Christian Barton: There is an evidence-practice gap in patellofemoral pain management that can be bridged

Introduction: Level 1 evidence supports quadriceps and gluteal exercise, tailored patellar taping and prefabricated foot orthoses for patellofemoral pain management. We have previously identified barriers preventing translation of this research into physiotherapy practice, including access to evidence (knowledge) and understanding how to confidently apply the evidence to patients in the clinic. This study evaluates (i) knowledge of current evidence, and confidence in its clinical use amongst physiotherapists; and (ii) whether a structured educational intervention can improve knowledge and confidence.

Methods: Physiotherapists attending a one day theoretical and practical educational course facilitated by one of the authors on the management of patellofemoral pain were invited to compete a survey to evaluate their knowledge of current evidence, and confidence in clinical use before and after course completion. Survey questions were constructed by three clinical researchers and piloted prior to commencing the study to ensure comprehension. The survey also explored potential resources which may assist in bridging any evidence-practice gaps.

Results: 72% (71/98) of invited physiotherapists averaging 15 years (range = 0 to 34 years) clinical experience participated in the first survey, with 82% (58/71) participating in the second survey. Knowledge of evidence for active and passive interventions was variable among responding physiotherapists, with generally poor knowledge related to passive interventions. Of note, 36% of participants believed there was supporting evidence for Kinesio® taping techniques despite an absence of evidence; and only 23% of respondents believed there was supporting evidence for prefabricated foot orthoses prescription, despite clear supporting evidence. Additionally, 75% of respondents were confident in the use of Kinesio® tape, but just 38% were confident in the use of prefabricated foot orthoses. Knowledge related to evidence supporting proximal exercise (p=0.029), foot orthoses (p<0.001) and tailored patellar taping (p<0.001) improved following the course. Additionally, confidence improved in the majority of physiotherapists for provision of quadriceps and gluteal exercise (75%), tailored patellar taping (88%) and prefabricated foot orthoses (70%). Numerous online educational interventions to improve knowledge and confidence in managing patellofemoral pain were proposed.

Discussion: This study highlights a clear evidence-practice gap in relation to the knowledge of physiotherapists managing patellofemoral pain, particularly for passive interventions. This evidence-practice gap can be bridged by a theoretical and practical educational course. Further research is needed to see if these improvements translate to improved patient outcomes, and whether more freely available online resources may be similarly effective in improving knowledge and confidence of physiotherapists managing patellofemoral pain.