PRE

(n=21)

Patient Education

(n=19)

Joint Mobilization

(n=12)

OsteoarthritisPatient Education

(n=9)PRE (n=9)

A/PROM (n=6)

Stretching (n=4)

Lateral Knee PainPatient Education

(n=12)Stretching

(n=12)PRE

(n=10)

Electrical Stimulation

(n=6)

Diagnosis # of Visits ImpairmentsSuccess vs.

Non-Success

PFPS7.7

Hamstring Tight, ITB Tight,

Rectus Femoris Tight

Success = 50%Non- Success = 50%

Osteoarthritis 11.0

Hamstring Tight, PROM Pain with

Extension, Gastroc Tight

Success = 30%Non- Success = 70%

Lateral Knee Pain6.7

ITB Tight, Patella Tender at Lateral Aspect,

PROM Pain with Flexion

Success =54%Non- Success = 46%

Table 2. Weeks 1 – 3 Most Common Interventions

Table 1. Patient Demographics Per Diagnosis Association between Interventions and Success.

Note: Alpha < 0.10

Chart 1 and 2. Change of Primary Outcome Measures

Chi-square statistics revealed that three of the 20 intervention options were associated with successful outcome:• Application of joint mobilization (p = .03)• Not performing isometric exercise (p = .05)• Not performing taping/bracing (p = .10)

PFPS OA Lat. Knee Pain OverallN

PR

S S

ca

le0

1

2

3

4

5

6

PFPS OA Lat. Knee Pain Overall

LE

FS

0

5

10

15

20

25

30

35

MCID = 9

MCID = 2