ABSTRACT
BACKGROUND: Although many authors have studied the prognostic factors that may contribute to anterior knee pain, synthesis of the existing evidence has not been performed. PURPOSE: The purpose of this systematic review is to summarize and examine existing prognostic models in patients with anterior knee pain that first present to physical therapists (primary care setting). DESIGN: Systematic review. METHOD: For this review Pubmed, Embase and Cinahl databases were searched and published papers that reported prognostic models for patients with anterior knee pain that first present to physical therapists (primary care setting) were selected. The authors extracted and summarized the univariate and multivariate predictors and evaluated which predictors consistently appeared to be relevant to pain, function, or recovery. RESULTS: Nine studies were included. The quality scores of these studies ranged from 9 to 17 positive items out of 21 items included in the assessment for quality. None of the prognostic models were validated internally or externally. Four studies were considered to be of sufficient quality. The authors of these four studies found 14 different predictors significantly related to pain intensity of which seven with limited evidence. Fifteen different predictors were found that were related to function of which seven with limited evidence. Furthermore, strong evidence was found that baseline pain intensity, pain coping and kinesiophobia are of no predictive value for pain, and activity related pain, pain coping and kinesiophobia are of no predictive value for function at follow up. CONCLUSIONS: Because of the low quality of a number of studies and the heterogeneity of the examined variables and outcome measures of most of the studies, only limited evidence for seven predictors related to pain and seven predictors related to function in patients with anterior knee pain in a primary care setting was found. LEVEL OF EVIDENCE: 1b.
ABSTRACT
OBJECTIVES: The Brief Illness Perception Questionnaire (Brief IPQ) is a commonly used questionnaire that aims to assess patients' illness beliefs. There is, however, no direct information on how people interpret and respond to this questionnaire, nor on the nature and extent of problems people have when completing it. The present study describes the problems that patients encounter when completing the Brief IPQ. DESIGN: Cross-sectional observational study. METHODS: A 'think-aloud' method was employed with two samples: 6 patients attending a preoperative exercise programme in secondary care, and 11 patients receiving physiotherapy in primary care. RESULTS: In total, 88 problems were identified, mostly (N= 45) consisted of participants re-reading a question or stumbling in reading it. In 8 cases, participants misinterpreted a question. The pattern of findings was striking similar across the two samples. The questions about identity, personal control, illness coherence, and causal attributions yielded most difficulties (18, 16, 16, and 11 problems, respectively). CONCLUSIONS: Given that the Brief IPQ assesses each construct with a single item, the number of problems people have with completing it is particularly problematic, and calls into question the content validity of this measure. Further developmental work with this questionnaire may be needed to better quantify and resolve the problems identified.
