ABSTRACT
BACKGROUND: Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain. HYPOTHESIS: Treatment designed according to subgroups will improve clinical outcomes in patients unresponsive to multimodal treatment. STUDY DESIGN: Prospective crossover intervention. LEVEL OF EVIDENCE: Level 3. METHODS: Patients with patellofemoral pain (PFP; n = 61; mean age, 27 ± 9 years) were enrolled. Patients with PFP received standard multimodal treatment 3 times a week for 6 weeks. Patients not responding to multimodal treatment were then classified into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot) using 6 simple clinical tests. They were subsequently administered 6 further weeks of targeted intervention, designed according to subgroup characteristics. Visual analog scale (VAS), perception of recovery scale (PRS), 5-Level European Quality 5 Dimensions (EQ-5D-5L), and self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (S-LANSS) were used to assess pain, knee function, and quality of life before and after the interventions. RESULTS: In total, 34% (n = 21) of patients demonstrated recovery after multimodal treatment. However, over 70% (n = 29/40) of nonresponders demonstrated recovery after targeted treatment. The VAS, PRS, S-LANSS, and EQ-5D-5L scores improved significantly after targeted intervention compared with after multimodal treatment (P < 0.001). The VAS score at rest was significantly lower in the "weak and pronated foot" and the "weak and tight" subgroups (P = 0.011 and P = 0.008, respectively). Posttreatment pain intensity on activity was significantly lower in the "strong" subgroup (P = 0.006). CONCLUSION: Targeted treatment designed according to subgroup characteristics improves clinical outcomes in patients unresponsive to multimodal treatment. CLINICAL RELEVANCE: Targeted intervention could be easily implemented after 6 simple clinical assessment tests to subgroup patients into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot). Targeted interventions applied according to the characteristics of these subgroups have more beneficial treatment effects than a current multimodal treatment program.
Subject(s)
Clinical Protocols , Exercise Therapy/methods , Patellofemoral Pain Syndrome/classification , Patellofemoral Pain Syndrome/therapy , Adult , Braces , Combined Modality Therapy , Cross-Over Studies , Foot Orthoses , Humans , Muscle Strength , Muscle Stretching Exercises , Prospective Studies , Treatment Outcome , Weight Loss , Young AdultABSTRACT
BACKGROUND: Balance disorders cause disability in stroke and increase risk of falls. The Balance Evaluation Systems Test (BESTest), examines balance, determines parameters causing balance disorders, provides information on risk factors for falls. OBJECTIVE: To investigate the sensitivity and specificity of the BESTest in determining the risk of falls in stroke patients. METHODS: Fifty patients with chronic stroke were included in the study. Balance was assessed using BESTest, Berg Balance Scale (BBS), Activity Specific Balance Confidence scale (ABC) and Biodex-BioSway Balance System. To examine the content validity of BESTest, the relationship between BESTest and other balance assessment methods was examined. The internal consistency reliability of BESTest was evaluated by Cronbach's α coefficient. Analysis of receiver operating characteristics (ROC) was performed to determine cut-off point, sensitivity and specificity. RESULTS: BESTest, BBS, ABC and Biodex-BioSway Balance System results of faller stroke patients were worse than that of non-faller (p <0.05). Internal consistency of BESTest was found to be Cronbach's α = 0.960. The BESTest value of area under curve (AUC) was 0.844, with a cut-off point of 69.44%, a sensitivity of 75% and a specificity of 84.6% (p < 0.01). CONCLUSION: BESTest is reliable and valid with high sensitivity and specificity in determining the risk of fall in stroke patients.
