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Ortesis de la rodilla para el tratamiento del síndrome de dolor patelofemoral

Appendices

Appendix 1. Search strategies

CENTRAL (Wiley Online Library)

#1 MeSH descriptor: [Patellofemoral Pain Syndrome] this term only (72)
#2 [mh Knee] or [mh ^"Knee Injuries"] or [mh ^"Knee Joint"] or [mh Patella] (3341)
#3 [mh ^Arthralgia] or [mh ^Pain] (10158)
#4 #2 and #3 (365)
#5 "anterior knee pain":ti,ab,kw (Word variations have been searched) (156)
#6 PFPS:ti,ab,kw (Word variations have been searched) (56)
#7 ((patell* or femoropatell* or femoro‐patell* or retropatell* or retro‐patell*) near/2 (pain or syndrome or dysfunction or sublux or malalign* or realign*)):ti,ab,kw (Word variations have been searched) (319)
#8 MeSH descriptor: [Chondromalacia Patellae] this term only (5)
#9 ((chondromalac* or chondropath*) near/2 (knee* or patell* or femoropatell* or femoro‐patell* or retropatell* or retro‐patell*)):ti,ab,kw (Word variations have been searched) (32)
#10 ((lateral compression or lateral facet or lateral pressure or odd facet) near syndrome):ti,ab,kw (Word variations have been searched) (1)
#11 {or #5‐#10} (451)
#12 #1 or #4 or #11 (742)
#13 MeSH descriptor: [Rehabilitation] explode all trees (15765)
#14 MeSH descriptor: [Physical Therapy Modalities] explode all trees (16415)
#15 MeSH descriptor: [Physical Therapy Specialty] this term only (114)
#16 MeSH descriptor: [Orthotic Devices] explode all trees (927)
#17 (brace* or sleeve* or strap* or orthotic* or orthosis or orthoses or bandage*):ti,ab,kw (Word variations have been searched)4467
#18 "realign":ti,ab,kw (Word variations have been searched) (21)
#19 (physiotherapy or physical therapy):ti,ab,kw (Word variations have been searched) (17257)
#20 rehabilitat*:ti,ab,kw (Word variations have been searched) (14093)
#21 Any MeSH descriptor with qualifier(s): [Rehabilitation ‐ RH] (13927)
#22 (non‐surg* or nonsurg* or non‐operat* or nonoperat* or conserv*):ti,ab,kw (Word variations have been searched) (9270)
#23 {or #13‐#22} (61513)
#24 #12 and #23 (319)

MEDLINE (Ovid Online)

1 Patellofemoral Pain Syndrome/ (510)
2 exp Knee/ or Knee Injuries/ or Knee Joint/ or exp Patella/ (65152)
3 Arthralgia/ or Pain/ (116321)
4 2 and 3 (3557)
5 anterior knee pain.tw. (1123)
6 pfps.tw. (297)
7 ((patell$ or femoropatell$ or femoro‐patell$ or retropatell$ or retro‐patell$) adj2 (pain or syndrome or dysfunction or sublux or malalign$ or realign$)).tw. (2083)
8 ((lateral compression or lateral facet or lateral pressure or odd facet) adj syndrome).tw. (21)
9 Chondromalacia Patellae/ (62)
10 ((chondromalac$ or chondropath$) adj2 (knee$1 or patell$ or femoropatell$ or femoro‐patell$ or retropatell$ or retro‐patell$)).tw. (512)
11 or/5‐10 (3483)
12 1 or 4 or 11 (6408)
13 exp Rehabilitation/ (155245)
14 exp Physical Therapy Modalities/ (129434)
15 Physical Therapy Specialty/ (2236)
16 exp Orthotic Devices/ (9782)
17 (brace$ or sleeve$ or strap$ or orthotic* or orthos#s or bandage$).tw. (22186)
18 realign$.tw. (3331)
19 (physiotherapy or physical therapy).tw. (23363)
20 rehabilitat*.tw. (113902)
21 rh.fs. (169770)
22 (non‐surg$ or nonsurg$ or non‐operat$ or nonoperat$ or conserv$).tw. (359633)
23 or/13‐22 (799951)
24 12 and 23 (1614)
25 Randomized controlled trial.pt. (394854)
26 Controlled clinical trial.pt. (89435)
27 randomized.ab. (320090)
28 placebo.ab. (162328)
29 Drug therapy.fs. (1771045)
30 randomly.ab. (230447)
31 trial.ab. (331205)
32 groups.ab. (1449538)
33 or/25‐32 (3528365)
34 exp Animals/ not Humans/ (4037832)
35 33 not 34 (3031597)
36 24 and 35 (452)

EMBASE (Ovid Online)

1 Patellofemoral Pain Syndrome/ (791)
2 Knee/ or Knee Injury/ or Patella/ (59862)
3 Arthralgia/ or Pain/ (255225)
4 2 and 3 (6247)
5 anterior knee pain.tw. (1339)
6 PFPS.tw. (351)
7 ((patell$ or femoropatell$ or femoro‐patell$ or retropatell$ or retro‐patell$) adj2 (pain or syndrome or dysfunction or sublux or malalign$ or realign$)).tw. (2424)
8 ((lateral compression or lateral facet or lateral pressure or odd facet) adj syndrome).tw. (25)
9 Patella Chondromalacia/ (597)
10 ((chondromalac$ or chondropath$) adj2 (knee$1 or patell$ or femoropatell$ or femoro‐patell$ or retropatell$ or retro‐patell$)).tw. (608)
11 or/5‐10 (4280)
12 1 or 4 or 11 (10233)
13 exp Rehabilitation/ (248682)
14 Physiotherapy/ (55685)
15 Orthotics/ (3013)
16 (brace$ or sleeve$ or strap$ or orthotic* or orthos#s or bandage$).tw. (29461)
17 realign$.tw. (3918)
18 (physiotherapy or physical therapy).tw. (33422)
19 rehabilitat$.tw. (153896)
20 (non‐surg$ or nonsurg$ or non‐operat$ or nonoperat$ or conserv$).tw. (400593)
21 or/13‐20 (811654)
22 12 and 21 (2533)
23 exp Randomized Controlled Trial/ or exp Single Blind Procedure/ or exp Double Blind Procedure/ or Crossover Procedure/ (416387)
24 (random$ or RCT or placebo or allocat$ or crossover$ or 'cross over' or trial or (doubl$ adj1 blind$) or (singl$ adj1 blind$)).ti,ab. (1362815)
25 23 or 24 (1438687)
26 (exp Animal/ or animal.hw. or Nonhuman/) not (exp Human/ or Human Cell/ or (human or humans).ti.) (5260646)
27 25 not 26 (1266421)
28 22 and 27 (500)

AMED (Ovid Online)

1 Patellofemoral Pain Syndrome/ (75)
2 Knee/ or Knee Injuries/ or Knee Joint/ or Patella/ (5599)
3 Pain/ or Arthralgia/ (10755)
4 2 and 3 (720)
5 anterior knee pain.tw. (134)
6 PFPS.tw. (115)
7 ((patell$ or femoropatell$ or femoro‐patell$ or retropatell$ or retro‐patell$) adj2 (pain or syndrome or dysfunction or sublux or malalign$ or realign$)).tw. (484)
8 ((lateral compression or lateral facet or lateral pressure or odd facet) adj syndrome).tw. (1)
9 ((chondromalac$ or chondropath$) adj2 (knee$1 or patell$ or femoropatell$ or femoro‐patell$ or retropatell$ or retro‐patell$)).tw. (27)
10 or/5‐9 (603)
11 1 or 4 or 10 (997)
12 Rehabilitation/ (46854)
13 Physical therapy modalities/ (4239)
14 exp Orthotic devices/ (1851)
15 (brace$ or sleeve$ or strap$ or orthotic* or orthos#s or bandage$).tw. (3286)
16 realign$.tw. (129)
17 (physiotherapy or physical therapy).tw. (17720)
18 rehabilitat$.tw. (55498)
19 (non‐surg$ or nonsurg$ or non‐operat$ or nonoperat$ or conserv$).tw. (2863)
20 or/12‐19 (71554)
21 11 and 20 (477)
22 Randomized controlled trial.pt. (3195)
23 Controlled clinical trial.pt. (70)
24 Randomized Controlled Trials/ (1709)
25 Random Allocation/ (312)
26 Double‐Blind Method/ (538)
27 or/22‐26 (5541)
28 exp Animals/ not Humans/ (8174)
29 27 not 28 (5511)
30 clinical trial.pt. (1167)
31 exp Clinical trials/ (3448)
32 (clinic$ adj25 trial$).tw. (6109)
33 ((singl$ or doubl$ or trebl$ or tripl$) adj (mask$ or blind$)).tw. (2448)
34 Placebos/ (561)
35 placebo$.tw. (2744)
36 random$.tw. (14963)
37 exp Research design/ (18228)
38 (latin adj square).tw. (24)
39 or/30‐38 (32656)
40 39 not 28 (32063)
41 40 not 29 (26708)
42 21 and 41 (99)

CINAHL (EBSCOHost)

S1 (MH "Patellofemoral Pain Syndrome") (1,005)
S2 (MH "Knee") OR (MH "Knee Injuries") OR (MH "Knee Joint") OR (MH "Patella") (19,617)
S3 (MH "Arthralgia+") OR (MH "Pain") (55,507)
S4 S2 AND S3 (2,193)
S5 TX anterior knee pain (486)
S6 TX PFPS (192)
S7 TX ((patell* or femoropatell* or femoro‐patell* or retropatell* or retro‐patell*) N2 (pain or syndrome or dysfunction or sublux or malalign* or realign*)) (1,425)
S8 TX ((lateral compression or lateral facet or lateral pressure or odd facet) N3 syndrome) (8)
S9 (MH "Chondromalacia Patella") (64)
S10 TX ((chondromalac* or chondropath*) N2 (knee* or patell* or femoropatell* or femoro‐patell* or retropatell* or retro‐patell*)) (104)
S11 S5 OR S6 OR S7 OR S8 OR S9 OR S10 (1,802)
S12 S1 OR S4 OR S11 (3,308)
S13 (MH "Orthoses+") (6,903)
S14 TX (brace* or sleeve* or strap* or orthotic* or orthos#s or bandage*) (20,151)
S15 S13 OR S14 (20,393)
S16 S12 AND S15 (343)
S17 PT Clinical Trial (77,889)
S18 (MH "Clinical Trials+") (187,289)
S19 TI clinical trial* OR AB clinical trial* (45,410)
S20 TI ( (single blind* or double blind*) ) OR AB ( (single blind* or double blind*) ) (21,470)
S21 TI random* OR AB random* (149,549)
S22 S17 OR S18 OR S19 OR S20 OR S21 (277,415)
S23 S16 AND S22 (85)

SPORTDiscus (EBSCOHost)

S1 TX anterior knee pain (595)
S2 TX PFPS (334)
S3 TX ((patell* or femoropatell* or femoro‐patell* or retropatell* or retro‐patell*) N2 (pain or syndrome or dysfunction or sublux or malalign* or realign*)) (1,357)
S4 TX ((lateral compression or lateral facet or lateral pressure or odd facet) N2 syndrome) (10)
S5 TX ((chondromalac* or chondropath*) N2 (knee* or patell* or femoropatell* or femoro‐patell* or retropatell* or retro‐patell*)) (242)
S6 S1 OR S2 OR S3 OR S4 OR S5 (1,926)
S7 DE "ORTHOPEDIC apparatus" (2,529)
S8 TX (brace* or sleeve* or strap* or orthotic* or orthos#s or bandage*) (9,150)
S9 S7 OR S8 (10,112)
S10 S6 AND S9 (195)
S11 TX ( (clinic* N3 trial) or (controlled N3 trial) or (comparative N3 trial) or (placebo N3 trial) or (prospective N3 trial) or (randomi?ed N3 trial) ) or TX ( (clinic* N3 study) or (controlled N3 study) or (comparative N3 study) or (placebo N3 study) or (prospective N3 study) or (randomi?ed N3 study) ) (65,289)
S12 (random* N7 allot*) or (random* N7 assign*) or (random* N7 basis*) or (random* N7 divid*) or (random* N7 order*) (8,538)
S13 TX ( (singl* N7 blind*) or (doubl* N7 blind*) or (trebl* N7 blind*) or (tripl* N7 blind*) ) or TX ( (singl* N7 mask*) or (doubl* N7 mask*) or (trebl* N7 mask*) or (tripl* N7 mask*) ) (5,465)
S14 TX (cross#over*) or TX (cross N1 over*) (4,067)
S15 TX randomi?ed control* trial* (9,473)
S16 TX ( (allocat* N3 condition*) or (allocat* N3 experiment*) or (allocat* N3 intervention*) or (allocat* N3 treatment*) or (allocat* N3 therap*) or (allocat* N3 control*) or (allocat* N3 group*) ) or TX ( (allot* N3 condition*) or (allot* N3 experiment*) or (allot* N3 intervention*) or (allot* N3 treatment*) or (allot* N3 therap*) or (allot* N3 control*) or (allot* N3 group*) ) or TX ( (assign* N3 condition*) or (assign* N3 experiment*) or (assign* N3 intervention*) or (assign* N3 treatment*) or (assign* N3 therap*) or (assign* N3 control*) or (assign* N3 group*) ) or TX ( (divid* N3 condition*) or (divid* N3 experiment*) or (divid* N3 intervention*) or (divid* N3 treatment*) or (divid* N3 therap*) or (divid* N3 control*) or (divid* N3 group*) ) (9,275)
S17 TX placebo* (7,914)
S18 S11 or S12 or S13 or S14 or S15 or S16 or S17 (80,389)
S19 S10 AND S18 (63)

Physiotherapy Evidence Databases (PEDro Platform)

a) Simple Search

  1. Patella* and brac* (31)

  2. Patella* and strap (4)

  3. Patella* and ortho* (128)

  4. Patella* and sleeve (2)

  5. Patella* and bandage (1)

  6. Knee and brac* (161)

  7. Knee and ortho* (1224)

  8. Knee and strap (5)

  9. Knee and sleeve (13)

  10. Knee and bandage (65)

b) Advanced Search

Abstract and title: patell
Therapy: orthoses, taping, splinting
Body Part: lower leg or knee
Method: clinical trial

Total = 48

WHO International Clinical Trials Registry Platform

  1. Patell* and brac* (9)

  2. Patell* and strap* (5)

  3. Patell* and orthos* (9)

  4. Patell* and orthot* (3)

  5. Patell* and sleeve* (0)

  6. Patell* and bandag* (4)

  7. Knee and brac* (41)

  8. Knee and strap* (16)

  9. Knee and orthos* (28)

  10. Knee and orthot* (21)

  11. Knee and sleeve* (3)

  12. Knee and bandag* (20)

Current Controlled Trials

  1. Knee and brace (12)

  2. Knee and strap (4)

  3. Knee and orthosis (8)

  4. Knee and orthotic (6)

  5. Knee and sleeve (1)

  6. Knee and bandage (10)

  7. Knee and ortho* (1)

  8. Knee and brac* (0)

  9. Patell* and ortho* (0)

  10. Patell* and brac* (0)

OpenGrey

  1. Knee brac* (5)

  2. Knee strap (0)

  3. Knee ortho* (51)

  4. Knee sleeve (0)

  5. Knee bandage (0)

  6. Patell* brac* (1)

  7. Patell* ortho* (11)

  8. Patell* strap (0)

  9. Patell* sleeve (0)

  10. Patell* bandage (0)

Orthopaedic Proceedings (Bone and Joint Journal Website)

  1. Patello* and random* (48)

  2. Anterior knee pain and random* (80)

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Forest plot 1.1. Comparison: knee orthosis and exercises versus exercises alone. Outcome: pain during activity (0 to 10; higher score means worse pain)
Figures and Tables -
Figure 4

Forest plot 1.1. Comparison: knee orthosis and exercises versus exercises alone. Outcome: pain during activity (0 to 10; higher score means worse pain)

Comparison 1 Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone, Outcome 1 Pain during activity (0 to 10; higher score means worse pain).
Figures and Tables -
Analysis 1.1

Comparison 1 Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone, Outcome 1 Pain during activity (0 to 10; higher score means worse pain).

Comparison 1 Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone, Outcome 2 Pain scores (0 to 10; higher score means worse pain).
Figures and Tables -
Analysis 1.2

Comparison 1 Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone, Outcome 2 Pain scores (0 to 10; higher score means worse pain).

Comparison 1 Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone, Outcome 3 Different pain scores (0 to 10; higher score means worse pain) at 12 weeks.
Figures and Tables -
Analysis 1.3

Comparison 1 Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone, Outcome 3 Different pain scores (0 to 10; higher score means worse pain) at 12 weeks.

Comparison 1 Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone, Outcome 4 Excellent or good results in terms of reduction in symptoms.
Figures and Tables -
Analysis 1.4

Comparison 1 Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone, Outcome 4 Excellent or good results in terms of reduction in symptoms.

Comparison 1 Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone, Outcome 5 Functional scores (higher score means higher function).
Figures and Tables -
Analysis 1.5

Comparison 1 Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone, Outcome 5 Functional scores (higher score means higher function).

Comparison 1 Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone, Outcome 6 Discontinuation of a basic military training programme.
Figures and Tables -
Analysis 1.6

Comparison 1 Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone, Outcome 6 Discontinuation of a basic military training programme.

Comparison 2 One type of orthosis versus another type, Outcome 1 Pain score (0 to 10: higher score means worse pain).
Figures and Tables -
Analysis 2.1

Comparison 2 One type of orthosis versus another type, Outcome 1 Pain score (0 to 10: higher score means worse pain).

Comparison 2 One type of orthosis versus another type, Outcome 2 Functional score (0 to 53: higher scores means greater function).
Figures and Tables -
Analysis 2.2

Comparison 2 One type of orthosis versus another type, Outcome 2 Functional score (0 to 53: higher scores means greater function).

Comparison 2 One type of orthosis versus another type, Outcome 3 Discontinuation of a basic military training programme.
Figures and Tables -
Analysis 2.3

Comparison 2 One type of orthosis versus another type, Outcome 3 Discontinuation of a basic military training programme.

Comparison 2 One type of orthosis versus another type, Outcome 4 Complications.
Figures and Tables -
Analysis 2.4

Comparison 2 One type of orthosis versus another type, Outcome 4 Complications.

Comparison 3 Orthosis versus exercise, Outcome 1 Pain during activity (0 to 10: higher score means worse pain).
Figures and Tables -
Analysis 3.1

Comparison 3 Orthosis versus exercise, Outcome 1 Pain during activity (0 to 10: higher score means worse pain).

Comparison 3 Orthosis versus exercise, Outcome 2 Sensitivity analyses (knees): Pain during activity (0 to 10: higher score means worse pain).
Figures and Tables -
Analysis 3.2

Comparison 3 Orthosis versus exercise, Outcome 2 Sensitivity analyses (knees): Pain during activity (0 to 10: higher score means worse pain).

Comparison 3 Orthosis versus exercise, Outcome 3 Functional scores (0 to 53: higher scores means greater function).
Figures and Tables -
Analysis 3.3

Comparison 3 Orthosis versus exercise, Outcome 3 Functional scores (0 to 53: higher scores means greater function).

Summary of findings for the main comparison. Summary of findings: Knee orthosis (any type) and exercise versus control (exercise only) for treating patellofemoral pain syndrome

Knee orthosis and exercise versus exercise alone for patellofemoral pain syndrome (PFPS)

Patient or population: Adults (recruited from health clinics or military recruits) with PFPS (duration of symptoms ranged from acute, under 2 to 3 weeks in two trials, to predominantly chronic in three trials: mean durations 8.3 months, 21 months, 21 months)

Settings: Health clinics, home and military training establishments

Intervention: Knee orthosis (various types: knee sleeve, knee brace or patellar strap) and exercise (military training, home exercise programme)

Comparison: Exercise alone

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Exercise alone

Knee orthosis and exercise

Pain score (VAS)

Scale from: 0 to 10 (higher scores mean worse pain)

Follow‐up: 3 to 12 weeks (short‐term)

The mean pain score for the exercise alone group ranged across the control groups from 2.7 to 3.2 points; the mean change score from ‐0.47 to ‐0.96 points

The mean pain score in the knee orthosis and exercise group was 0.46 points lower (1.16 lower to 0.24 higher)

MD ‐0.46 (‐1.16 to 0.24)

234 (3)

⊕⊝⊝⊝
very low1

The MD and 95% CIs do not include clinically important treatment effects.

MCID: 30 mm on an 100 mm VAS (Lee 2003)

Functional outcomes

Scale various 2

Follow‐up:

6 and 12 weeks (short‐term)

The mean functional score in the knee orthosis and exercise group was 0.15 points lower (0.69 lower to 0.38 higher)

The mean difference in knee function (short‐term) in the knee orthosis group was 0.25 standard deviations lower (0.55 lower to 0.05 higher)

SMD ‐0.25 (‐0.55 to 0.05)

183 (2)

⊕⊝⊝⊝
very low3

Lower values equate to higher disability.

The SMD result equates to a small difference at most and in absolute terms, the mean differences for each trial were small (e.g. 0.9 for a range 0 to 68) and not clinically important

Quality of Life and General Health Assessments

See comment

See comment

No study reported this outcome

Impact on sporting and occupational participation

See comment

See comment

51 (1)4

⊕⊝⊝⊝
very low 5

One trial reported that 2 out of 31 (6.5%) participants in the knee orthosis groups versus 0 of 20 (0%) in the control group withdrew from their military training programme.

Resource use

See comment

See comment

No study reported this outcome

Participant satisfaction

See comment

See comment

No study reported this outcome

Complications

Follow‐up: 14 weeks6

See comment

See comment

59 with 84 affected knees (1)

⊕⊝⊝⊝
very low 7

Trial reported 16 complications (skin abrasions or discomfort) for 44 knees (36%) of participants in the knee orthosis group.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence Interval; MCID: Minimal Clinically Important Difference; MD: Mean Difference; RR: Risk Ratio; SMD: Standardised Mean Difference; VAS: Visual Analogue Scale

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1. The quality of the evidence was downgraded two levels for major study limitations resulting in very serious risk of bias (including selection bias (1 trial) and performance bias (all 3 trials)), and one level for indirectness (this reflects the clinical heterogeneity such as variation in the interventions and outcome measures and measurement, and the generally inadequate description of these). There was, however, no statistical heterogeneity in the pooled data.

2. One trial reported WOMAC functional scores (0 to 68; higher values mean worse function) at six weeks and the other the results of a modified version of the Knee Function Scale (0 to 53; higher values mean better function) at 12 weeks.

3. The quality of the evidence was downgraded two levels for major study limitations resulting in very serious risk of bias (including selection bias (1 trial) and performance bias (both trials)), and one level for imprecision (wide confidence intervals and limited data).

4. Data on resumption of sports activities were not split by treatment group in one trial (35 participants).

5. The quality of the evidence was downgraded two levels for major study limitations resulting in very serious risk of bias (including performance and detection biases), and one level for indirectness (abandonment of military training may be for other reasons than serious knee pain).

6. The single study recording this outcome did not record complications for all groups. The follow‐up for complications appeared be during use; i.e. the basic military training programme of 14 weeks..

7. The quality of the evidence was downgraded two levels for major study limitations resulting in very serious risk of bias (including performance and detection biases and serious unit of analyses issues relating to the inclusion of participants with anterior knee pain in both knees), and imprecision (incomplete data from one small trial).

Figures and Tables -
Summary of findings for the main comparison. Summary of findings: Knee orthosis (any type) and exercise versus control (exercise only) for treating patellofemoral pain syndrome
Comparison 1. Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain during activity (0 to 10; higher score means worse pain) Show forest plot

3

234

Mean Difference (IV, Fixed, 95% CI)

‐0.46 [‐1.16, 0.24]

1.1 Knee sleeve

3

162

Mean Difference (IV, Fixed, 95% CI)

‐0.48 [‐1.31, 0.35]

1.2 Patellar strap

1

23

Mean Difference (IV, Fixed, 95% CI)

‐1.09 [‐3.71, 1.53]

1.3 Knee brace

1

49

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐1.68, 1.28]

2 Pain scores (0 to 10; higher score means worse pain) Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 Knee orthosis (any)

3

234

Mean Difference (IV, Fixed, 95% CI)

‐0.46 [‐1.16, 0.24]

2.2 Sensitivity analysis (knees). Knee orthosis (any)

3

276

Mean Difference (IV, Fixed, 95% CI)

‐0.41 [‐1.04, 0.23]

3 Different pain scores (0 to 10; higher score means worse pain) at 12 weeks Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 Pain during activity

1

97

Mean Difference (IV, Fixed, 95% CI)

‐0.15 [‐1.20, 0.90]

3.2 Sensitivity analysis (knees). Pain during activity

1

139

Mean Difference (IV, Fixed, 95% CI)

‐0.15 [‐1.02, 0.72]

3.3 Pain 1 hour after sporting activity

1

97

Mean Difference (IV, Fixed, 95% CI)

0.75 [‐0.19, 1.69]

3.4 Sensitivity analysis (knees). Pain 1 hour after sporting activity

1

139

Mean Difference (IV, Fixed, 95% CI)

0.75 [‐0.04, 1.53]

3.5 Pain after 30 minutes sitting with knees flexed

1

97

Mean Difference (IV, Fixed, 95% CI)

0.25 [‐0.82, 1.32]

3.6 Sensitivity analysis (knees). Pain after sitting with knees flexed

1

139

Mean Difference (IV, Fixed, 95% CI)

0.25 [‐0.64, 1.14]

4 Excellent or good results in terms of reduction in symptoms Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 At 12 weeks

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 At 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Functional scores (higher score means higher function) Show forest plot

2

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 Knee orthosis (any)

2

183

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.25 [‐0.55, 0.05]

5.2 Sensitivity analysis (knees): Knee orthosis (any)

2

225

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.28 [‐0.55, ‐0.01]

6 Discontinuation of a basic military training programme Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 1. Knee orthosis and non‐operative intervention (exercises) versus non‐operative intervention (exercises) alone
Comparison 2. One type of orthosis versus another type

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain score (0 to 10: higher score means worse pain) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Patellar strap versus knee sleeve

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Knee brace versus knee sleeve

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Knee brace versus knee sleeve (sensitivity analysis: knees)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.4 Knee brace versus knee sleeve

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.5 Knee brace versus knee sleeve (sensitivity analysis: knees)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Functional score (0 to 53: higher scores means greater function) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 Knee brace versus knee sleeve

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Knee brace versus knee sleeve (sensitivity analysis: knees)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Discontinuation of a basic military training programme Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Patellar strap versus knee sleeve

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Complications Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 Knee sleeve and patella ring versus knee sleeve without patellar ring

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. One type of orthosis versus another type
Comparison 3. Orthosis versus exercise

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain during activity (0 to 10: higher score means worse pain) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Pain score during sporting activity

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Pain score 1 hour after sporting activity

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Pain score following 30 minutes of sitting with knees flexed

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Sensitivity analyses (knees): Pain during activity (0 to 10: higher score means worse pain) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 Pain score during sporting activity

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Pain score 1 hour after sporting activity

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Pain score following 30 minutes of sitting with knees flexed

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Functional scores (0 to 53: higher scores means greater function) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Participants = denominators

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Sensitivity analysis (knees)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 3. Orthosis versus exercise