Item

Score

Notes

D1. Was a method of randomisation performed?

2 = yes, clearly described method of randomisation
1 = unclear whether treatment allocation was truly random
0 = no, prospective study or other design without (quasi‐)random assignment

Cochrane code (Clarke 2003b): Clearly yes = A; Not sure = B; Clearly no = C

M‐A. (D2) Was the assigned treatment adequately concealed prior to allocation?

2 = method did not allow disclosure of assignment
1 = small but possible chance of disclosure of assignment or unclear
0 = quasi‐randomised or open list/tables

M‐B. (D9) Were the outcomes of patients who withdrew described and included in the analysis (intention‐to‐treat)?

2 = withdrawals well described and accounted for in analysis
1 = withdrawals described and analysis not possible
0 = no mention, inadequate mention or obvious differences and no adjustment

M‐C. (D5) Were the outcome assessors blinded to treatment status?

2 = effective action taken to blind assessors
1 = small or moderate chance of unblinding of assessors
0 = not mentioned or not possible

M‐D. (D3) Were the treatment and control group comparable at entry?

2 = good comparability of groups, or confounding adjusted for in analysis
1 = confounding small; mentioned but not adjusted for
0 = large potential for confounding, or not discussed

M‐E. (D7) Were the participants blind to assignment status after allocation?

2 = effective action taken to blind participants
1 = small or moderate chance of unblinding participants
0 = not possible, or not mentioned (unless double‐blind), or possible but not done

M‐F. (D6) Were the treatment providers blind to assignment status after allocation?

2 = effective action taken to blind treatment providers
1 = small or moderate chance of unblinding of treatment providers
0 = not possible, or not mentioned (unless double‐blind), or possible but not done

M‐G. Were care programmes, other than the trial options, identical?

2 = care programmes clearly identical
1 = clear but trivial differences
0 = not mentioned or clear and important differences in care programmes

M‐H. (D4) Were the inclusion and exclusion criteria clearly defined?

2 = clearly defined
1 = inadequately defined
0 = not defined

M‐I. Were the interventions clearly defined?

2 = clearly defined interventions are applied with a standardised protocol
1 = clearly defined interventions are applied but the application protocol is not standardised
0 = intervention and/or application poorly or not defined

M‐J. Were the outcome measures used clearly defined?

2 = clearly defined
1 = inadequately defined
0 = not defined

M‐K. Were diagnostic tests used in outcome assessment clinically useful? (by outcome)

2 = optimal
1 = adequate
0 = not defined, not adequate

M‐L. Was the surveillance active and of clinically appropriate duration?

2 = active surveillance and appropriate duration (>three weeks)
1 = active surveillance, but inadequate duration (<three weeks)
0 = surveillance not active or not defined

D8. Were point estimates and measures of variability presented for the primary outcome measures?

2 = point estimates and measures of variability presented
1 = point estimates, but no measures of variability presented
0 = only vague descriptions of outcome measures presented

T. Was the compliance rate in each group unlikely to cause bias?

2 = compliance well described and accounted for in analysis
1 = compliance well described but differences between groups not accounted for in analysis
0 = compliance unclear

X. Was a predefined set of diagnostic criteria provided for the included participants?

2 = clear description of diagnosis as well as diagnostic criteria were provided, or clear diagnostic exclusion criteria were provided
(e.g. 'chondromalacia', defined by the presence of lesions in patellar cartilage determined at arthroscopy)
1 = only diagnosis without criteria was provided (e.g. 'chondromalacia') and no clear diagnostic exclusion criteria were provided
0 = neither clear diagnosis nor criteria or symptoms were provided (e.g. 'anterior knee pain')

Study ID

Outcome measure

Instrument

Weeks

N exercise

Change (%) or N

N no exercise

Change (%) or N

Mean diff. (95% CI)

Stat. sign.?

Clark 2000

Pain

VAS (0‐100 mm)

13

32

‐34.4 ±41.6 (45%)*
individual changes
averaged by author

39

‐26.8 ±43.8 (43%)*
individual changes
averaged by author

‐7.6 (‐28 ‐ 12.9)

no

52

22

‐39.8 (52%)*
as calculated
from means

27

‐17.0 (21%)*
as calculated
from means

Not reported†
significance stated

yes

Function

WOMAC

13

32

‐11.7 ±12.4 (48%)*
individual changes
averaged by author

39

‐13.4 ±14.2 (33%)*
individual changes
averaged by author

1.7 (‐4.7 ‐ 8.1)

no

52

22

‐9.4 (38%)*
as calculated
from means

27

‐6.4 (21%)*
as calculated
from means

Not reported
no significance
mentioned

no

Patient
satisfaction

Discharge from
therapy

13

40

39*

31

21*

OR = 1.90
(1.41 ‐ 2.58) †
NNT=3(1.6‐3.3)

yes

Recovery

No longer troubled

52

22

9

27

5

OR = 2.21
(0.87 ‐ 5.64)

no

Recovery

Discontinuing therapy

52

22

18

27

19

OR = 1.16
(0.85 ‐ 1.59)

no

McMullen 1990

Pain

VAS (0‐10 cm)

4

"No change"

"No change"

no

Function

Overall activity level (CRS)
static vs control)

4

11

Medium effect size

9

Small effect size

yes

Isokinetic vs control

4

9

Medium effect size

yes

Timm 1998

Pain

VAS (0‐10 cm)

4

50

‐2.96 (47%)*

50

+0.20 (0.03%)

‐3.16†

yes

Function

KPFS

4

50

+45.04 (108%)*

50

‐0.22 (0.01%)

45.26†

yes

* = significant
change from
baseline
NS = not significant
† = significant
difference
between therapies

VAS=Visual Analog Scale
KPFS=Kujala
Patellofemoral
Function Scale
CRS=Cincinnatti
Rating Scale

RR=Relative Risk
NNT=Number needed
to treat

Study ID

Outcome

Instrument

Weeks

N open chain

Change (%)

N closed chain

Change (%)

Mean diff. (95% CI)

Stat. sign.?

Witvrouw 2000

Pain

VAS (0‐100 mm)
triple jump test

5

30

‐11.5 (‐46%)*

30

‐11.0 (‐46%)*

0.5

no

13

30

‐16.1 (‐64%)*

30

‐13.3 (‐56%)*

2.8

no

VAS (0‐100 mm)
daily activity

5

30

‐17.0 (‐31%)*

30

‐15.0 (‐27%)*

2

no

13

30

‐15.0 (‐28%)*

30

‐25.0 (‐45%)*

‐10

no

Function

KPFS

5

30

+12 (18%)*

30

+15 (22%)*

3

no

13

30

+16 (24%)*

30

+19 (28%)*

3

no

N asymptomatic
unilateral squat

5

30

+5 (83%)*

30

+7 (117%)*

RR = 1.52
(0.41 ‐ 5.62)

no

13

30

+10 (167%)*

30

+11 (183%)*

RR = 1.16
(0.39 ‐ 3.42)

no

N asymptomatic
step up

5

30

+12 (109%)*

30

+10 (125%)*

RR = 0.75
(0.26 ‐ 2.20)

no

13

30

+11 (100%)*

30

+14 (175%)*

RR = 1.51
(0.53 ‐ 4.33)

no

N asymptomatic
step down

5

30

+11 (138%)*

30

+7 (140%)*

RR = 0.53
(0.17 ‐ 1.66)

no

13

30

+15 (188%)*

30

+15 (300%)*

RR = 1.00
(0.36 ‐ 2.81)

no

Wijnen 1996

Pain

VAS (0‐10)
walking stairs

6

7

‐1.2 (‐23%)

8

‐1.9 (‐30%)

0.3 (‐2.66 ‐ 3.26)

no

VAS (0‐10)
sitting with knees bent

6

7

‐0.5 (‐10%)

8

‐2.7 (‐59%)

‐2.4 (‐10.6 ‐ 5.84)

no

VAS (0‐10)
squatting

6

7

+0.4 (7%)

8

‐2.6 (‐34%)

‐0.9 (‐2.30 ‐ 0.50)

no

Function

KPFS

6

7

+9.5 (15%)

8

+25.7 (44%)

9.9 (‐2.32 ‐ 22.12)

no

Ranawat scale

6

7

+6.3 (8%)

8

+20.6 (28%)

9.7 (‐3.72 ‐ 23.12)

no

Satisfaction

VAS (0‐10)
with therapy

6

7

4.3

8

7.6

3.3 (0.32 ‐ 6.28)†

yes?

VAS (0‐10)
with recovery

6

7

3.4

8

6.1

2.7 (0.24 ‐ 5.46)

no

Stiene 1996

Function

Retro‐step
repetitions

8

12

+1.8 (72%)

11

+15.4 (481%)*

13.6†

yes

52

12

+4.2 (168%)

11

+24.1 (753%)*

19.9†

yes

Gaffney 1992

Pain

VAS (0‐10)

6

?

‐3.17 (55%)*

?

‐3.21 (53%)*

0.04

no

Function

N improved

6

32

15 (47%)*

28

18 (64%)*

RR = 1.37
(0.87 ‐ 2.17)

no

Satisfaction

N treatment succes

6

32

24 (75%)*

28

25 (89%)*

RR = 1.19
(0.94 ‐ 1.51)

no

Colòn 1988

Pain

N improved > 50%

6‐8

11

9 (82%)*

14

13 (93%)*

RR = 1.13
(0.83 ‐ 1.55)

no

* = significant
change from
baseline
NS = not significant
† = significant
difference
between therapies

VAS=Visual Analog Scale
KPFS=Kujala
Patellofemoral
Function Scale