Objective Define a best practice guide for managing people with patellofemoral pain (PFP). Methods A mixed-methods convergent segregated synthesis of meta-analysed data with a thematic analysis of semistructured interviews and focus groups. Agreement between subproject results informed the strength of clinical recommendation for interventions eligible for best practice recommendation. Data sources Medline, Web of Science, Scopus, reference lists and citation tracking; semistructured interviews of people with PFP; and semistructured interviews and focus groups with clinical experts. Eligibility criteria High-quality (PEDro scale >7) randomised controlled trials (RCTs) were retained for efficacy estimation using meta-analysis. People with PFP were required to have experienced an episode of care in the past 6 months and clinical experts were required to have>5 years of clinical experience alongside direct involvement in research. Results Data from 65 high-quality RCTs involving 3796 participants informed 11 meta-analyses of interventions. Interviews with 12 people with PFP led to 3 themes and interviews with 19 clinical experts led to 4 themes. These were further explored in three clinical expert focus groups. Best practice for PFP should first involve understanding a patient’s background risk factors, their reasons for seeking care, greatest symptoms, and physical impairments, to inform treatment selection. Synthesis led to six distinct interventions being recommended. Knee-targeted±hip-targeted exercise therapy underpinned by education should be delivered, with additional supporting interventions such as prefabricated foot orthoses, manual therapy, movement/running retraining, or taping decided on and tailored to a patient’s needs and preferences. Conclusion A best practice guide based on a synthesis of three data streams recommends that exercise therapy and education be delivered as the primary intervention for people with PFP. Prescription of other supporting interventions should be aligned with the individual patient’s particular presentation following a thorough assessment. Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. All systematic review/meta-analysis dates are included in the manuscript or the published version (DOI:10.2519/jospt.2022.11359). Transcripts from any of the qualitative elements could be made available on reasonable request.

中文翻译：

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基于系统评价、患者声音和专家临床推理的综合的髌股关节疼痛最佳实践指南


目的 定义管理髌股关节疼痛 （PFP） 患者的最佳实践指南。方法 荟萃分析数据的混合方法收敛分离综合，以及半结构化访谈和焦点小组的主题分析。子项目结果之间的一致性决定了符合最佳实践推荐条件的干预措施的临床推荐强度。数据来源 Medline、Web of Science、Scopus、参考文献列表和引文跟踪;PFP 患者的半结构化访谈;以及与临床专家的半结构化访谈和焦点小组。资格标准 保留高质量 （PEDro 量表 >7） 随机对照试验 （RCT） 用于使用荟萃分析进行疗效评估。PFP 患者需要在过去 6 个月内经历过一次护理，临床专家需要具有 >5 年的临床经验并直接参与研究。结果 来自 65 项高质量 RCT 的数据，涉及 3796 名参与者，为 11 项干预措施的荟萃分析提供了信息。对 12 名 PFP 患者的采访导致了 3 个主题，对 19 名临床专家的采访导致了 4 个主题。这些在三个临床专家焦点小组中进行了进一步探讨。PFP 的最佳实践应首先包括了解患者的背景危险因素、他们寻求护理的原因、最大的症状和身体损伤，以告知治疗选择。综合导致推荐了六种不同的干预措施。应提供以教育为基础的膝关节靶向±髋关节靶向运动疗法，并根据患者的需求和偏好决定额外的支持干预措施，例如预制足部矫形器、手法治疗、运动/跑步再训练或贴扎。 结论 基于三个数据流综合的最佳实践指南建议将运动疗法和教育作为 PFP 患者的主要干预措施。在全面评估后，其他支持性干预措施的处方应与个体患者的特定表现保持一致。数据可应合理要求提供。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。所有系统评价/荟萃分析日期都包含在手稿或出版版本中 （DOI：10.2519/jospt.2022.11359）。任何定性要素的成绩单都可以在合理要求提供。