Bridging Gaps in Delivering High-Value Treatment for Patellofemoral Pain: A Systematic Evidence and Gap Map of Interventions for Patellofemoral Pain

OBJECTIVE: To synthesize the literature and generate evidence and gap maps examining randomized controlled trial interventions and outcome measures for patellofemoral pain (PFP). DESIGN: A systematic evidence and gap map. LITERATURE SEARCH: PubMed, CINAHL Complete via EBSCO, PEDro, Scopus, SPORTDiscus (EBSCO), Embase via Ovid, Cochrane Database of Systematic Reviews via Ovid, Web of Science, and CENTRAL. STUDY SELECTION CRITERIA: Peer-reviewed randomized controlled trials (RCTs), pilot RCTs, and pilot feasibility RCTs evaluating interventions for PFP. DATA SYNTHESIS: Interventions were mapped against outcomes. The Cochrane Risk of Bias tool was used to assess risk of bias, and the PFP diagnosis checklist was used to assess the criteria used in each study to confirm a diagnosis of PFP. RESULTS: 307 studies were included. The most frequently included intervention was physical intervention, particularly therapeutic exercises (n=281, 82%), 59 studies (19%) included non-physical interventions. Pain outcomes were included in 274 studies (89%), and patient-reported physical function in 216 (70%). Other outcomes, such as activity or movement-related psychological factors, quality of life, and sleep, were infrequently assessed (each <10%). 207 studies (67%) were at high risk of bias, and 45 studies (15%) met the recommended PFP diagnostic criteria checklist. CONCLUSION: Among 307 RCTs, with approximately three-quarters published in the past 10 years, there was an uneven focus on physical interventions and pain and physical function outcomes.