ORIGINAL ARTICLE

How evidence based is the management of two common sports injuries in a sports injury clinic?

I R Murray¹, S A Murray², K MacKenzie³, S Coleman⁴

¹ College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4SB, Scotland, UK
² Division of Community Health Sciencies, General Practice Section, University of Edinburgh, Edinburgh EH8 9DX
³ Fitness Assessment and Sports Injuries Clinic, University of Edinburgh, Edinburgh EH8 9TJ
⁴ Department of Physical Education, Sport and Leisure Studies, University of Edinburgh, Edinburgh EH8 8AQ

Correspondence to:
Correspondence to:
I R Murray
College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4SB, Scotland, UK; i.m{at}ed.ac.uk

Objectives: To examine the diagnosis and management of adults attending a sports injury clinic, to establish to what extent the management of the two most common injuries treated at this clinic is evidence based, and to explore factors that affect management.

Methods: A retrospective examination of 100 random case notes extracted age, sex, sport, type and site of injury, treatment, and outcome. Systematic literature reviews examined the extent and quality of scientific evidence for the management of the two most commonly presenting injuries. A clinical attachment period and practitioner interviews allowed recognition of factors impinging on management decisions.

Results: Patellofemoral pain syndrome (PFPS; 10% of all injuries) and Achilles tendinopathy (6% of all injuries) were the most commonly presenting injuries. The mean (SD) number of treatments used for PFPS was 2.8 (0.9). The mean number of treatments used for Achilles tendinopathy was 3.7 (1.0). Clinicians reported that personal experience formed the basis of management plans in 44% of PFPS cases and 59% of Achilles tendinopathy cases, and that primary research evidence only accounted for 24% of management plans in PFPS and 14% in Achilles tendinopathy. Practitioners were unaware of literature supporting over 50% of the treatment modalities they used. However, clinicians were often using evidence based treatments, unaware of the supporting research data.

Conclusions: This study highlights a lack of evidence base, a lack of knowledge of the research evidence, and a lack of management based on the current evidence that is available for these conditions. Practitioners practised evidence based medicine in under 50% of cases.

Abbreviations: ACL, anterior cruciate ligament; ITB, iliotibial band; MCL, medial collateral ligament; PFPS, patellofemoral pain syndrome; RCT, randomised controlled trial

Keywords: sports injury clinic; evidence based management; patellofemoral pain syndrome; Achilles tendinopathy

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Commentary

M Cullen

Consultant in Sport and Exercise Medicine, Chairperson BASEM; docmcullen{at}aol.com

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Patellofemoral pain sydrome and Achilles tendinopathy

N Fusun Toraman

BJSM Online, 9 Jan 2006 [Full text]