Best tests/clinical findings for screening and diagnosis of patellofemoral pain syndrome: a systematic review

Background: Diagnosis of patellofemoral pain syndrome (PFPS) is commonly performed using a myriad of clinical and imaging-based criteria.

Objectives: The objective of this systematic literature review was to summarize the research on accuracy of individual clinical tests/findings for PFPS.

Data sources: MEDLINE, ProQuest Nursing and Allied Health, Cochrane Trials, PEDro, and CINAHL. STUDY SELECTION OR ELIGIBILITY CRITERIA: PRISMA guidelines were followed for this review. To be considered for review, the study required: (1) a description of a clinical test or tests used for diagnosing PFPS (including a test that was combined with another finding such as patient history), (2) a report of the diagnostic accuracy of the measures (e.g., sensitivity and specificity), and (3) an acceptable reference standard for comparison. STUDY APPRAISAL OR SYNTHESIS METHODS: Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) scores were completed on each selected article. Sensitivity, specificity, and negative and positive likelihood ratios (LR-/LR+) were calculated for each diagnostic test described.

Results: The systematic search strategy and hand search revealed 704 potential articles, 9 of which met the criteria for this review; analysing a total of 22 PFPS clinical tests. After assessment using the QUADAS score, 1 of the 9 articles was of high quality. The tests with the highest reported diagnostic value were also associated with studies that had the lowest QUADAS values.

Conclusion: A majority of the studies that have investigated diagnostic accuracy of clinical tests for PFPS demonstrate notable design or reporting biases, and at this stage, determining the best tests for diagnosis of PFPS is still difficult.