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The additional effect of orthotic devices on exercise therapy for patients with patellofemoral pain syndrome: a systematic review
  1. Nynke M Swart1,
  2. Robbart van Linschoten2,
  3. Sita M A Bierma-Zeinstra2,
  4. Marienke van Middelkoop2
  1. 1Clinical Health Sciences, Department of Physical Therapy Science, Utrecht University, Utrecht, The Netherlands
  2. 2Department of General Practice, Erasmus Medical University, Rotterdam, The Netherlands
  1. Correspondence to Dr Marienke van Middelkoop, Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; m.vanmiddelkoop{at}


The aim of the study is to determine “the additional effect of... function” for patellofemoral pain syndrom (PFPS). The additional effect of orthotic devices over exercise therapy on pain and function. A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane and PEDro. Randomised controlled trials and controlled clinical trials of patients diagnosed with PFPS evaluating a clinically relevant outcome were included. Treatment had to include exercise therapy combined with orthotics, compared with an identical exercise programme with or without sham orthotics. Data were summarised using a best evidence synthesis. Eight trials fulfilled the inclusion criteria, of which three had a low risk of bias. There is moderate evidence for no additive effectiveness of knee braces to exercise therapy on pain (effect sizes (ES) varied from −0.14 to 0.04) and conflicting evidence on function (ES −0.33). There is moderate evidence for no difference between knee braces and exercise therapy versus placebo knee braces and exercise therapy on pain and function (ES −0.1–0.10). More studies of high methodological quality are needed to draw definitive conclusions.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.