Patelarno postavljanje ljepljive trake za liječenje patelofemoralnog bolnog sindroma u odraslih
Abstract
Background
Patellofemoral pain syndrome refers to the clinical presentation of knee pain related to changes in the patellofemoral joint. Patellofemoral pain syndrome usually has a gradual onset of pain with none of the features associated with other knee diseases or trauma. It is often treated by physiotherapists, who use a variety of techniques including patellar taping. This involves the application of adhesive sports medical tape applied directly to the skin over the patella on the front of the knee. Patients often report an instantaneous improvement in pain and function after the tape is applied, but its longer term effects are uncertain.
Objectives
The objective was to assess the effects, primarily on pain and function, of patellar taping for treating patellofemoral pain syndrome in adults.
Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE, PEDro, SPORTDiscus, AMED, reference lists of articles, trial registers and conference proceedings. All were searched to August 2011.
Selection criteria
Randomised controlled trials and quasi‐randomised controlled trials testing the effects of patellar taping on clinically relevant outcomes, pain and function, in adults with patellofemoral pain syndrome. We excluded studies testing only the immediate effects of tape application.
Data collection and analysis
Both review authors independently performed study selection, data extraction and assessment of risk of bias. Trialists were contacted for more information. Data were pooled where possible.
Main results
Five small heterogeneous randomised controlled trials, all at high risk of performance bias and most at risk of at least one other type of bias, were included. These involved approximately 200 participants with a diagnosis of patellofemoral pain syndrome. All compared taping versus control (no or placebo taping) and all included one or more co‐interventions given to both taping and control group participants; this was prescribed exercise in four trials. The intensity and length of treatment was very varied: for example, length of treatment ranged from one week in one trial to three months in another. A meta‐analysis of the visual analogue scale (VAS) pain data (scale 0 to 10: worst pain), measured in different ways, from four trials (data from 161 knees), found no statistically or clinically significant difference between taping and non taping in pain at the end of the treatment programmes (mean difference (MD) ‐0.15; 95% confidence interval (CI) ‐1.15 to 0.85; random‐effects model used given the significant heterogeneity (P < 0.0001)). Data for other outcomes measuring function and activities of daily living were from single trials only and gave contradictory results.
Authors' conclusions
The currently available evidence from trials reporting clinically relevant outcomes is low quality and insufficient to draw conclusions on the effects of taping, whether used on its own or as part of a treatment programme. Further research involving large, preferably multi‐centre, good quality and well reported randomised controlled trials that measure clinically important outcomes and long‐term results is warranted. Before this, consensus is required on the diagnosis of patellofemoral pain syndrome, the standardisation of outcome measurement and an acceptable approach for patellar taping.
PICO
Plain language summary
Postavljanje ljepljive trake preko koljena kod odraslih s dugotrajnom boli u prednjem dijelu koljena (patelofemoralna bol)
Bol u prednjem dijelu koljena, koja se još zove i prednja koljenska bol ili patelofemoralna bol) često se javlja, osobito u osoba koje se bave nekim vrstama sporta ili tjelovježbe. tipično se pogoršava pri uspinjanju i silasku niz stepenice, izvođenju čučnjeva, klečanju i sjedenju sa savijenim koljenima. To je drugačija bolest nego što je artritis koljena.
Takvu prednju koljensku bol često liječe fizioterapeuti, koji koriste razne terapijske metode. Jedna takva metoda uključujući postavljanje ljepljive trake na koljeno iznad male kosti patele, neposredno na kožu prednje strane koljena, čiji je cilj kontroliranje položaja patele i potencijalno smanjenje boli tijekom pokreta.
Cochrane sustavni pregled pronašao je pet malih randomiziranih kontroliranih studija, koje su uključivale otprilike 200 sudionika s dijagnozom patelarnog bolnog sindroma, kod kojih je provedena usporedba stavljanja ljepljive trake na koljeno i kontrolne skupine bez takve terapije. Sve su se studije poprilično razlikovale s obzirom na vrstu ispitanika (u jednoj studiji su bili uključeni vojni regruti), duljini studije, i načinu provođenja terapije, kao i načinu procjene uspjeha liječenja. U 4 studije su ispitanici i u skupini koja je nosila ljepljivu traku i u placebo skupini ujedno imali propisano i vježbanje. Budući su i terapeut i ispitanici znali tko dobiva ljepljivu traku, nužan je oprez u tumačenju rezultata studija. Zbirna analiza podataka od 161 koljena za razinu boli na kraju liječenja (1 tjedan ‐ 3 mjeseca) nije pokazala statistički ili klinički značajnu razliku u boli između pacijenata koji su nosili ljepljivu traku i onih koji nisu imali takvu traku na kraju provedenog liječenja. Podaci ostalih ishoda koji su mjerili funkciju i aktivnosti svakodnevnog života su davali kontradiktorne rezultate, i prikazani samo u pojedinačnim studijama.
Trenutno dostupni dokazi iz ispitivanja koja prikazuju klinički relevantne rezultate su niske kvalitete i nedovoljni za izvući zaključke o učincima ljepljive trake na prednju koljensku bol, bilo da se koristi samostalno ili u sklopu složenog programa liječenja. Nužna su daljnja istraživanja, uključujući velike, po mogućnosti multicentrične, kvalitetne i dobro opisane randomizirane kontrolirane studije koje bi mjerile klinički značajne ishode i dugoročne rezultate. Prije toga, potrebno je suglasje o dijagnozi patelofemoralnog bolnog sindroma, standardizacija mjerenja rezultata i dogovor o prihvatljivim metodama postavljanja ljepljive trake na koljeno.
