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Title: Investigations on the physiotherapy management of people following first-time patellar dislocation
Author: Smith, Toby O.
ISNI:       0000 0004 2736 0057
Awarding Body: University of East Anglia
Current Institution: University of East Anglia
Date of Award: 2012
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Background: First-time patellar dislocation (FTPD) is a disabling musculoskeletal disorder. Whilst physiotherapy is considered the cornerstone treatment in FTPD, its evidence-base is limited. Three studies were undertaken to develop knowledge on this area. Study 1: All 306 National Health Service acute hospitals with an accident and emergency and/or an orthopaedic department were sent a fourteen-item questionnaire pertaining to the management of FTPD. Physiotherapists reported they most commonly assessed this population for reduced quadriceps or vastus medialis oblique (VMO) capacity, patellar maltracking and excessive patellar glide. Reassurance, proprioceptive, knee mobility, quadriceps and VMO-specific exercises were the most commonly cited treatments. Study 2: Ninety people who had experienced recurrent patellar instability completed a questionnaire which assessed the frequency with which they perceived patellar instability during various activities. Sporting and multidirectional activities were frequently associated with patellar instability. Females and those without a family history of patellar instability reported more frequent patellar instability symptoms compared to males, or those with a family history of this disorder. The results were used to construct the Norwich Patellar Instability Score. Study 3: A pragmatic multi-centre randomised controlled trial was conducted to compare the prescription of a general quadriceps exercise and rehabilitation programme (n=15) to a VMO-specific exercise and rehabilitation regime (n=12). Whilst Lysholm Knee Score was statistically different between the groups (p=0.02) this was not clinically significant. The general quadriceps exercise group reported a statistically significantly greater Tegner Level of Activity Score at six weeks (p=0.03) but not at six months (p=0.42). There was no significant difference between the groups for isometric knee extension, Short Form-12 or recurrent patellar dislocation at either follow-up (p>0.05). Conclusions: The studies undertaken have significantly developed the evidence-base in this field. Further investigations are recommended to further inform the clinical decision-making of physiotherapists who manage people following FTPD.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available