Regis Dpt Class Of 2009 Knee Aop Project

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Practice Patterns and Outcomes of Care for Patients with Non-Traumatic Knee Disorders Jessica B. Albers, Alison M. Nading, Chelsea M. O’Driscoll, Jeremy W. Schmidt, Charlene M. Sheaman, Shannon B. Strimple

School of Physical Therapy, Regis University, Denver, CO

Knee pain is a common ailment among a variety of age-groups.1,2 While 3.9% of children between 9 and 10 years of age reported chronic knee pain, the prevalence increases to 18.5% by the age of 15 years, and 20.8% by age 60.1,2 These studies suggest that the prevalence of knee pain continues to increase as the population ages. Knee pain is typically classified as either traumatic or non-traumatic. Nontraumatic knee pain includes but is not limited to patellofemoral pain syndrome (PFPS), osteoarthritis (OA), and lateral knee pain. Although extensive research has been conducted on a variety of knee disorders including many randomized trials, there is currently insufficient data from studies that monitor intervention choices and resulting outcomes in patients treated by student physical therapists and their clinical instructors.

METHODS

Table 1. Patient Demographics Per Diagnosis Diagnosis

Procedures: •Data collected by Regis University Doctor of Physical Therapy students during three clinical affiliations on patients with nontraumatic knee pain. •Data collection included baseline, weekly, and discharge measurements using the Lower Extremity Functional Scale (LEFS) and the Numeric Pain Rating Scale (NPRS). •Patients were classified as successful if they met the minimal clinically important difference (MCID) values for both of the following criteria: •NPRS > 2 point decrease •LEFS > 9 point increase •Data was coded and statistically analyzed with SPSS 17.0 version primarily consisting of descriptive and correlative statistics. •Statistical significance set at an alpha < .10 for Chi-square testing.

Success = 50% Non- Success = 50%

6.7

Success = 30% Non- Success = 70%

Success =54% Non- Success = 46%

Association between Interventions and Success. Chi-square statistics revealed that three of the 20 intervention options were associated with successful outcome: • Application of joint mobilization (p = .03) • Not performing isometric exercise (p = .05) • Not performing taping/bracing (p = .10) Note: Alpha < 0.10

DISCUSSION

Diagnosis

#1 Intervention

#2 Intervention

#3 Intervention

#4 Intervention

PFPS

Stretching (n=23)

PRE (n=21)

Patient Education (n=19)

Joint Mobilization (n=12)

Osteoarthritis

Patient Education (n=9)

PRE (n=9)

A/PROM (n=6)

Stretching (n=4)

Lateral Knee Pain

Patient Education (n=12)

Stretching (n=12)

PRE (n=10)

Electrical Stimulation (n=6)

Nearly 50% of subjects achieved a successful outcome as defined by changes in pain and function, although patients with OA experienced less success. Interventions appeared to match the impairments identified. Although this was an initial exploratory study, interventions have been identified that are associated with outcomes and could be used in future prospective study designs.

CLINICAL RELEVANCE

6

5

4

3

MCID = 2

2

1

0 PFPS

OA

Lat. Knee Pain

Overall

35 30

•Most Common Diagnoses:

•Lateral Knee Pain (n=13; 24.1%)

Hamstring Tight, ITB Tight, Rectus Femoris Tight

Chart 1 and 2. Change of Primary Outcome Measures

•Average age: 37.8 years ± 18.1

•Osteoarthritis (n=11; 20.4%)

Success vs. Non-Success

Table 2. Weeks 1 – 3 Most Common Interventions

•Total Subjects: 65 (F = 36, M = 29)

•PFPS (n=26; 48.1%)

Impairments

Hamstring Tight, PROM Pain with Extension, Gastroc Tight ITB Tight, Patella Tender at Lateral Aspect, PROM Pain with Flexion

11.0

Lateral Knee Pain

25

LEFS

The purpose of this analysis of practice was to identify the physical therapy interventions and practice patterns implemented by student physical therapists in the treatment of PFPS, OA, and lateral knee pain.

7.7

Osteoarthritis

RESULTS Purpose:

# of Visits

PFPS

NPRS Scale

INTRODUCTION

Monitoring patient demographics, outcome measures and prioritized interventions can inform clinical practice. The use of both the LEFS and NPRS appear to be appropriate measures in tracking changes in patients with non-traumatic knee pain. Assessment of a multimodal approach to treating PFPS, yielded similar results in changes in NPRS (4 point change from baseline to discharge) and the LEFS (14 point change from baseline to discharge).3 References:

20 15 10

MCID = 9

5 0 PFPS

OA

Lat. Knee Pain

Overall

1. Anderson R, Crespo C, Ling S, Batham J, Bartlett S. Prevalence of significant knee pain among older americans: results from the third national health and nutrition examination survery. J Am Geriatr Soc. 1999;47:1435-1438. 2.Vanasarja V. Prevalence of chronic knee pain in children and adolescence in northern Finland. Acta Pediatric. 1995;84:803-805. 3. Lowry C, Cleland J, Dyke K. Management of patients with patellofemoral pain syndrome using a multimodal approach: a case series. J Orthop Sport Phys Ther. 2008; 38: 691-702