Effectiveness of early rehabilitation on range of motion, muscle strength and arm function after breast cancer surgery: a systematic review of randomized controlled trials

2019 ◽  
Vol 33 (12) ◽  
pp. 1876-1886 ◽  
Author(s):  
Ivana Leão Ribeiro ◽  
Roberta Fátima Carreira Moreira ◽  
Angélica Viana Ferrari ◽  
Francisco Alburquerque-Sendín ◽  
Paula Rezende Camargo ◽  
...  
Keyword(s):  
Methodological Quality ◽  
External Rotation ◽  
Early Rehabilitation ◽  
Breast Cancer Surgery ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Shoulder Flexion ◽  
Patient Reported ◽  
Strengthening Exercises ◽  
And Function

Objective: The objective was to evaluate the effectiveness of early rehabilitation on arm range of motion (ROM), strength and function after breast cancer surgery (BCS). Data sources: PubMed, MEDLINE, Bireme, Embase, LILACS and CINAHL databases were searched. Methods: Two independent reviewers selected randomized controlled trials evaluating women who underwent early rehabilitation to restore arm ROM, strength or function after BCS. Cochrane Collaboration recommendations and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Methodological quality was assessed by the PEDro scale. The International Classification of Functioning, Disability and Health was considered to analyze results. Effect size (ES) was calculated for clinical relevance interpretation of the outcomes of interest, and the evidence was summarized through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Up to June 2019, a total of 1658 references were identified and 15 studies were included. Twelve of them presented adequate methodological quality. A total of 1710 patients were evaluated. Few studies performed the simultaneous assessment of variables related to body structure and function and patient-reported outcomes. A moderate level of evidence was synthesized regarding the effectiveness of ROM exercises for improving arm flexion, abduction and external rotation (ES: 0.45–2.5). A low level of evidence was synthesized regarding the effectiveness of isolated strengthening exercises for patient-reported arm function. ROM exercises associated with muscle strengthening exhibited a moderate level of evidence for improving shoulder flexion (ES: 1.4–2.4). Conclusion: Both ROM and strengthening exercises associated with ROM exercises improved shoulder flexion, abduction and external rotation ROM after BCS. Shoulder abduction and external rotation showed less recovery, irrespective of the intervention applied.

scholarly journals Combined Hip Abductor and External Rotator Strengthening and Hip Internal Rotator Stretching Improves Pain and Function in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial With Crossover Design

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712198972
Author(s):  
Anis Jellad ◽  
Amine Kalai ◽  
Mohamed Guedria ◽  
Mahbouba Jguirim ◽  
Sana Elmhamdi ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Group Standard ◽  
Hip Muscle ◽  
And Function

Background: Active rehabilitation has an important role in the management of patellofemoral pain syndrome (PFPS). Although some studies have shown the benefit of hip-muscle strengthening, the effect of combining hip-muscle stretching with strengthening has not yet been defined. Purpose: To evaluate the effect of combined strengthening of the hip external rotators and abductors and stretching of the hip internal rotators on pain and function in patients with PFPS. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 109 patients with PFPS (75 female and 34 male; mean age, 31.6 ± 10.8 years) were first randomly assigned to protocol A (n = 67) of the A-B arm (AB group; standard rehabilitation) or protocol B (n = 42) of the B-A arm (BA group; standard rehabilitation with strengthening of the hip external rotators and abductors and stretching of the hip internal rotators). Each protocol consisted of 3 sessions a week for 4 weeks. After a washout period, corresponding to a symptom-free period, rehabilitation programs were crossed over. A visual analog scale (VAS) evaluating perceived pain, the Functional Index Questionnaire (FIQ), and the Kujala score were administered at baseline, the end of each rehabilitation protocol, and 12 weeks after the completion of the second protocol for each group. Results: Until the final follow-up, VAS, FIQ, and Kujala scores were significantly improved in both the A-B and B-A arms ( P < .05 for all). Compared with protocol A, protocol B provided significant improvement in terms of pain and function in both the BA (VAS and Kujala; P < .001) and AB (VAS and Kujala; P < .001) groups. Conclusion: Combined strengthening of the hip abductors and external rotators with stretching of the hip internal rotators provided better outcomes, which were maintained for at least 12 weeks, in terms of pain and function in patients with PFPS.

Upper Extremity and Hip Range of Motion Changes Throughout a Season in Professional Baseball Players

2019 ◽  
Vol 48 (2) ◽  
pp. 481-487
Author(s):  
Justin M. Chan ◽  
John Zajac ◽  
Brandon J. Erickson ◽  
David W. Altchek ◽  
Christopher Camp ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Range Of Motion ◽  
External Rotation ◽  
Significant Risk ◽  
Case Series ◽  
Significant Risk Factor ◽  
Professional Baseball ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Shoulder Flexion

Background: Loss of upper and lower extremity range of motion (ROM) is a significant risk factor for injuries in professional baseball players. Purpose/Hypothesis: The purpose was to determine changes in ROM in professional baseball players over the course of a single season and their careers. We hypothesized that pitchers and position players would lose ROM, specifically total shoulder motion (total ROM [TROM]) and hip internal rotation (IR), over the course of a season and their careers. Study Design: Case series; Level of evidence, 4. Methods: Upper and lower extremity ROM measurements were recorded during pre-, mid-, and postseason on all professional baseball players for a single organization between 2011 and 2018. ROM measurements were compared for pitchers and position players over the course of the season and their careers. Also, ROM measurements over the pre-, mid-, and postseason were compared between pitchers and position players. Results: A total of 166 professional baseball players (98 pitchers, 68 position players) were included. Pitcher hip external rotation (ER; P < .001), IR ( P = .010), and TROM ( P < .001) for lead and trail legs decreased over the course of the season. Pitcher shoulder ER ( P = .005), TROM ( P = .042), and horizontal adduction ( P < .001) significantly increased over the course of the season. Position player shoulder flexion ( P = .046), hip ER ( P < .001, lead leg; P < .001, trail leg), and hip TROM ( P = .001; P = .002) decreased over the course of the season. Position player shoulder ER ( P = .031) and humeral adduction ( P < .001) significantly increased over the course of the season. Over the course of pitchers’ careers, there was decreased shoulder IR ( P = .014), increased shoulder horizontal adduction ( P < .001), and hip IR ( P = .042) and hip TROM ( P = .027) for the lead leg. Position players experienced loss of hip TROM ( P = .010, lead leg; P = .018, trail leg) over the course of their careers. Pitchers started with and maintained more shoulder ER and gained more shoulder TROM over a season as compared with position players. Conclusion: Pitchers and position players saw overall decreases in hip ROM but increases in shoulder ROM over the course of the season and career.

Acute and Subacute Changes in Hip Strength and Range of Movement After Arthroscopy to Address Chondrolabral Pathology

2019 ◽  
Vol 47 (8) ◽  
pp. 1939-1948 ◽  
Author(s):  
Matthew D. Freke ◽  
Kay Crossley ◽  
Kevin Sims ◽  
Trevor Russell ◽  
Patrick Weinrauch ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Repeated Measures ◽  
External Rotation ◽  
Case Series ◽  
Hip Pain ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Hip Strength ◽  
Hip Flexion ◽  
And Function

Background:Hip pain is associated with reduced muscle strength, range of movement (ROM), and function. Hip arthroscopy is undertaken to address coexistent intra-articular pathologies with the aim of reducing pain and improving function.Purpose:To evaluate changes in strength and ROM in a cohort with chondrolabral pathology before surgery to 3 and 6 months after hip arthroscopy.Study Design:Case series; Level of evidence, 4.Methods:Sixty-seven individuals with hip pain who were scheduled for hip arthroscopy were matched with 67 healthy controls. Hip strength and ROM were collected preoperatively and at 3 and 6 months postoperatively. Repeated measures analysis of variance evaluated whether strength and ROM differed between limbs and among time points. Bonferroni post hoc tests determined differences in hip strength and ROM among testing times and between the hip pain group and matched controls.Results:Hip extension, internal rotation (IR), external rotation (ER), and adduction ( P < .040) strength were greater at 3 months after surgery; all directions, including flexion, abduction, and squeeze, were greater at 6 months ( P < .015). Hip flexion ROM was greater at 3 months after surgery ( P = .013). Flexion, IR, and ER ROM was greater at 6 months ( P < .041). At 6 months, IR ROM ( P = .003) and flexion, IR, and ER strength ( P < .005) remained less than matched controls.Conclusion:With the exception of squeeze and flexion, all directions of hip strength and hip flexion ROM are significantly improved 3 months after arthroscopy to address chondrolabral pathology. By 6 months after arthroscopy, strength in all directions and flexion and rotation ROM are significantly improved in both limbs, but hip flexion, IR, and ER strength and IR ROM remain significantly less than that of healthy matched controls in both limbs.

scholarly journals Outcomes After Dermal Allograft Reconstruction of Chronic or Subacute Pectoralis Major Tendon Ruptures

2018 ◽  
Vol 6 (1) ◽  
pp. 232596711774583 ◽  
Author(s):  
Julie A. Neumann ◽  
Christopher M. Klein ◽  
Carola F. van Eck ◽  
Hithem Rahmi ◽  
John M. Itamura
Keyword(s):  
External Rotation ◽  
Constant Score ◽  
Case Series ◽  
Pectoralis Major ◽  
Tissue Quality ◽  
Level Of Evidence ◽  
Allograft Reconstruction ◽  
Tendon Reconstruction ◽  
Number Of Patients ◽  
Patient Reported

Background: Avoiding delay in the surgical management of pectoralis major (PM) ruptures optimizes outcomes. However, this is not always possible, and when a tear becomes chronic or when a subacute tear has poor tissue quality, a graft can facilitate reconstruction. Purpose: The primary aim was to evaluate the clinical outcomes of PM reconstruction with dermal allograft augmentation for chronic tears or for subacute tears with poor tissue quality. A second aim was to determine patient and surgical factors affecting outcome. Study Design: Case series; Level of evidence, 4. Methods: Nineteen consecutive patients (19 PM ruptures) with a mean ± SD age of 39.1 ± 8.4 years were retrospectively reviewed at 26.4 ± 16.0 months following PM tendon reconstruction with dermal allograft. Surgery was performed at 19.2 ± 41.2 months after injury (median, 7.6 months; range, 1.1-185.4 months). Several outcome scores were recorded pre- and postoperatively, including Disabilities of the Arm, Shoulder, and Hand (DASH), as well as visual analog scale (VAS) (range, 0-10; 0 = no pain) and Single Assessment Numeric Evaluation (SANE). Range of motion, Constant score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test score, and complications/reoperations were recorded postoperatively. Results: Scores improved significantly for the DASH (preoperative, 34.9; postoperative, 8.0; P < .001) and VAS (preoperative, 5.0; postoperative, 1.5; P = .011). There was a trend toward improved SANE scores (preoperative, 15.0; postoperative, 80.0; P = .097), but the difference was not statistically significant, likely because of the small number of patients having preoperative SANE scores for review. Increased age was associated with higher VAS scores ( r = 0.628, P = .016) and less forward flexion ( r = –0.502, P = .048) and external rotation ( r = –0.654, P = .006). Patients with workers’ compensation had lower scores for 3 measures: SANE (75.8 vs 88.4, P = .040), Constant (86.7 vs 93.4, P = .019), and ASES (81.9 vs 97.4, P = .016). Operating on the dominant extremity resulted in lower Constant scores (87.8 vs 95.4, P = .012). A 2-head tendon tear (107.5° vs 123.3°, P = .033) and the use of >1 graft (105.0° vs 121.3°, P = .040) resulted in decreased abduction. Conclusion: This was the first large series to observe patients with chronic or subacute PM tendon tears treated with dermal allograft reconstruction. PM tendon reconstruction with dermal allografts resulted in good objective and subjective patient-reported outcomes.

scholarly journals The safety and efficacy of irreversible electroporation versus tamsulosin in the treatment of benign prostatic obstruction: study protocol and rationale for a randomized controlled trial

2019 ◽  
Author(s):  
Qi-Xiang Song ◽  
Biming He ◽  
Xu Gao ◽  
Chuanliang Xu ◽  
Yinghao Sun ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Day Treatment ◽  
Controlled Trial ◽  
Standard Procedure ◽  
Irreversible Electroporation ◽  
Specific Antigen ◽  
Benign Prostatic Obstruction ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Patient Reported

Abstract Background Though transurethral resection of the prostate is still considered to be the ‘‘gold standard’’ procedure for benign prostatic obstruction (BPO), the reported post-operative complication rate is not uncommon. The emerging of minimally invasive focal ablative therapies provide an alternative option for patients who are dissatisfied with medical treatment yet do not willing to take the interventional procedures. Irreversible electroporation (IRE) is a novel focal therapy which can accurately ablate the target tissues with minimum damage to the surrounding structures. The application of IRE in selected patients with prostate cancer has yielded promising results, but no report on BPO has been published. Methods/design This is a single-centered, prospective, randomized controlled trial to evaluate the effectiveness and safety of IRE in treating BPO compare with tamsulosin. We aim to recruit BPO patients who are currently taking tamsulosin but without absolute indications for surgical intervention. Eligible subjects will undergo a 3-day treatment free washout period, followed by baseline assessment. After randomized into IRE group and tamsulosin (0.2mg orally once daily) group, subjects will be followed-up for up to 24 months. The primary clinical outcome is the change in maximum flow rate from baseline at 6 months. Other assessments, including symptom questionnaires, ultrasound, prostatic specific antigen, prostate magnetic resonance image and pressure-flow study, will be carried out at different time points during follow-up. Any perception or patient-reported adverse events in both treatment arms will be documented. Data will be analyzed by a specialist who is blinded to the medical status and treatment modality in order to minimize the potential bias. Discussion This is the first randomized controlled trial evaluating the feasibility of IRE for the treatment of BPO. The outcomes of this study will provide high level of evidence to determine its true clinical value.

scholarly journals Bipolar lateralization in reverse shoulder arthroplasty for avoidance of scapular notching

2020 ◽  
Vol 15 (3) ◽  
pp. 207-212
Author(s):  
Patric Raiss ◽  
Rainer Neumann
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Scapular Notching ◽  
Neck Shaft Angle ◽  
Shoulder Flexion

Abstract Introduction Reverse shoulder arthroplasty (RSA) has become a well-established treatment option for multiple disorders of the shoulder joint. In recent years, implant designs and configurations have been modified in order to improve function and avoid complications. Lateralization on the glenoid and the humeral side has been described to improve function and decrease radiographic scapular notching. Data on the clinical and radiographic results of bipolar lateralization in RSA are lacking. Methods In 38 cases, RSA was performed using an uncemented humeral short-stem component with a 145° neck–shaft angle in combination with bone lateralization on the glenoid side (Bony Increased-Offset Reversed Shoulder Arthroplasty, BIO-RSA; Wright Medical Inc., Memphis, TN, USA). Mean follow-up was 19 months (range 12–34 months). Patients were followed clinically using the Constant score as well as range of motion for shoulder flexion and external rotation. Radiographs in two different plains were analyzed for implant seating and the occurrence of scapular notching. Results There was a significant increase in all measured clinical parameters. Forward flexion increased from a mean of 75° preoperatively to 151° postoperatively, and mean Constant score increased from 21 to 71 points postoperatively (p < 0.001). Glenoid notching of grade 1 according to Sirveuax was observed in 3 out of 35 cases (9%); no grade 2, 3, or 4 notching was present. Revision surgery was necessary in one case (3%). Conclusion RSA with bipolar lateralization leads to excellent clinical outcomes, low complication rates, and low rates of radiographic scapular notching. Longer follow-up and prospective randomized trials are needed. Level of evidence Level IV.

Bilateral total shoulder arthroplasty: A systematic review of clinical outcomes

2020 ◽  
pp. 175857322091682
Author(s):  
John-Rudolph H Smith ◽  
Darby A Houck ◽  
Jessica A Hart ◽  
Jonathan T Bravman ◽  
Rachel M Frank ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
English Language ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Patient Reported

Background The purpose of this study was to describe the clinical outcomes following bilateral total shoulder arthroplasty (TSA). Methods A systematic search of the PubMed, Embase, and Cochrane Library databases following PRISMA guidelines was performed. English-language literature published from 2010 to 2018 analyzing bilateral TSA (anatomic and/or reverse) with a minimum one-year follow-up was reviewed by two independent reviewers. Study quality was evaluated with the Modified Coleman Methodology Score and the methodological index for non-randomized studies score. Results Eleven studies (1 Level II, 3 Level III, 7 Level IV) with 292 patients were included. Two studies reported on bilateral anatomic TSA ( n = 54), six reported on bilateral reverse TSA (RTSA; n = 168), two reported on anatomic TSA with contralateral RTSA (TSA/RTSA; n = 31), and one compared bilateral anatomic TSA ( n = 26) and bilateral RTSA ( n = 13). Among studies, mean revision rate ranged from 0% to 10.53% and mean complication rate ranged from 4.9% to 31.3%. At final follow-up, patients experienced significant overall improvements in range of motion and patient-reported outcome score measurements. However, bilateral anatomic TSA resulted in greater improvements in external rotation compared to bilateral RTSA. Overall patient satisfaction was 91.0%. Conclusion The available data indicate that bilateral TSA allows for functional and pain improvements and result in high patient satisfaction. Level of evidence IV.

Patient-reported outcomes (PRO) in cancer trials submitted to the FDA from 2012-2015.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e14024-e14024 ◽  
Author(s):  
Bindu Kanapuru ◽  
Harpreet Singh ◽  
Janice Kim ◽  
Paul Gustav Kluetz ◽  
Keyword(s):  
Statistical Testing ◽  
Open Label ◽  
Randomized Controlled ◽  
Analysis Methods ◽  
Patient Reported ◽  
Accelerated Approval ◽  
Cancer Trials ◽  
Cancer Agent ◽  
Eortc Qlq ◽  
And Function

e14024 Background: PRO measures are commonly assessed in cancer trials. We reviewed the PRO strategy, tools and trial designs for new drug applications (NDA) and biologics license applications (BLA) submitted to FDA over a 4 year period. Methods: A review of protocols and clinical study reports for original NDA and BLA applications submitted to the Office of Hematology and Oncology Products between 2012 and 2015 to support initial approval for adult malignant hematology and oncology conditions was done. We reviewed applications for inclusion of PRO data, trial design, type of PRO measure employed and statistical analysis methods. Results: Forty three trials were submitted to support 40 original NDA or BLA approvals targeting adult malignancies between 2012 and 2015. Of these 43 trials, 17/43 (40%) were accelerated approval, 26/43 (60%) were randomized, 17/43 (40%) were single arm and 27/43 (63%) were open label trials. Sponsors documented the incorporation of PRO assessments in 28/43 (65%) trials. For trials that included PRO assessments, 22/28 (79%) were randomized controlled trials, 6/28 (21%) were single arm and 17/28 (61%) were open label studies. The most common PRO instruments used were the EORTC-QLQ-C30 (15/28; 54%), EQ-5D (13/28; 46%) and various FACIT measures (8/28; 29%). Although 20/28 (71%) trials had PRO measures listed as a secondary endpoint, only 1 trial included PRO endpoints in the statistical testing hierarchy. Conclusions: PRO measures are often employed in randomized controlled cancer trials; however accelerated approval is common in oncology and trial designs are increasingly open label and single arm. Patient-focused drug development efforts will need to identify clinical trial objectives and analysis methods for PRO measures to describe symptoms and function that are suitable for these contexts. Descriptive PRO data on the tolerability of an anti-cancer agent may be one objective that is relevant across trial contexts. To support a claim of superiority, PRO endpoints should be adjusted for multiplicity by inclusion in the statistical hierarchy.

Three-and-a-half to 18 year outcome data for costal osteochondral grafts for salvage of the proximal pole of the scaphoid

2020 ◽  
Vol 45 (9) ◽  
pp. 959-964
Author(s):  
Charles Bain ◽  
Stephen Tham ◽  
Chris Powell ◽  
Anthony Berger ◽  
Aaron Withers ◽  
...  
Keyword(s):  
Patient Reported Outcome ◽  
Outcome Data ◽  
Osteochondral Graft ◽  
Proximal Pole ◽  
Level Of Evidence ◽  
Osteochondral Grafts ◽  
Pain Scores ◽  
Patient Reported ◽  
And Function ◽  
Graft Reconstruction

Twelve patients who had undergone costal osteochondral graft reconstruction of the proximal pole of scaphoid were evaluated with clinical examination, patient-reported outcome scores and radiographs with an average follow-up of 10 years (range 3.5–18). The range of wrist motion was not significantly changed compared with the preoperative range of motion and functional outcomes scores were acceptable. The patients reported low pain scores despite the universal presence of radiographic changes of reduced carpal height and arthritis of the midcarpal and radiocarpal joints. Costal osteochondral graft reconstruction of the proximal pole of scaphoid offers good long-term pain relief and function. Level of evidence: IV

scholarly journals Systematic Review of the Addition of Hip Strengthening Exercises for Adults with Patellofemoral Pain Syndrome

2018 ◽  
Author(s):  
Cara Elliott ◽  
Fraser Green ◽  
Karen Hang ◽  
Bronwen Jolliffe ◽  
Maureen McEvoy
Keyword(s):  
Methodological Quality ◽  
Critical Appraisal ◽  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Physiotherapy Treatment ◽  
Strengthening Exercises ◽  
Randomised Controlled ◽  
And Function ◽  
Hip Strengthening

Patellofemoral Pain Syndrome (PFPS) is a common musculoskeletal disorder typically occurring in physically active people aged 40 years and younger, causing pain, functional deficits and lower limb weakness. Traditional treatment has been aimed at strengthening the knee, however recent research suggests the muscles around the hip also play an important role in the development and continuity of Patellofemoral Pain Syndrome. Purpose: To investigate the effectiveness of the addition of hip strengthening exercises to standard physiotherapy treatment (knee strengthening and stretching exercises) on reducing pain, and enhancing strength and function when compared to standard physiotherapy treatment alone in adults with Patellofemoral Pain Syndrome. Method: A systematic search of Cochrane, CINAHL, Embase, MEDLINE®, PEDro and SportDiscus was conducted. Studies of participants aged 18 to 44, diagnosed with Patellofemoral Pain Syndrome by a healthcare practitioner, or reporting peripatellar or retropatellar pain with common functional tasks, were included. A critical appraisal, using the Critical Appraisal Skills Program for Randomised Controlled Trials (CASP) was used to assess methodological quality. Results: Five randomised controlled trials of varying methodological quality met the inclusion criteria. The participants in these studies were aged between 18 to 40 years of age. The duration of the intervention ranged from four to six weeks consisting of 12 to 30 supervised exercise sessions. Studies used varying outcome measures for each of the three outcomes. Overall, the studies demonstrated that the addition of hip strengthening exercises to standard physiotherapy care consistently improved pain and function, but the impact on strength was variable. Conclusion: Previously, only a small number of studies have looked at the addition of hip exercises to standard physiotherapy care for treatment of Patellofemoral Pain Syndrome. While there is a growing body of evidence for the efficacy of hip strengthening exercises for Patellofemoral Pain Syndrome, this is constrained by bias towards female participants, lack of true controls in most studies, and low methodological quality of studies overall. Hip exercises added to standard physiotherapy care shows potential as a treatment method for improving outcomes of pain and function in adults with Patellofemoral Pain Syndrome.

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