The Effectiveness of Exercise on Recovery and Clinical Outcomes in Patients With Soft Tissue Injuries of the Hip, Thigh, or Knee: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Courtney K Brown; Danielle Southerst; Pierre Côté; Heather M Shearer; Kristi Randhawa; Jessica J Wong; Hainan Yu; Sharanya Varatharajan; Deborah Sutton; Paula J Stern; Kevin D'Angelo; Sarah Dion; Jocelyn Cox; Rachel Goldgrub; Maja Stupar; Linda J Carroll; Anne Taylor-Vaisey

doi:10.1016/j.jmpt.2016.01.003

The Effectiveness of Exercise on Recovery and Clinical Outcomes in Patients With Soft Tissue Injuries of the Hip, Thigh, or Knee: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

J Manipulative Physiol Ther. 2016 Feb;39(2):110-120.e1. doi: 10.1016/j.jmpt.2016.01.003.

Authors

Courtney K Brown¹, Danielle Southerst², Pierre Côté³, Heather M Shearer⁴, Kristi Randhawa⁵, Jessica J Wong⁶, Hainan Yu⁷, Sharanya Varatharajan⁷, Deborah Sutton⁷, Paula J Stern⁸, Kevin D'Angelo¹, Sarah Dion¹, Jocelyn Cox¹, Rachel Goldgrub⁹, Maja Stupar¹⁰, Linda J Carroll¹¹, Anne Taylor-Vaisey¹²

Affiliations

¹ Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
² Research Coordinator, Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
³ Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Oshawa, ON, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
⁴ Adjunct Professor, Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada; Clinical Research Manager, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Senior Clinical Research Scientist, Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
⁵ Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
⁶ Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Associate Clinical Research Scientist, Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada; Instructor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
⁷ Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
⁸ Director, Graduate Education Program, Canadian Memorial Chiropractic College, Toronto, ON, Canada; Assistant Clinical Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
⁹ Graduate Student, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.
¹⁰ Adjunct Professor, Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada; Postdoctoral Fellow, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
¹¹ Professor, Injury Prevention Centre and School of Public Health, University of Alberta, Edmonton, AB, Canada.
¹² Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.

PMID: 26976374
DOI: 10.1016/j.jmpt.2016.01.003

Abstract

Objective: The purpose of this systematic review was to determine the effectiveness of exercise for the management of soft tissue injuries of the hip, thigh, and knee.

Methods: We conducted a systematic review and searched MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, and CINAHL Plus with Full Text from January 1, 1990, to April 8, 2015, for randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effect of exercise on pain intensity, self-rated recovery, functional recovery, health-related quality of life, psychological outcomes, and adverse events. Random pairs of independent reviewers screened titles and abstracts and assessed risk of bias using the Scottish Intercollegiate Guidelines Network criteria. Best evidence synthesis methodology was used.

Results: We screened 9494 citations. Eight RCTs were critically appraised, and 3 had low risk of bias and were included in our synthesis. One RCT found statistically significant improvements in pain and function favoring clinic-based progressive combined exercises over a "wait and see" approach for patellofemoral pain syndrome. A second RCT suggests that supervised closed kinetic chain exercises may lead to greater symptom improvement than open chain exercises for patellofemoral pain syndrome. One RCT suggests that clinic-based group exercises may be more effective than multimodal physiotherapy in male athletes with persistent groin pain.

Conclusion: We found limited high-quality evidence to support the use of exercise for the management of soft tissue injuries of the lower extremity. The evidence suggests that clinic-based exercise programs may benefit patients with patellofemoral pain syndrome and persistent groin pain. Further high-quality research is needed.

Keywords: Exercise; Hip; Hip Injuries; Knee; Knee Injuries; Thigh; Thigh Pain.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Exercise Therapy*
Humans
Joints / injuries*
Lower Extremity / injuries*
Recovery of Function
Soft Tissue Injuries / therapy*
Systematic Reviews as Topic