OBJECTIVE: To evaluate the effect of education interventions compared with any type of comparator on managing patellofemoral pain (PFP).
DESIGN: Intervention systematic review. PROSPERO identifier: CRD42018088671.
LITERATURE SEARCH: MEDLINE, Embase, CINAHL, and Web of Science were searched for studies evaluating the effect of education on clinical and functional outcomes in people with PFP.
STUDY SELECTION CRITERIA: Two reviewers independently assessed studies for inclusion and quality. We included randomized controlled trials on PFP where at least 1 group received an education intervention (in isolation or in combination with other interventions).
DATA SYNTHESIS: Available data were synthesized via meta-analysis where possible; data that were not appropriate for pooling were synthesized qualitatively. Interpretation was guided by the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS: Nine trials were identified. Low-credibility evidence indicated that health education material alone was inferior to exercise therapy for pain and function outcomes. Low- and very low-credibility evidence indicated that health professional-delivered education alone produced outcomes similar to those of exercise therapy combined with health professional-delivered education for pain and function, respectively.
CONCLUSION: Health professional-delivered education may produce similar outcomes in pain and function compared to exercise therapy plus health professional-delivered education in people with PFP. J Orthop Sports Phys Ther 2020;50(7):388-396. Epub 29 Apr 2020. doi:10.2519/jospt.2020.9400.
|Rehab Clinician (OT/PT)|
This is of most interest to sports medicine and physical therapist professionals. It's reassuring that a small number of professionally-administered education sessions is almost as effective as multiple exercise sessions.
Though evidence seems scarce, the difference between health education alone and health professional–delivered education is interesting and useful for health policies.
"Health professional–delivered education produced similar outcomes in pain and function compared to exercise therapy plus health professional–delivered education at 3 and 6 months post intervention." They also found out it's less expensive. By their own admission, they had "low - very low credibility evidence. I would be leery to stop treating and only educate.
The low and very low credibility evidence produces seemingly conflicting results. Education was worse than exercise, but education plus exercise was not different from education alone. The conclusions then only mention the part of the findings that are more positive for pain education. "Health professional–delivered education may produce similar outcomes in pain and function compared to exercise therapy plus health professional– delivered education." in people with PFP.
This is a reasonable study, but it did not add anything new. The benefit of patient education alone would be closely linked to patient expectation of an appropriate intervention and the real effect of delivering this independently would need to be studied separately.
This is very well presented; It's a pleasure to read and contains clear and concise implications.