Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Short-term effects of hip abductors and lateral rotators strengthening in females with patellofemoral pain syndrome: a randomized controlled clinical trial. Factors that predict a poor outcome 5–8 years after the diagnosis of patellofemoral pain: a multicentre observational analysis The Effects of Exercise for the Prevention of Overuse Anterior Knee Pain Effects of prefabricated foot orthoses on pain and function in individuals with patellofemoral pain syndrome: a cohort study. Effect of bracing on the prevention of anterior knee pain—a prospective randomized study Prognostic factors for patellofemoral pain: a multicentre observational analysis Comparison of symptoms and clinical findings in subgroups of individuals with patellofemoral pain The impact of PTSD on pain experience in persons with HIV/AIDS A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works? A comparison of two taping techniques (kinesio and mcconnell) and their effect on anterior knee pain during functional activities. The evidence‐based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome Etiologic factors associated with anterior knee pain in distance runners. Evaluation of a treatment algorithm for patients with patellofemoral pain syndrome: a pilot study. How can we best categorize cognitive impairment in nondemented older adults? Medially posted insoles consistently influence foot pronation in runners with and without anterior knee pain. Is patellofemoral osteoarthritis a common sequela of patellofemoral pain? Gait metric profile of 157 patients suffering from anterior knee pain. A controlled study. Reliability of clinical temporomandibular disorder diagnoses Prevalence and consequences of delayed diagnosis of anterior cruciate ligament ruptures A systematic review of the effects of therapeutic taping on patellofemoral pain syndrome. The natural history of anterior knee pain in 2 posterior-stabilized, modular total knee arthroplasty designs. Induced Anterior Knee Pain Immediately Reduces Involuntary and Voluntary Quadriceps Activation
OBJECTIVE To examine the test-retest reliability , validity , and responsiveness of several outcome measures in the treatment of patellofemoral pain . DESIGN Evaluation of the clinimetric properties of individual outcome measures for patellofemoral pain treatment , using data collected from a previously published r and omized controlled trial ( RCT ) . SETTING General community and private practice . PARTICIPANTS The data from 71 persons enrolled in an RCT of a conservative intervention for patellofemoral pain were used to evaluate the measures ' validity and responsiveness . A subset of this cohort ( n=20 ) was used to assess reliability . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Three  10-cm visual analog scales ( VASs ) for usual pain ( VAS-U ) , worst pain ( VAS-W ) , and pain on 6 aggravating activities ( walking , running , squatting , sitting , ascending and descending stairs ) ( VAS-activity ) ; the Functional Index Question naire ( FIQ ) ; the Anterior Knee Pain Scale ( AKPS ) ; and the global rating of change . RESULTS The test-retest reliability ranged from poor ( intraclass correlation coefficient [ICC]=.49 ) to good ( ICC=.83 ) , and the measures correlated moderately with each other ( r range,.56-.72 ) . Median change scores differed significantly between improved and unimproved persons for all measures . The effect sizes for VAS-U ( .79 ) , VAS-W ( .88 ) , and the AKPS ( .98 ) were large , indicating greater responsiveness than the FIQ ( .37 ) and VAS-activity ( .66 ) . Similarly , the AKPS and VAS-W were the most efficient measures for detecting a treatment effect when compared with a reference measure ( VAS-U , which was assigned a value of 1 ) . The minimal difference that patients or clinicians consider clinical ly important for the AKPS is 10 ( out of 100 ) points and for the VAS it is 2 cm ( out of 10 cm ) . CONCLUSIONS The AKPS and VAS for usual or worst pain are reliable , valid , and responsive and are therefore recommended for future clinical trials or clinical practice in assessing treatment outcome in persons with patellofemoral pain STUDY DESIGN R and omized clinical trial . OBJECTIVE To investigate the influence of strengthening the hip abductor and lateral rotator musculature on pain and function of females with patellofemoral pain syndrome ( PFPS ) . BACKGROUND Hip muscle weakness in women athletes has been the focus of many recent studies and is suggested as an important impairment to address in the conservative treatment of women with PFPS . However , it is still not well established if strengthening these muscles is associated with clinical improvement in pain and function in sedentary females with PFPS . METHODS Seventy females ( average±SD age , 25±07 years ) , with a diagnosis of unilateral PFPS , were distributed r and omly into 3 groups : 22 females in the knee exercise group , who received a conventional treatment that emphasized stretching and strengthening of the knee musculature ; 23 females in the knee and hip exercise group , who performed exercises to strengthen the hip abductors and external rotators in addition to the same exercises performed by those in the knee exercise group ; and of the 25 females who did not receive any treatment . The females of the nontreatment group ( control ) were instructed to maintain their normal daily activities . An 11-point numerical pain rating scale ( NPRS ) was used to assess pain during stair ascent and descent . The lower extremity functional scale ( LEFS ) and the anterior knee pain scale ( AKPS ) were used to assess function . The single-limb single hop test was also used as a functional outcome to measure preintervention and 4-week postintervention function . RESULTS The 3 groups were homogeneous prior to treatment in respect to demographic , pain , and functional scales data . Both the knee exercise and the knee and hip exercise groups showed significant improvement in the LEFS , the AKPS , and the NPRS , when compared to the control group ( P<.05 and P<.001 , respectively ) . But , when we considered minimal clinical ly important differences , only the knee and hip exercise group demonstrated mean improvements in AKPS and pain scores that were large enough to be clinical ly meaningful . For the single-limb single hop test , both groups receiving an intervention showed greater improvement than the control group , but there was no difference between the 2 interventions ( P>.05 ) . CONCLUSION Rehabilitation programs focusing on knee strengthening exercises and knee strengthening exercises supplemented by hip strengthening exercises were both effective in improving function and reducing pain in sedentary women with PFPS .  Improvements of pain and function were greater for the group that performed the hip strengthening exercises , but the difference was significant only for pain rating while descending stairs . LEVEL OF EVIDENCE Therapy , level 1b- Background Patellofemoral pain ( PFP ) has traditionally been viewed as self-limiting , but recent studies show that a large proportion of patients report chronic knee pain at long-term follow-up . We identified those patients with an unfavourable recovery ( ‘ moderate improvement ’ to ‘ worse than ever ’ measured on a Likert scale ) and examined whether there is an association between PFP and osteoarthritis ( OA ) at 5–8-year follow-up . Methods Long-term follow-up data were derived from 2 r and omised controlled trials ( n=179 , n=131 ) .  Patient-reported measures were obtained at baseline .  Pain severity ( 100 mm visual analogue scale ( VAS ) ) , function ( Anterior Knee Pain Scale ( AKPS ) ) and self-reported recovery were measured 5–8 years later , along with knee radiographs . Multivariate backward stepwise linear regression analyses were used to evaluate the prognostic ability of baseline pain duration , pain VAS and AKPS on outcomes of pain VAS and AKPS at 5–8 years . Results 60 ( 19.3 % ) participants completed the question naires at 5–8-year follow-up ( 45 women , mean age at baseline 26 years ) and 50 underwent knee radiographs . No differences were observed between responders and non-responders regarding baseline demographics , and 3-month and 12-month pain severity and recovery . 34 ( 57 % ) reported unfavourable recovery at 5–8 years . 48 out of 50 participants ( 98 % ) had no signs of radiographic knee OA . Multivariate models revealed that baseline PFP duration ( > 12 months ; R2=0.22 ) and lower AKPS ( R2=0.196 ) were significant predictors of poor prognosis at 5–8 years on measures of worst pain VAS and AKPS , respectively . Summary and conclusion More than half of participants with PFP reported an unfavourable recovery 5–8 years after recruitment , but did not have radiographic knee OA . Longer PFP duration and worse AKPS score at baseline predict poor PFP prognosis . Education of health practitioners and the general public will provide patients with more realistic expectations regarding prognosis Background : Anterior knee pain ( AKP ) is the most common activity-related injury of the knee . The authors investigated the effect of an exercise intervention on the incidence of AKP in UK army recruits undergoing a 14-week physically arduous training program . Hypothesis : Modifying military training to include targeted preventative exercises may reduce the incidence of AKP in a young recruit population . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A single-blind cluster r and omized controlled trial was performed in 39 male and 11 female training groups ( median age : 19.7 years ; interquartile range , 17 - 25 ) undergoing phase 1 of army recruit training . Each group was r and omly assigned to either an intervention ( n = 759 ) or control ( n = 743 ) protocol . The intervention consisted of 4 strengthening and 4 stretching exercises completed during supervised physical training lessons ( 7 per week ) . The control group followed the existing training syllabus warm-up exercises . The primary outcome was a diagnosis of AKP during the 14-week training program . Results : Forty-six participants ( 3.1 % ; 95 % confidence interval [ CI ] , 2.3 - 4.1 ) were diagnosed with AKP . There were 36 ( 4.8 % ; 95%CI , 3.5 - 6.7 ) new cases of AKP in the control group and 10 ( 1.3 % ; 0.7 - 2.4 ) in the intervention group . There was a 75 % reduction in AKP risk in the intervention group ( unadjusted hazard ratio = 0.25 ; 95 % CI , 0.13 - 0.52 ; P < .001 ) . Three participants ( 0.4 % ) from the intervention group were discharged from the military for medical reasons compared to 25 ( 3.4 % ) in the control group . Conclusion : A simple set of lower limb stretching and strengthening exercises result ed in a substantial and safe reduction in the incidence of AKP in a young military population undertaking a physical conditioning program . Such exercises could also be beneficial for preventing this common injury among nonmilitary participants in recreational physical activity OBJECTIVES This study evaluated the effects of unmodified prefabricated foot orthoses over a 12-week period on functional performance ; and subjective pain and function in individuals with patellofemoral pain syndrome ( PFPS ) . DESIGN Prospect i ve cohort study over 12 weeks . Each participant was prescribed prefabricated foot orthoses at baseline . PARTICIPANTS Sixty individuals with PFPS ( 18 - 35 years ) . MAIN OUTCOME MEASURES Change in pain and ease of completing a single leg squat ; change in the number of pain free step downs and single leg rises from sitting ; usual and worst pain in the previous week ; the anterior knee pain scale ( AKPS ) ; and the lower extremity functional scale ( LEFS ) . RESULTS At 12 weeks , significant improvements in single leg squat pain and ease , and the number of pain free step downs and single leg rises from sitting were found . Additionally , significant reductions in usual and worst pain , and improvements on the AKPS and LEFS were observed . CONCLUSIONS Functional performance improvements following unmodified prefabricated foot orthoses were greater at 12 weeks that those achieved immediately . Enhanced functional performance over time may have significant implication s for osteoarthritis prevention in some individuals with PFPS . Improvements in subjective pain and function appear to plateau over time There have been numerous reports about the use of knee braces to prevent traumatic knee injuries . Despite the frequent use of braces , very few prospect i ve studies have been performed to study the effect of knee braces for preventing  anterior knee pain syndrome ( AKPS ) . The purpose of this study was to assess the effectiveness of a dynamic patellofemoral brace ( On-Track System , dj Orthopedics ) in the prevention of AKPS .  167 military recruits without history of knee pain were r and omized into two groups prior to the start of their 6-week basic military training ( BMT ) program . The first group ( brace group ) consisted of 54 recruits who  wore the braces for all physical activities during these 6 weeks . 113 recruits served as a control group , and followed the same 6-week strenuous training program . Chi square statistics ( Fisher exact test ) were used to compare the number of AKPS patients in the brace group and in the non-brace group . Our results indicated that recruits in the brace group appeared to develop significantly less anterior knee pain compared to the recruits in the control group ( p = 0.020 ) . Out of the 54 recruits in the brace group , ten ( 18.5 % ) developed anterior knee pain during this study . In the control group ( n = 113 ) , 42 recruits ( 37 % ) developed anterior knee pain . We conclude that the result of the present study suggests that the use of a dynamic patellofemoral brace is an effective way to prevent the development of anterior knee pain in persons undergoing a strenuous training program Objectives Describe proportions of individuals with patellofemoral pain ( PFP ) with an unfavourable recovery over 12 months ; identify clinical predictors of poor recovery at 3 and 12 months ; and determine baseline values of predictors that identify those with poor 12-month prognosis . Methods An observational analysis utilised data from 310 individuals with PFP enrolled in two r and omised clinical trials . Thirteen baseline variables ( participant , PFP , study characteristics ) were investigated for their prognostic ability . Pain , function and global recovery were measured at 3 and 12 months . Multivariate backward stepwise regression analyses ( treatment-adjusted , p<0.10 ) were performed for each follow-up measure . Receiver operator characteristic curves identified cut-points associated with unfavourable recovery at 12 months . Results 55 % and 40 % of participants had an unfavourable recovery at 3 and 12 months , respectively . Longer baseline pain duration was significantly associated with poor 3-month and 12-month recovery on measures of pain severity ( β 11.36 to 24.94 ) , Anterior Knee Pain ( AKP ) Scale ( −4.44 to −11.33 ) and global recovery ( OR : 2.32 to 6.11 ) . Greater baseline pain severity and lower AKP Scale score were significantly associated with poor recovery on multiple measures ( p<0.05 ) . Baseline duration > 2 months and AKP Scale score < 70/100 were associated with unfavourable 12-month recovery . Conclusions A substantial number of individuals with PFP have an unfavourable recovery over 12 months , irrespective of intervention . Knee pain duration > 2 months is the most consistent prognostic indicator , followed by AKP Scale score < 70 . Sports medicine practitioners should utilise interventions with known efficacy in reducing PFP , and promote early intervention to maximise prognosis . Trial registration Australian study : Australian Clinical Trials Registry ( ACTRN012605000463673 ) , Clinical Trials.gov ( NCT00118521 ) ; Dutch study : International St and ard R and omised Controlled Trial Number Register ( IS RCT N83938749 Patellofemoral pain syndrome ( PFPS ) is one of the most common musculoskeletal disorders . However , no consensus on the definition , classification , assessment , diagnosis , or management has been reached . We evaluated symptoms and clinical findings in subgroups of individuals with PFPS , classified on the basis of the findings in radiological examinations and compared the findings with knee-healthy subjects . An orthopedic surgeon and a physical therapist consecutively examined 80 patients clinical ly diagnosed as having PFPS and referred for physical therapy .  The examination consisted of taking a case history and clinical tests . Radiography revealed pathology in 15 patients , and scintigraphic examination revealed focal uptake in 2 patients indicating pathology ( group C ) . Diffusely increased uptake was present in 29 patients ( group B ) . In the remaining 29 patients radiographic and scintigraphic examinations were normal ( group A ) . Knee-healthy controls ( group D ) reported no clinical symptoms . No symptom could be statistically demonstrated to differ between the three patient groups . Knee-healthy subjects differed significantly from the three patient groups in all clinical tests measuring pain in response to the provocations ; compression test , medial and lateral tenderness , passive gliding of the patella , but they also differed in Q angle . Differences in clinical tests between the patient groups were nonsignificant . The main finding in our study on patients clinical ly diagnosed with PFPS is that possible pathologies can not be detected from the patient 's history or from commonly used clinical tests & NA ; Pain is a common and pervasive symptom for persons infected with the human immunodeficiency virus ( HIV ) . Individuals with persistent pain are known to be at heightened risk for posttraumatic stress disorder ( PTSD ) , an anxiety disorder that manifests itself following exposure to a traumatic event . Moreover , research suggests that patients with persistent pain who develop PTSD often experience greater pain intensity and pain‐related disability than those who do not develop PTSD . The purpose of this study was to assess the relation of PTSD to pain intensity and pain‐related interference in HIV‐infected persons suffering from persistent pain . Study participants included 145 ambulatory persons living with HIV/AIDS ( PWHAs ) who were enrolled in a r and omized clinical trial assessing the impact of a pain communication intervention .  Participants completed a series of self‐report measures including the Stressful Life Events Checklist ( SLE ) , the Posttraumatic Stress Disorder Checklist‐Civilian ( PCL‐C ) , the Mental Health Inventory ( MHI ) , and the Brief Pain Inventory ( BPI ) . On average , participants reported being exposed to 6.3 different types of trauma over the course of their lifetime , of which receiving an HIV diagnosis was rated as being among the most stressful . Over half ( 53.8 % ) merited a PTSD diagnosis according to the PCL‐C. Those with PTSD reported having significantly higher pain intensity and greater pain‐related interference in performance of daily activities ( i.e. , working , sleeping , walking ability and general activity ) , and affect ( i.e. , mood , relations with other people , enjoyment of life ) over time than those who did not meet the diagnostic criteria . Possible explanations for these findings are discussed along with implication s for clinical care Purpose There is research evidence which supports the effectiveness of exercise in reducing pain and increasing function in patients with patellofemoral pain syndrome . However , what is unclear are the parameters underpinning this intervention . This has led to uncertainty when operationalizing exercises for patients with patellofemoral pain syndrome in clinical practice . The aim of this review was to evaluate the parameters of exercise programs reported in primary research , to provide clinicians with evidence -based recommendations for exercise prescription for patellofemoral pain . Methods A systematic review of r and omized controlled trials was undertaken . Only trials that identified exercise to be effective in treating patellofemoral pain were included . Appropriate data bases and reference lists were search ed using established keywords . Data relating to common exercise parameters such as the type of exercise , length , and frequency of intervention , intensity , repetitions , sets , and specific technique were extracted , along with details of co- interventions that may have been used . Results A total of ten r and omized controlled trials were included in this review and from these trials 14 interventions arms were evaluated . All 14 interventions focused on active exercises , all but two of which also included a passive stretching component . The current body of evidence demonstrates positive results with exercise interventions such as  knee extension , squats , stationary cycling , static quadriceps , active straight leg raise , leg press , and step-up and down exercises  for patients with patellofemoral pain syndrome . A progressive regime of daily exercises of two to four sets of ten or more repetitions over an intervention period of 6 weeks or more , combined with exercises to address flexibility of the lower limb musculature was commonly used . Conclusion Currently , the primary research on this topic supports the use of closed kinetic chain , strengthening exercises for musculature of the lower limb , combined with flexibility options . The current evidence base supports a prescription of daily exercises of two – four sets of ten or more repetitions over a period of 6 weeks or more BACKGROUND Anterior knee pain is a clinical syndrome characterized by pain experienced perceived over the anterior aspect of the knee that can be aggravated by functional activities such as stair climbing and squatting . Two taping techniques commonly used for anterior knee pain in the clinic include the McConnell Taping Technique ( MT ) and the Kinesio Taping ® Method ( KT ® ) . OBJECTIVE The purpose of this study was to compare the effectiveness of KT ® and the MT versus no tape in subjects with anterior knee pain during a squat lift and stair climbing . DESIGN Pretest- posttest design . PARTICIPANTS A total of 20 subjects ( 15 female , 5 male ) with unilateral anterior knee pain were recruited . The mean age of the subjects was 24 ( + /-3 ) years , with a mean weight of 160 ( + /-28 ) pounds . METHODS Each participant was tested during two functional activities ; a squat lift with a weighted box ( 10 % of his/her body weight , plus the weight [ 8.5 pounds ] of the box ) and stair climbing under three conditions : 1 ) no tape , 2 ) MT and 3 ) KT ® . Pain levels were assessed ( verbally ) using the 0 - 10 Numeric Pain Intensity Scale . RESULTS The median ( interquartile range [ IQR ] ) pain during squat lift was 2 ( 2.75 ) for no tape , 1 ( 1 ) for KT ® , and 0.5 ( 2 ) for McConnell , with no significant differences between the groups . During the stair activity the median ( IQR ) pain was 1.5 ( 2.75 ) for no tape , 1 ( 1.75 ) for KT ® , and 1 ( 1.75 ) for MT with a significant difference ( p=0.024 ) between the groups . Further analysis determined that the only a significant difference was ( p=0.034 ) between the no tape and the KT ® conditions . CONCLUSION The results of this study found that both the KT ® and the MT may be effective in reducing pain during stair climbing activities . LEVEL OF EVIDENCE Level 2 , Prospect i ve Cohort study New insights into the phenotype of Joint Hypermobility Syndrome ( JHS ) and Ehlers‐Danlos Syndrome‐hypermobile type ( hEDS ) have raised many issues in relation to classification , diagnosis , assessment , and treatment . Within the multidisciplinary team , physical therapy plays a central role in management of individuals with hypermobility related disorders . However , many physical therapists are not familiar with the diagnostic criteria , prevalence , common clinical presentation , and management . This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children , adolescents , and adults with JHS/hEDS . Due to the complexity of the symptoms in the profile of JHS/hEDS , the International Classification of Functioning , Disability and Health ( ICF ) is adopted as a central framework whereby the umbrella term of disability is used to encompass functions , activities and participation , as well as environmental and personal factors . The current evidence ‐based literature regarding the management of JHS/hEDS is limited in size and quality and there is insufficient research exploring the clinical outcomes of a number of interventions . Multicenter r and omized controlled trials are warranted to assess the clinical and cost‐effectiveness of interventions for children and adults . Until further multicenter trials are conducted , clinical decision‐making should be based on theoretical and the current limited research evidence . For all individuals diagnosed with JHS/hEDS , international consensus and combined efforts to identify risk profiles would create a better underst and ing of the pathological mechanisms and the potential for optimizing health care for affected individuals . © 2017 Wiley Periodicals , PURPOSE The objectives of this study were 1 ) to examine the differences between a noninjured ( C ) cohort of runners ( N = 70 ) and runners afflicted with anterior knee pain ( AKP ) according to selected training , anthropometric , rearfoot motion , ground reaction force , and muscular strength and endurance variables ; 2 ) to explore multivariate relationships among these measures in the well and injured groups ; and 3 ) to develop specific hypotheses concerning risk factors for injury that will later be tested in a prospect i ve clinical study . METHODS High speed videography ( 200 frames x s(-1 ) ) , a force platform ( 500 Hz ) , and a Cybex II+ isokinetic dynamometer were used to assess rearfoot motion , ground reaction forces , and knee muscular strength and endurance , respectively . A linear discriminant function was performed on each of the five categories of variables and revealed 19 significant ( P < or = 0.05 ) predictors . These variables were then combined and a final discriminant function analysis was performed . RESULTS Pronation through the first 10 % of stance , arch index , shoe mileage , and extension peak torque were the best overall ( P < or = 0.05 ) predictors . The AKP group had smaller mean values on all four significant predictors . CONCLUSION With the exception of shoe mileage , which is likely a response to rather than a risk factor for AKP , these results should prove useful to clinicians in identifying runners at risk for anterior knee pain BACKGROUND Treatment of patellofemoral pain syndrome ( PFPS ) has been extensively studied in physical therapy literature . Patients with PFPS demonstrate quadriceps and hip musculature weakness , altered lower extremity ( LE ) kinematics , and decreased LE flexibility . Psychosocial factors have also been identified as an important factor in patients with PFPS . The authors hypothesize that an ordered approach addressing each of these impairments sequentially will result in greater improvement in PFPS symptoms . The purpose of this pilot study was to assess the feasibility of performing a r and omized trial and to determine the sample size necessary to examine the validity of this hypothesis . METHODS Patients received a sequential treatment approach using a PFPS treatment algorithm ( PFPS Algorithm ) design ed by the authors . Patients were evaluated assessing psychosocial factors , flexibility , LE kinematics , and LE strength . Impairments that were found in the evaluation were addressed sequentially over the episode of care . Patients were prescribed therapy two times per week for six weeks . Pain , Anterior Knee Pain Scale ( AKPS ) , and Global Rating of Change ( GROC ) were measured at evaluation and discharge . RESULTS Thirty consecutive patients with PFPS who were referred to physical therapy were enrolled in the pilot study . All phases of the feasibility study including recruitment , treatment protocol s and data collection were effectively carried out . One hundred percent of patients treated with the PFPS algorithm who completed the prescribed treatment had a clinical ly significant improvement in the AKPS and GROC . A floor effect was noted with NPRS with 38 % of patients unable to achieve clinical ly significant improvement . CONCLUSIONS With minor changes to the protocol and outcome measures used , a full r and omized trial is feasible and merited . Steps must be taken to reduce the high drop-out rate among both groups . LEVEL OF EVIDENCE 1b Cognitive disorders in elderly individuals frequently have a basis in neurodegenerative or vascular brain diseases , which typically evolve over a long period of time . By the time a diagnosis of dementia is made , the individual has often suffered some deficits in cognition over many years . The predementia phase of cognitive impairment has been of much recent interest because research ers focus on strategies to prevent dementia . There are also many conditions such as brain trauma , cerebral infection , cerebrovascular disease , neoplasia , or depression , in which decline in cognition is incontrovertible but insufficiently disabling to justify a diagnosis of dementia . Some of these individuals do not have a predementia cognitive syndrome but a subthreshold one , i.e. , their cognitive impairment , while clinical ly significant , is often nonprogressive and , therefore , not a prodrome of dementia . Nosologists , epidemiologists , clinicians , and clinical research ers have all struggled with defining this syndrome , especially in the last 2 decades . A plethora of terms has emerged , some of which include Benign or Malignant Senescent Forgetfulness , Age-Associated Memory Impairment , Aging-Associated Cognitive Decline , Cognitive Impairment Not Dementia , Mild Neurocognitive Disorder , and Question able Dementia with a Clinical Dementia Rating ( CDR ) scale rating of 0.5 . The term that has achieved the most widespread usage is Mild Cognitive Impairment ( MCI ) , originally proposed in 1988 , for which diagnostic criteria were first described in 1999 . More than a decade after these criteria were proposed , the construct of MCI remains imprecise , with considerable variability in studies examining its prevalence estimates , the heterogeneity in its clinical features , and its variable predictive value for dementia . The publication of consensus criteria by an international working group on MCI made some headway toward resolving the discrepancies , but many difficulties remain in its operationalization . The use of  MCI  , both in clinical work and research , has , however , been widespread , and there has been an exponential increase in publications related to MCI in recent years . Neurology service providers in the United States reported frequently using the  MCI diagnosis for diagnostic and billing purpose s , and most use cholinesterase inhibitors and other drugs at least sometimes for these patients . Thus , despite remaining uncertainties , the concept of MCI has importantly served to focus our attention on the early and prodromal stages of cognitive decline . There are many reasons for the highly variable use of MCI and related terms . The 1999 criteria for MCI focused on it as a prodrome of Alzheimer disease , with an emphasis on memory impairment that does not equally apply to other types of dementia . The original and revised definitions of MCI were intended more as guidelines for experienced clinicians and clinician research ers than as operational criteria in and of themselves . Population studies have operationalized these definitions in different ways and applied them retrospectively or prospect ively Anterior  knee pain  ( AKP ) is a common injury among runners and effectively treated with posted insoles and foot orthotics . While clinical ly effective , the underlying biomechanical mechanisms that bring about these improvements remain debatable . Several method ological factors contribute to the inconsistent biomechanical findings , including errors associated with removing and reattaching markers , inferring foot motion from markers placed externally on a shoe , and redefining segmental coordinate systems between conditions . Therefore , the purpose of this study was to evaluate the influence of medially posted insoles on lower extremity kinematics in runners with and without AKP while trying to limit the influence of these method ological factors . Kinematics of 16 asymptomatic and 17 runners with AKP were collected while running with and without insoles . Reflective markers were attached to the surface of the calcaneus and kept in place ( as opposed to detached ) between conditions , eliminating the error associated with reattaching markers and redefining segmental coordinate systems . Using these methods , no significant interactions between insole and injury and the main effect of injury were detected ( p>0.05 ) ; therefore , means were pooled across injury . Insoles , on average , reduced peak eversion by 3.6 ° ( 95 % confidence interval -2.9 ° to -4.3 ° ) , peak eversion velocity by 53.2 ° /s ( 95 % confidence interval -32.9 to -73.4 ) and eversion range of motion by 1.33 ( 95 % confidence interval -0.8 to -1.9 ) . However , while insoles systematic ally reduced eversion variables , they had small influences on the transverse plane kinematics of the tibia or knee , indicating that they may bring about their clinical effect by influencing other variables Patellofemoral pain ( PFP ) remains one of the most common conditions encountered in sports medicine . Characterised by anterior knee pain that is aggravated by activities such as running , squatting and stair ambulation ; PFP generally reduces or restricts physical activity . While PFP may subside with activity reduction , the natural history of this common condition is not one of spontaneous recovery . Indeed , PFP is often recalcitrant and can persist for many years . In a prospect i ve study of people with PFP , symptoms persisted in 25 % of people up to 20 years.1 Despite considerable evidence for the efficacy of conservative interventions for PFP , such as multimodal physiotherapy,2 these interventions do not appear to have long-lasting effects.2 Compounding the management of PFP is that surgery for PFP is widely considered to have poor outcomes . As mentioned in the 2014 consensus statement from the International Patellofemoral Pain Research Retreat3 there is speculation that PFP may be a prelude to degenerative joint changes and ultimately the development of patellofemoral osteoarthritis (PFOA).4 , 5 While no current studies have prospect ively studied people with PFP through to the development of PFOA ( and thus verify this relationship ) , a recent systematic review 4 observed that individuals undergoing arthroplasty for PFOA were more than twice as likely ( OR=2.31 , 95 % CI 1.37 to 3.88 ) to report having had PFP as an adolescent than patients undergoing an arthroplasty for isolated tibiofemoral OA . In the absence of rigorous PURPOSE Gait metric alterations have been previously reported in patients suffering from anterior knee pain ( AKP ) . Characterization of simple and measureable gait parameters in these patients may be valuable for assessing disease severity as well as for follow-up . Previous gait studies in this population have been comprised of relatively small cohorts and the findings of these studies are not uniform . The objective of the present study was to examine spatio-temporal gait parameters in patients with AKP in comparison to symptom-free controls . Furthermore , the study aim ed to examine the relationship between self-reported disease severity and the magnitude of gait abnormalities . METHODS 157 patients with AKP were identified and compared to 31 healthy controls . Patients were evaluated with a spatiotemporal gait analysis via a computerized mat , the Western Ontario and McMaster Osteoarthritis Index ( WOMAC )  question naire and the Short Form (SF)-36 health surveys . RESULTS AKP patients walked with significantly lower velocity ( 15.9 % ) and cadence ( 5.9 % ) , shorter step length ( 9.5 % ) , stride length ( 9.6 % ) , and showed significant differences in all gait cycle phases ( P<0.05 for all ) . Study group reported higher levels of pain ( 96 % ) , functional limitation ( 94 % ) , and poorer perception of mental quality of life ( 30 % ) ( P<0.05 for all ) . CONCLUSION Significant differences were found between the spatiotemporal gait profile of AKP patients and symptom-free matched controls . In addition , an association was found between subjective disease severity and gait abnormalities . These findings suggest the usefulness of gait parameters , alongside with the use of self-evaluation question naires , in identifying deviations of these patients from healthy population & NA ; Temporom and ibular disorders ( TMD ) diagnoses can be viewed as the most useful clinical summary for classifying subtypes of TMD . The Research Diagnostic Criteria for TMD ( RDC/TMD ) is the most widely used TMD diagnostic system for conducting clinical research . It has been translated into 18 language s and is used by a consortium of 45 RDC/TMD‐based international research ers . While reliability of RDC/TMD signs and symptoms of TMD has been amply reported , the reliability of RDC/TMD diagnoses has not . The aim of the study was to determine the reliability of clinical TMD diagnoses using st and ardized methods and operational definitions contained in the Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) . Data came from reliability assessment trials conducted at 10 international clinical centers , involving 30 clinical examiners assessing 230 subjects .  Intraclass correlation coefficients ( ICC ) were calculated to characterize the reliability . The reliability of the diagnoses was fair to good . Median ICCs for the diagnoses myofascial pain with and without limited opening were 0.51 and 0.60 , respectively . Median ICC for arthralgia was 0.47 and 0.61 for disc displacement with reduction . RDC/TMD diagnoses of disc displacement without reduction , osteoarthritis and osteoarthrosis were not prevalent enough to calculate ICC 's , but percent agreement was always > 95 % . The reliability of diagnostic classification improved when diagnoses were grouped into pain versus non‐pain diagnoses ( ICC=0.72 ) and for detecting any diagnosis versus no diagnosis ( ICC=0.78 ) . In clinical decision‐making and research , arriving at a reliable diagnosis is critical in establishing a clinical condition and a rational approach to treatment . The RDC/TMD demonstrates sufficiently high reliability for the most common TMD diagnoses , supporting its use in clinical research and decision making Abstract Purpose Rupture of the anterior cruciate ligament ( ACL ) is a common injury , often presenting with a typical injury pattern . Historically , the literature indicates that the accuracy of diagnosis of ACL ruptures is poor at the initial medical consultation . The aims of this study were to determine : the mechanism of injury ; changes in accuracy of diagnosis of ACL ruptures at initial presentation over the last decade ; and the effect of subsequent delay in diagnosis and definitive treatment . Methods A prospect i ve cohort of one hundred and thirty-two consecutive patients who underwent ACL reconstruction between 2005 and 2009 were analysed . The median age of the patients was 18 years ( 12–57 ) . Sixteen patients were excluded due to chronic ACL injury . Results One hundred and sixteen patients ( 117 ACL ruptures ) were included in the analysis . A typical injury pattern was documented in 87 ( 74.4 % ) of cases . The most common sporting activities associated with an ACL injury were football ( 35.3 % ) , skiing ( 21.6 % ) and rugby ( 10.3 % ) . The majority of patients ( 67.5 % ) sought medical attention within 1 week from time of injury . The correct diagnosis of an ACL rupture was made in 33 cases ( 28.2 % ) at the initial medical consultation . The diagnosis was made following medical consultation in 13 ( 11.1 % ) of cases with the use of magnetic resonance imaging and 6 ( 5.1 % ) cases at arthroscopy . The median time to diagnosis was 6 weeks ( 0–192 ) , and the median time to ACL reconstruction was 24 weeks ( 1–240 ) . A delay in diagnosis of > 6 months was associated with a medial meniscal tear rate of 72.2 % compared to 23.1 % if the diagnosis was made within 4 months of the injury ( p < 0.05 ) . Conclusions Despite a ‘ typical ’ mechanism of injury leading to ACL rupture , the rate of initial diagnosis in the UK still remains poor . This often leads to an unnecessary delay in the diagnosis and subsequent treatment and increases the risk of secondary injury to the knee . A delay in diagnosis of > 6 months was associated with an increased medial meniscal tear rate . Patients who present with a ‘ typical ’ injury pattern should therefore be referred for further assessment by a knee specialist within 6 weeks . Level of evidence IV OBJECTIVE To investigate the efficacy of patellar taping on pain control , patellar alignment , and neuromuscular control ( ie , vastus medialis oblique activation , knee extensor moment , etc ) in subjects with patellofemoral pain syndrome . DATA SOURCES We search ed MEDLINE , SPORT Discus , PEDro , and CINAHL through December 2004 , using the key words patellar taping , therapeutic taping , McConnell taping , taping , chronic injury , patellofemoral pain , and knee . STUDY SELECTION Criteria for inclusion criteria were studies that exclusively recruited patients diagnosed with patellofemoral pain syndrome or anterior knee pain and outcome measures specific to pain reduction , neuromuscular control , and patellar positioning . DATA EXTRACTION We identified and review ed 16 studies with an average PEDro score of 4.25/10 . Articles were divided into 3 categories based on primary outcome measures : 4 r and omized controlled trials on treatment methods and pain , 9 studies on neuromuscular control , and 3 on patellar positioning . DATA SYNTHESIS Although patellar taping seems to reduce pain and improve function in people with patellofemoral pain syndrome during activities of daily living and rehabilitation exercise , strong evidence to identify the underlying mechanisms is still not available Anterior knee pain ( AKP ) has been a persistent complaint after total knee arthroplasty ; however , the natural course of this complaint has not been fully investigated . This is a 10-year follow-up report of a prospect i ve , r and omized study between the Insall-Burstein II ( Zimmer , Warsaw , IN ) and the Press Fit Condylar Modular ( Johnson & Johnson , Raynham , MA ) knees . Up to one third of total knee arthroplasties will experience mild to moderate AKP at 1-year follow-up , which will persist in approximately 30 % of these previously symptomatic knees at 10-year follow-up . New-onset AKP will develop in approximately 10 % of previously asymptomatic knees Objective : To examine the immediate effects of experimentally induced anterior knee pain ( AKP ) on involuntary and voluntary quadriceps strength and activation . Design : Crossover 3 × 3 r and omized controlled laboratory study with repeated measures . Setting : Human Performance Research Center , Brigham Young University . Participants : Thirteen neurologically sound volunteers ( age , 21.9 ± 3.2 years ) . Interventions : Subjects underwent 3 different conditions ( pain , sham , and control ) . To induce AKP and sham condition , 5 % sodium chloride and 0.9 % sodium chloride ( total volume of 1.0 mL for each condition ) , respectively , were injected into the infrapatellar fat pad on the dominant leg . No injection was performed for the control condition . Main Outcome Measures : The vastus medialis peak Hoffmann reflex normalized by the peak motor response ( H : M ratio ) was used to measure involuntary quadriceps activation . Quadriceps central activation ratio ( CAR ) using maximal isometric knee extension torque ( N·m ) was calculated to assess voluntary quadriceps activation . The visual analog scale was used to measure pain perception . Results : Our pain model increased perceived pain immediately after the 5 % hypertonic saline injection and pain lasted for 12 minutes on average ( F40,743 = 16.85 , P < 0.001 ) . During the pain condition , subjects showed a 12 % decrease in H : M ratio ( F2,59 = 8.64 , P < 0.001 ) , a 34 % decrease in maximal isometric knee extension torque ( F2,59 = 5.89 , P < 0.01 ) , and a 5 % decrease in CAR ( F2,59 = 3.83 , P = 0.03 ) . Conclusions : Our data showed that joint pain may be an independent factor to alter function of the muscles surrounding the painful joint . Both involuntary and voluntary inhibitory pathways may play a role in an immediate reduction of muscle activation
Of the functional tests , squatting demonstrated the highest sensitivity .
Other useful tests include pain during stair climbing and prolonged sitting .
Conclusion A diagnostic checklist is useful as it provides a structured method for diagnosing AKP in a clinical setting .
Background  Anterior knee pain ( AKP ) or patellofemoral pain syndrome is common and may limit an individual 's ability to perform common activities of daily living such as stair climbing and prolonged sitting .
The diagnosis is difficult as there are multiple definitions for this disorder and there are no accepted criteria for diagnosis .
It is therefore most commonly a diagnosis that is made once other pathologies have been excluded .
Objectives The aim of this study was to create an evidence -based checklist for research ers and clinicians to use for the diagnosis of AKP .