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Can we predict the outcome for people with patellofemoral pain? A systematic review on prognostic factors and treatment effect modifiers
  1. M Matthews1,
  2. M S Rathleff2,3,
  3. A Claus1,
  4. T McPoil4,
  5. R Nee5,
  6. K Crossley6,
  7. B Vicenzino1
  1. 1Sports Injuries Rehabilitation and Prevention for Health Research Unit, The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
  2. 2Research Unit for General Practice in Aalborg and Department of Clinical Medicine, Aalborg, Denmark
  3. 3SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
  4. 4School of Physical Therapy, Rueckert-Hartman College for Health Professions, Regis University, Denver, Colorado, USA
  5. 5School of Physical Therapy, Pacific University, Hillsboro, Oregon, USA
  6. 6La Trobe University, La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
  1. Correspondence to Professor B Vicenzino, Sports Injuries Rehabilitation and Prevention for Health Research Unit, The University of Queensland, School of Health and Rehabilitation Sciences, CCRE Spine, Brisbane, QLD 4072, Australia; b.vicenzino{at}


Background Patellofemoral pain (PFP) is a multifactorial and often persistent knee condition. One strategy to enhance patient outcomes is using clinically assessable patient characteristics to predict the outcome and match a specific treatment to an individual.

Aim A systematic review was conducted to determine which baseline patient characteristics were (1) associated with patient outcome (prognosis); or (2) modified patient outcome from a specific treatment (treatment effect modifiers).

Methods 6 electronic databases were searched (July 2016) for studies evaluating the association between those with PFP, their characteristics and outcome. All studies were appraised using the Epidemiological Appraisal Instrument. Studies that aimed to identify treatment effect modifiers underwent a checklist for methodological quality.

Results The 24 included studies evaluated 180 participant characteristics. 12 studies investigated prognosis, and 12 studies investigated potential treatment effect modifiers. Important methodological limitations were identified. Some prognostic studies used a retrospective design. Studies aiming to identify treatment effect modifiers often analysed too many variables for the limiting sample size and typically failed to use a control or comparator treatment group. 16 factors were reported to be associated with a poor outcome, with longer duration of symptoms the most reported (>4 months). Preliminary evidence suggests increased midfoot mobility may predict those who have a successful outcome to foot orthoses.

Conclusions Current evidence can identify those with increased risk of a poor outcome, but methodological limitations make it difficult to predict the outcome after one specific treatment compared with another. Adequately designed randomised trials are needed to identify treatment effect modifiers.

  • Knee
  • Treatment
  • Physiotherapy

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  • Twitter Follow Mark Matthews @Mark_MatthewsNZ, @MichealRathleff, @kaycrossley, @Bill_Vicenzino

  • Contributors MM, MSR, AC, KCP, RN, TM and BV conceived and designed the review. MM executed the search. MM, MSR and BV screened the articles, extracted the data and rated the methodological quality of the studies. MM, MSR, AC and BV performed the analysis and drafted the manuscript. MM, MSR, AC, KCP, RN, TM and BV interpreted the data, revised the manuscript and approved the final version.

  • Funding NHMRC programme grant (number 1091302) funded the review. MM is funded by the Australian Postgraduate Award.

  • Competing interests None declared.

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