Apesar da dor femoropatelar (DFP) apresentar alta incidência e prognóstico desfavorável, sua etiologia permanece obscura e seu diagnóstico clínico e funcional indefinido. Acredita-se que uma das causas da DFP seja a alteração na ativação dos músculos vasto medial (VM) e vasto lateral (VL), porém são escassos os estudos que investigam parâmetros eletromiográficos no domínio da frequência destes músculos. Portanto, o objetivo é analisar parâmetros da frequência, obtidos por dois métodos de processamento, para identificação de padrões eletromiográficos em mulheres com DFP que apresentem elevada capacidade discriminatória, correlação com a dor e que possam ser considerados como fator de risco. O sinal eletromiográfico dos músculos VM e VL de 80 mulheres (40 mulheres assintomáticas e 40 mulheres com DFP) foi coletado durante a subida de escada. Considerou-se para análise o sinal eletromiográfico correspondente à componente vertical da força de reação do solo (Fz) e à loading rate (LR) da Fz. Os parâmetros eletromiográficos foram comparados entre os grupos e testados quanto à (ao) reprodutibilidade, capacidade discriminatória, associação com a dor e fator de risco. Os resultados evidenciaram que os parâmetros eletromiográficos correspondentes à Fz e a LR da Fz são reprodutíveis e estão alterados em pacientes com DFP. Entretanto, os parâmetros do sinal eletromiográfico correspondente à Fz apresentaram valores altos de correlação com a dor e capacidade discriminatória quando comparados ao segundo processamento. Além disso, a alteração eletromiográfica, representada pela banda de frequência entre 45 e 96 Hz do VL, mostrou ser um possível fator de risco para DFP. Os achados deste estudo mostram uma nova abordagem na interpretação e aplicabilidade das alterações eletromiográficas dos músculos VM e VL, evidenciando que alterações de controle neuromuscular devem ser consideradas no processo de avaliação, tratamento e prevenção da DFP. / Despite the patellofemoral pain (PFP) has high incidence and unfavorable prognosis, its etiology remains unclear and clinical diagnosis indefinite. It is believed that one of the causes of PFP is the muscle activation altered of the vastus medialis (VM) and vastus lateralis (VL), however there are few studies that investigate electromyographic parameters in the frequency domain in these muscles. Therefore, the purpose is to analyze parameters of the frequency domain, using two different processing methods, to identify electromyographic patterns in women with PFP that have high discriminatory capacity, correlation with pain and that could be a risk factor. The electromyography signal of the VM and VL muscles of the 80 women (40 pain-free women and 40 women with PFP) was collected during stair ascend. Electromyography signal related to vertical ground reaction force (Fz) and loading rate (LR) of Fz was considered to analysis. Electromyography signal was compared between groups and tested about the reliability, discriminatory capacity, correlation with pain and risk factor. Results evidenced that electromyography signal related to Fz and LR are reliable and altered in women with PFP. However, electromyography signal related to Fz has higher values of correlation with pain and discriminatory capacity than electromyography signal related to LR. Furthermore, the altered electromyography signal, represented by the frequency between 45 and 96Hz of the VL muscles, may be consider a risk factor for PFP. Findings of this study show a new approach for understanding and applicability of the altered electromyography signal of the VL and VM muscles, evidencing that changes in the neuromuscular control should be considered in the assessment, management and prevention of the PFP.

Subir e descer escadas são atividades funcionais habituais e muito relatadas como queixa principal por pacientes com alterações ortopédicas como a síndrome dolorosa femoropatelar - por ser um movimento que acarreta descarga de peso unilateral e assim causa um aumento da dor - e por pacientes com afecções neurológicas - devido à dificuldade na execução deste gesto. Além disso, a subida e descida de escadas é habitualmente utilizada como técnica terapêutica na reabilitação destes pacientes; porém poucos estudos foram realizados com o intuito de caracterizar este gesto e, estes estudos, concluem que a alta variabilidade dos dados não permite confirmar os resultados. Estudos com pacientes com dor femoropatelar usualmente avaliam estes sujeitos com eletromiografia de superfície e sugerem que exista um déficit de equilíbrio na musculatura estabilizadora da patela e que esta é a causa da dor nestes pacientes; porém, também há uma grande variabilidade nos resultados encontrados, não sendo possível confirmar esta hipótese. Neste contexto, este estudo teve o objetivo de verificar quais parâmetros do sinal eletromiográfico apresentaram boa reprodutibilidade e menor variabilidade e são, portanto, mais adequados para caracterizar o gesto proposto, podendo ser utilizado para comparar grupos de indivíduos com e sem dor femoropatelar. Para isto, foi utilizada a eletromiografia para avaliar a atividade dos músculos vasto lateral e vasto medial do quadríceps durante a subida de escada em 39 indivíduos clinicamente saudáveis e 23 indivíduos com dor femoropatelar. Os resultados mostraram que os parâmetros que apresentaram boa reprodutibilidade entre os dois dias de avaliação foram: início de ativação, duração da contração muscular, tempo mediano da contração, intensidade do sinal, co-ativação muscular e frequência mediana. Dentre estes parâmetros, aqueles que permitiram diferenciar os grupos de estudo foram o tempo mediano da ativação, que ocorreu mais tardiamente nos indivíduos com dor e a co-ativação muscular, que demonstrou menor porcentagem de ativação conjunta nos indivíduos com dor. Estes dados indicam uma alteração no controle neuromotor durante a subida de escada, sugerindo que a abordagem clínica deva passar por treinos de equilíbrio, coordenação e propriocepção, para melhorar a estabilidade articular durante a realização de atividades dinâmicas. / Go up and down stairs are functional activities very habitual and reported as complaint for patients with orthopedic alterations as patellofemoral pain syndrome because it is a movement that carries unilateral weight bearing and thus cause an increase in pain and for patients with neurological disorders due to the difficulty in carrying out this gesture. Moreover, the ascent and descent of stairs is usually used as a therapeutic technique in the rehabilitation of these patients, but few studies have been conducted in order to characterize this gesture and, these studies conclude that the high variability of the data does not confirm the results. Studies on patients with patellofemoral pain usually assess these subjects with surface electromyography and suggest that there is a balance deficit in the patella stabilizer muscles and that this is the cause of pain in these patients, but there is also a great variability in the results, that does not allow to confirm this hypothesis. In this context, this study aimed to determine which parameters of electromyographic signals showed good reproducibility and low variability and are, therefore, more appropriate to characterize the proposed gesture and can be used to compare groups of individuals with and without patellofemoral pain. For this, we used electromyography to evaluate the activity of the vastus lateralis and vastus medialis of the quadriceps during stair climbing in 39 clinically healthy individuals and 23 individuals with patellofemoral pain. The results showed that the parameters with good reproducibility between the two days of evaluation were: onset, duration of muscle contraction, median time of contraction, intensity of activation, muscular co-activation and median frequency. Among these parameters, those that could differentiate the groups were the median time of activation, which occurred later in subjects with pain and muscle co-activation, which showed a lower percentage of combined activation in individuals with joint pain. These data indicate a change in neuromotor control during stair climbing, suggesting that the clinical approach should undergo training of balance, coordination and proprioception, in order to improve joint stability while performing dynamic activities.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-06-19T15:01:27Z No. of bitstreams: 1 Gustavo Lacreta Toledo Colonezi.pdf: 608536 bytes, checksum: 6f8b788f6abee5387f62055ac9f34005 (MD5) / Made available in DSpace on 2018-06-19T15:01:27Z (GMT). No. of bitstreams: 1 Gustavo Lacreta Toledo Colonezi.pdf: 608536 bytes, checksum: 6f8b788f6abee5387f62055ac9f34005 (MD5) Previous issue date: 2015-12-15 / INTRODUCTION: Abnormal trunk movements in the sagittal plane during weight-bearing activities can have a direct effect on the joints of the lower limbs. It is known that a greater range of trunk flexion leads to less patellofemoral stress. Assessments of the kinematics of patients who suffer from patellofemoral pain (PFP) during several activities can be found in the literature. However, none of these studies have addressed the effects of trunk flexion during the single leg hop test (SLHT). OBJECTIVE: Therefore, the aim of the present study was to assess the relation of trunk flexion on pain (NPRS 0-10), functional performance (SLHT distance) and the angular kinematics of the lower limbs of women with PFP during the propulsion phase of the SLHT. METHODS: Thirty-four sedentary women, with a mean age of 25.59 (18 - 35 years), were assessed retrospectively in terms of pain, functional performance and three-dimensional kinematics during the propulsion phase of the SLHT. The women were then divided into two groups based on the maximum angular value of the trunk: less trunk flexion (LFT group, n=17) and greater trunk flexion (GFT group, n=17). RESULTS: Differences were found between the groups for pain (P=0.04; Effect Size (ES) =0.70 ; mean difference = 0.88; Confidence Interval (CI) = 95%: 0.01 – 1,75), LFT group presented less pain than GFT group. Therefore women in the GFT group exhibited better functional performance funcional (P=0.01; ES=1.17 mean difference: 16.29cm; 95% CI: 25.95 - 6.62) than those in the LFT group. The GFT group also performed higher values of ipsilateral trunk lean (mean difference: 2.5°; 95% CI: 0.9 a 4.1°), pelvic anteversion (mean difference: 5.8°; 95% CI: 1.7 a 9.8°), hip flexion (mean difference: 8.2°; 95% CI: 2.1 a 14.4°) and ankle dorsiflexion (mean difference: 3.7°; 95% CI: 0.3 a 7.1°) than the LFT group. CONCLUSION: Increases in the sagittal plane trunk flexion shows relation to the functional performance and angular kinematics of proximal segments during the propulsion phase of the SLHT. / INTRODUÇÃO: Alterações dos movimentos do tronco no plano sagital durante atividades com descarga de peso podem ter efeito direto sobre as articulações dos membros inferiores. Sabe-se que maior amplitude de flexão do tronco diminui o estresse femoropatelar. Avaliações cinemática de pacientes que sofrem com dor femoropatelar (DPF) durante várias atividades podem ser encontrados na literatura. No entanto, nenhum estudo abordou a influência da flexão do tronco durante o single leg hop test (SLHT). OBJETIVO: Portanto, o objetivo do presente estudo foi avaliar a relação da flexão do tronco sobre a dor (NPRS 0-10), o desempenho funcional (distancia do SLHT) e da cinemática angular dos membros inferiores em mulheres com DPF durante a fase de propulsão dos SLHT. MÉTODOS: Trinta e quatro mulheres sedentárias, com idade média de 25,59 (18 - 35 anos), foram avaliadas em termos de dor, desempenho funcional e cinemática tridimensional durante a fase de propulsão do SLHT. As voluntárias foram divididas em dois grupos com base no valor angular máximo de flexão de tronco: menor flexão de tronco (MEFT grupo, n = 17), e com maior flexão do tronco (MAFT grupo, n = 17). RESULTADOS: Diferenças foram encontradas entre os grupos para a dor (P=0.04; Effect Size (ES) =0.70 ; diferença média = 0.88; Intervalo de Confiança (IC) = 95%: 0.01 – 1,75), sendo que, o grupo MEFT apresentou menos dor em relação ao grupo MAFT. Entretanto as voluntárias do grupo MAFT exibiram melhor desempenho funcional (P=0.01; ES=1.17 diferença média: 16.29cm; 95% IC: 25.95 - 6.62) do que aquelas do grupo MEFT. O grupo MAFT também apresentou maiores valores de inclinação ipsilateral de tronco (diferença média: 2.5°; 95% IC: 0.9 a 4.1°), anteversão pélvica (diferença média: 5.8°; 95% IC: 1.7 a 9.8°), flexão de quadril (diferença média: 8.2°; 95% IC: 2.1 a 14.4°) e dorsiflexão do tornozelo (diferença média: 3.7°; 95% IC: 0.3 a 7.1°). CONCLUSÃO: O aumento da flexão do tronco no plano sagital mostra relação com melhor desempenho funcional e com a cinemática angular de segmentos proximais durante a fase de propulsão do SLHT.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-16T19:41:25Z No. of bitstreams: 1 Amir Curcio dos Reis.pdf: 1475489 bytes, checksum: 32eea3f7e24896f451e6ba9cb6544786 (MD5) / Made available in DSpace on 2018-07-16T19:41:26Z (GMT). No. of bitstreams: 1 Amir Curcio dos Reis.pdf: 1475489 bytes, checksum: 32eea3f7e24896f451e6ba9cb6544786 (MD5) Previous issue date: 2016-11-29 / Patellofemoral pain (PFP) is one of the main diseases of the lower limbs, especially physically active women. The etiology is multifactorial and is directly linked to biomechanical disorders in the lower limb. Dynamic knee valgus is one of the major lower limb misalignment linked to PFP. Among the biomechanical characteristics in dynamic knee valgus, we highlight the excessive movement of hip adduction and internal rotation during closed kinetic chain activities, especially the squat. In addition to squat, dynamic valgus is described in other activities considered as low impact, such as stair climbing, and descending, walking and step downs tests, however, when we look for comparative information between high and low impact activity there is a gap in the literature. Furthermore, the kinematic behavior of the foot has been frequently associated with patellofemoral pain, however, studies evaluating the kinematic specifically during the functional activities through a multisegmented model are also scarce in the literature. Regarding treatment, there is no consensus about best approach, but the kinematic biofeedback has become an increasingly useful tool. The application can intervene directly in the joints of interest. Therefore, this PhD thesis was divided into 3 studies, with the following objectives: 1: Assess through kinetic and kinematic variables, the phase of high-impact single leg triple hop test (SLTHT) promotes more biomechanical changes in lower limb the phase of the low impact; 2: Compare the women foot kinematics with patellofemoral pain and pronated foot with asymptomatic during the implementation of the previous step down and side; and 3: To assess whether the 20% reduction results hip adduction or an increase of 20% of the anterior trunk tilt through kinematic biofeedback display different results when given the verbal biofeedback to lower hip adduction and most anterior trunk flexion and to evaluate whether these strategies are able to improve the pain immediately of women with patellofemoral pain during the squat. / A dor femoropatelar (DFP) constitui uma das principais afecções dos membros inferiores, sobretudo de mulheres fisicamente ativas. Sua etiologia é multifatorial e está diretamente ligada à desarranjos biomecânicos que envolvem o membro inferior, sendo o valgo dinâmico do joelho uma das principais alterações ligadas à ela. Dentre as características biomecânicas, destacamos a movimentação excessiva de adução e rotação medial do quadril durante atividades em cadeia cinética fechada, sobretudo o agachamento unipodal. Além do agachamento unipodal, o valgo dinâmico é descrito em outras atividades consideradas de baixo impacto, como a subida de escadas, descida de escadas, marcha, corrida e step downs tests, entretanto, quando se busca informações comparativas entre atividades de alto versus baixo impacto, há ima importante lacuna na literatura. Além disso, o comportamento cinemático do pé tem sido frequentemente associado à dor femoropatelar, entretanto, estudos que avaliem especificamente a cinemática durante as atividades funcionais por meio de um modelo multisegmentar também são escassos na literatura. Em relação ao tratamento, não existe um consenso sobre a melhor conduta, mas o biofeedback cinemático tem se tornado uma ferramenta cada vez mais útil. Sua aplicação pode intervir de forma direta nas articulações de interesse. Sendo assim, essa tese de Doutorado foi dividida em 3 estudos, com os seguintes objetivos: 1: Avaliar através de variáveis cinéticas e cinemáticas, se a fase de alto impacto do single leg triple hop test (SLTHT) promove mais alterações biomecânicas no membro inferior do que a fase de baixo impacto; 2: Comparar a cinemática do pé de mulheres com dor femoropatelar e o pé pronado com as assintomáticas durante a execução do do step down anterior e lateral; e 3: Avaliar se os resultados da redução de 20% da adução de quadril ou um aumento de 20% da inclinação anterior do tronco através do biofeedback cinemático apresentam resultados diferentes quando dado o biofeedback verbal para menor adução do quadril e maior flexão anterior do tronco, assim como avaliar se essas estratégias são capazes de melhorar a dor de forma imediata das mulheres com dor femoropatelar durante o agachamento unipodal.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-17T20:24:08Z No. of bitstreams: 1 Aline de Almeida Novello.pdf: 1138078 bytes, checksum: 601d6ef4a7fc406204ec932dce901793 (MD5) / Made available in DSpace on 2018-07-17T20:24:08Z (GMT). No. of bitstreams: 1 Aline de Almeida Novello.pdf: 1138078 bytes, checksum: 601d6ef4a7fc406204ec932dce901793 (MD5) Previous issue date: 2016-12-13 / Evidences found in the literature are inconsistent and there is no consensus about the kinematic differences performed by women with patellofemoral pain (PFP) during stair descent, and there are no studies that have evaluated the tridimensional kinematics of the trunk, pelvis, hip, knee and ankle using a multisegmental model of the foot, simultaneously during this task in patients with PFP and evaluated separately the sub phases of stair descent. Therefore, the aim of this study was to compare the tridimensional kinematics of the trunk, pelvis and lower limbs in different sub phases of stair descent and identify the discriminatory capability of the kinematic variables among PFP and healthy women during this task. In this cross-sectional study, thirty-four women with PFP (PFP group) and thirty-four painless women (control group) between 18 and 35 years-old underwent kinematic evaluation during the stair descent. It was observed that kinematic differences between groups occurred only in the first double support phase of the stair descent and the variables of internal rotation of the hindfoot in relation to the tibia in the initial contact, the contralateral pelvic drop in the load-response, external rotation range of motion of the hindfoot in relation to the tibia and dorsiflexion of the forefoot in relation to the hindfoot were the variables that presented the best capacity to discriminate women with and without PFP. Therefore, our results provided a better understanding of the trunk, pelvis and lower limbs kinematics in different subphases of the support phase of stair descent in women with PFP. / As evidências encontradas na literatura são inconsistentes e não há consenso sobre as alterações cinemáticas em mulheres com dor femoropatelar (DFP) durante a descida de escadas. Além disso, não há estudos que tenham avaliado a cinemática tridimensional do tronco, pelve, quadril, joelho e tornozelo, utilizando um modelo multisegmentar do pé, simultaneamente durante esta tarefa em pacientes com DFP e que tenha avaliado separadamente as subfases da descida de escadas. Portanto, os objetivos deste estudo foram comparar a cinemática tridimensional do tronco, pelve, e membros inferiores em diferentes subfases da descida de escadas e identificar a capacidade discriminatória das variáveis cinemáticas entre mulheres com DFP e saudáveis nesta tarefa. Neste estudo transversal trinta e quatro mulheres com DFP (grupo DFP) e trinta e quatro mulheres sem dor (grupo controle) entre 18 e 35 anos foram submetidas à avaliação cinemática durante a descida de escadas. Foi observado que diferenças cinemáticas entre os grupos ocorreram somente na fase de primeiro duplo apoio da descida de escadas, sendo que as variáveis de rotação interna do retropé em relação à tíbia no contato inicial, a queda contralateral da pelve na resposta à carga, a amplitude de rotação externa do retropé em relação à tíbia e de dorsiflexão do antepé em relação ao retropé foram as variáveis que apresentaram melhor capacidade de discriminar mulheres com e sem DFP. Sendo assim, nossos resultados proporcionaram maior entendimento da cinemática do tronco, pelve e membros inferiores em diferentes subfases do apoio na descida de escadas em mulheres com DFP.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-17T20:38:16Z No. of bitstreams: 1 André Nogueira Ferraz de Carvalho e Silva.pdf: 1053634 bytes, checksum: 032d316a96c55892bc3977f4efa8f29c (MD5) / Made available in DSpace on 2018-07-17T20:38:16Z (GMT). No. of bitstreams: 1 André Nogueira Ferraz de Carvalho e Silva.pdf: 1053634 bytes, checksum: 032d316a96c55892bc3977f4efa8f29c (MD5) Previous issue date: 2016-12-15 / Background: Patellofemoral pain (PFP) is described as anterior knee pain, aggravated by negotiating stairs, squats, running and prolonged sitting. Proximal changes such as trunk, pelvic drop, hip adduction and medial rotation may cause pain. Recently, new studies have indicated that distal changes influence PFP. Objective: Analyze trunk, lower limbs, rearfoot and forefoot kinematics during the beginning of the movement, 15º, 30º and 45º of knee flexion and their discriminatory capacity between patients with PFP and healthy on the lateral step down. Methods: Thirty-four healthy sedentary women and thirty-four women with PFP were evaluated in three-dimensional kinematics during Lateral Step Down at the beginning of the movement, 15º, 30º and 45º of knee flexion. Analyzes were performed between the groups and the Receiver Operational Characteristic Curves (ROC) were applied to determine the discriminatory capacity between them. Results: Differences were found between the groups being more evident at 30º and 45º of knee flexion in the PFP group in the trunk and lower limbs. Conclusion: The main kinematic changes occur at 30º and 45º of knee flexion. At 30º of knee flexion, the main variables to discriminate women with PFP from the healthy ones are: pelvic drop, hip adduction, rearfoot eversion in relation to the ground and forefoot pronation in relation to the rearfoot, already at 45º, a main variable is the eversion of the rearfoot in relation to the ground. / Introdução: A dor femoropatelar (DFP) é descrita como uma dor anterior no joelho, agravada em subida e descida de escadas, agachamentos, corridas e tempo prolongado na posição sentado. Alterações proximais como de tronco, quadril, queda da pelve, adução e rotação medial do fêmur podem causar a dor. Recentemente, novos estudos apontam que alterações distais influenciam na DFP. Objetivo: Analisar a cinemática do tronco, membros inferiores, retropé e antepé durante o início do movimento, 15º, 30º e 45º de flexão do joelho e sua capacidade discriminatória entre pacientes com DFP e saudáveis no lateral step down. Métodos: Trinta e quatro mulheres sedentárias saudáveis e trinta e quatro mulheres com a DFP, foram avaliadas na cinemática tridimensional durante Lateral Step Down no início do movimento, 15º, 30º e 45º de flexão do joelho. Foram feitas análises entre os grupos e aplicado as Curvas de Características de Operação do Receptor (ROC) para determinar a capacidade discriminatória entre eles. Resultados: Diferenças foram encontradas entre os grupos sendo mais evidentes a 30º e 45º de flexão do joelho no grupo DFP no tronco e membros inferiores. Conclusão: As principais alterações cinemáticas acontecem a 30º e 45º de flexão do joelho. A 30º de flexão do joelho, as principais variáveis para discriminar mulheres com a DFP das saudáveis são: a queda da pelve, adução do quadril, eversão do retropé em relação ao solo e pronação do antepé em relação ao retropé, já a 45º, a principal variável é a eversão do retropé em relação ao solo.

ABSTRACT Background: Patellofemoral pain syndrome (PFPS) is commonly seen in athletes and common symptoms are for example pain and stiffness, and difficulty in climbing stairs. Physiotherapy exercise interventions aim to increase the range of motion, strength, knee stability, balance, and functional ability. Shaping knowledge with patient education is a behaviour change technique that has proven important in musculoskeletal pain. How patient education can contribute to positive outcomes for physiotherapy exercise interventions in PFPS is unknown. Aim: To describe the effects of physiotherapy exercise interventions including patient education for adult and adolescent athletes with patellofemoral pain syndrome. Method: In a systematic literature review, only randomized controlled trials, on patients with a primary diagnosis of PFPS, published in English, were included. The data search was conducted by PICO in Pubmed and CINAHL. The methodological quality of the included studies was assessed by using the SBU checklist. Results: Six randomized controlled studies were included. According to the quality assessment the included studies had moderate to high quality and the outcome measures of the included studies were reliable and valid for measuring pain intensity, health-related quality of life, physical function, isometric muscle strength, and fear of movement. The results showed that physiotherapy interventions including patient education led to improved symptoms, functional ability, and health-related quality of life (HRQoL) for patients with patellofemoral pain syndrome in adult and adolescent athletes. Conclusion: Physiotherapy exercise interventions including patient education appear to increase physical function, muscle strength, and health-related quality of life and decrease pain and fear of movement for adult and adolescent athletes with patellofemoral pain syndrome. The conclusions are tentative as the review of the study quality for the included studies implied that four studies had a moderate risk of bias.

Sammanfattning Bakgrund: Patellofemoralt smärtsyndrom (PFSS) är ett vanligt förekommande muskuloskeletalt besvär bland kvinnor och karaktäriseras av smärta runt eller bakom patella, som förvärras vid vissa viktbärande aktiviteter. Då prevalens är hög hos kvinnor är det av stor betydelse att de får en välanpassad behandling baserad på den senaste tillgängliga evidensen. Syfte:  Att genom en litteraturstudie undersöka effekten av styrketräning på utfallsmåtten smärta och funktion hos kvinnor med PFSS samt gradera den aktuella evidensen. Metod: Litteratursökning utfördes i databasen PubMed. Nio artiklar inkluderades. Artiklarna granskades sedan enskilt enligt TESTEX scale och därefter bedömdes evidensgraden enligt SBU:s GRADE. Resultat: Studien visade en begränsad evidensgrad för att styrketräning av höftmuskulatur minskar smärta. Det finns även en begränsad evidensgrad för att kombinerad styrketräning av höft- och knämuskulatur minskar smärta och ökar funktion. Styrketräning av höftmuskulatur jämfört med styrketräning av endast knämuskulatur har ej effekt på funktion, men evidensgraden bedöms som begränsad. Studiekvaliteten av de enskilda studierna varierade mellan 7–13 poäng vid granskning med TESTEX scale. Konklusion: Evidensen talar för att kombinerad styrketräning av höft- och knämuskulatur bör användas i första hand vid behandling av PFSS, men fler studier behövs för att bekräfta studieresultatet.  Nyckelord: Exercise, hip musculature, patellofemoral pain syndrome, quadriceps musculature / Abstract Background: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition among women and is characterized by pain around or behind the patella, which is aggravated by weightbearing activities. Since the prevalence among women is high, it is of great importance that they receive a well-adjusted treatment based on the latest available evidence. Objective: To investigate through a literature study the effect of strength training on the outcome measures pain and function among women with PFPS Method: The litterature search was conducted in the database PubMed. Nine papers were included. The papers were evaluated by each author using the TESTEX scale and then the level of evidence was assessed according to SBU’s GRADE. Results: There is limited evidence that strength training of the hip musculature reduces pain. There is also limited evidence that combined strength training of the hip and knee musculature reduces pain and increases function. Compared to strength training of the knee musculature, isolated strength training of the hip musculature is no better to increase function but the evidence is limited. The study quality of the included papers varied between 7–13 points after evaluation with TESTEX scale. Conclusion: The evidence suggests that combined strength training of the hip and knee musculature should be used as the first line of treatment when treating PFPS, but further research is warranted. Key words: Exercise, hip musculature, patellofemoral pain syndrome, quadriceps musculature

Das mediale patello-femorale Ligament (MPFL) wurde in den letzten Jahren und Jahrzehnten als maßgeblicher passiver Stabilisator der Kniescheibe identifiziert und in biomechanischen Studien beschrieben. Auch wurden die verschiedenen Möglichkeiten der operativen Rekonstruktion des MPFL und deren klinisches Outcome bei patellofemoraler Instabilität in zahlreichen Studien beschrieben sowie relevante Ergebnisse für den klinischen Alltag formuliert. Ziel dieser Arbeit war es, die MPFL-Ersatzplastik als Revisionseingriff mit dem Outcome bei Primäreingriffen zu vergleichen und Faktoren zu bestimmen, die das klinische Outcome beeinflussen. Hierzu wurden 61 Patienten, die von Januar 2009 bis Dezember 2012 in der Klinik für Unfall- und Wiederherstellungschirurgie des Diakoniekrankenhauses Friederikenstift gGmbH Hannover operativ mittels MPFL-Ersatzplastik stabilisiert worden sind, untersucht. Retrospektiv nach Aktenlage und im Rahmen einer klinischen Nachuntersuchung wurden anhand eines standardisierten Studienprotokolls verschiedene Ausgangs- und Outcome-Parameter erhoben und mittels IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Released 2011 ausgewertet. Es zeigte sich, dass die Patienten der Primärgruppe eine signifikante Verbesserung durch die Operation erzielen konnten, bei den Patienten der Revisionsgruppe traf dies nicht auf alle Parameter zu. Im Vergleich der Ausgangs- und Outcome-Parameter der Primär- und Revisionsgruppe zeigten sich keine signifikanten Unterschiede. Des Weiteren zeigte sich, dass die Ausgangsparameter Alter bei OP, operativ-versorgte Seite, BMI, Beruf, generelle sportliche Betätigung, verwendete Fadenanker zur Transplantatfixierung an der Patella und Lage der Bohrkanäle in der Patella das Outcome der Operation signifikant beeinflussten.

Abstrakt Bakgrund: Patellofemoralt smärtsyndrom är ett vanligt förekommande smärttillstånd. Tejpning som behandlingsalternativ är väl använt av fysioterapeuter, trots bristande vetenskapligt underlag. Det skulle vara av värde att undersöka vad tidigare evidens säger kring tejpning som behandling vid PFSS.  Syfte: Att sammanställa och kartlägga om tejpning som isolerad eller kombinerad behandling minskar smärta hos personer med PFSS. Kvalitetsgranska resultaten av randomiserade kontrollstudier (RCT) med PEDro och bedöma dess tillförlitlighet med GRADEstud.  Metod: För systemisk litteratursökning formulerades följande PICO. P: Friska personer med PFSS, I: Tejpning, C: Annan behandling/ingen behandling, O: Smärtintensitet mätt med etablerade mätinstrument. Inklusionskriterier var randomiserade kontrollerade studier, studier publicerade de senaste 20 åren, studier på engelska och studier som finns att tillgå i fulltext.Exklusionskriterier var studier som är tillgängliga mot avgift. Systematisk sökning genomfördes i Pubmed, Cochrane och Web of Science. Åtta studier inkluderades och granskades med PEDro. GRADEstud användes för att bedöma resultatets tillförlitlighet.  Resultat: De åtta inkluderade studiernas kvalitet varierade mellan medelgod och hög kvalitet, enligt PEDro scale. Gällande kombinerad behandling fann två av de sex inkluderande studierna en signifkant skillnad. Gällande isolerad behandling fann en av de två studierna en signifikant skillnad. Det sammanvägda resultatets tillförlitlighet graderades som mycket låg (+), enligt GRADEstud.  Slutsats: Tejpning som behandling har en tvetydig evidens. Därmed kan denna studie inte avgöra huruvida tejpning har smärtlindrande effekt eller ej vid PFSS. / Abstract Background: Patellofemoral pain syndrome (PFPS) is a common pain condition. Taping as a treatment option is well used among physiotherapists, despite lack of evidence. It would be of value to investigate what earlier evidence says about taping as a treatment option in PFPS.  Objective: Compile and survey whether taping as an isolated or combined treatment has an effect on pain for people with PFPS. Quality review the results of randomized control studies (RCTs) with PEDro and assess its reliability with GRADEstud. Method: Structured question according to PICO. P: Healthy people with PFPS, I: Taping, C: Other / no treatment, O: Pain intensity measured with established measuring instruments. Inclusion criterias were RCTs, studies published in the last 20 years, studies in English and studies in full text. Exclusion criteria were studies available for a fee. Searches were conducted in Pubmed, Cochrane and Web of Science. Eight studies were included and reviewed with PEDro and GRADEstud.  Results: The eight included studies quality varied between moderate to high, according to the PEDro scale. Regarding combined treatment, two of the six included studies found a significant difference. Regarding isolated treatment only one of the two studies found a significant difference. The reliability of the weighted result was rated as very low (+), according to GRADEstud.  Conclusion: Taping as a treatment option has ambiguous evidence. Therefore, this study can not determine whether taping has a pain-relieving effect or not in PFPS.