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Which treatment is most effective for patients with patellofemoral pain? A protocol for a living systematic review including network meta-analysis
  1. Marinus Winters1,
  2. Sinead Holden1,2,
  3. Bill Vicenzino3,
  4. Nicky J Welton4,
  5. Deborah M Caldwell4,
  6. Carolina Bryne Lura1,
  7. Adam Weir5,6,
  8. Michael Skovdal Rathleff1,2
  1. 1 Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  2. 2 SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
  3. 3 School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Queensland, Queensland, Australia
  4. 4 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  5. 5 Department of Orthopaedics, Erasmus MC University Medical Center for Groin Injuries, Rotterdam, The Netherlands
  6. 6 Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  1. Correspondence to Dr Marinus Winters; marinuswinters{at}


Introduction Patellofemoral pain (PFP) affects 1 in every 14 adults. Many treatments for PFP have been evaluated, but the comparative effectiveness of all available treatments has never been examined. Network meta-analysis is the only design to study the comparative effectiveness of all available treatments in one synthesis. This protocol describes the methods for a systematic review including network meta-analysis to assess which treatment is most likely to be effective for patients with PFP.

Methods and analysis The primary outcome measures of this network meta-analysis are the global rating of change scale at 6–12 weeks, 13–52 weeks and >52 weeks. The secondary outcome measures are patient-rated pain scales at 6–12 weeks, 13–52 weeks and >52 weeks. Completed published and unpublished randomised controlled trials with full-text reports are eligible for inclusion. We will search Embase, PubMed (including MEDLINE), CENTRAL, Scopus, Web of Science, and CINAHL, SPORTDiscus, OpenGrey, WorldCat, conference Proceedings and multiple trial registers for relevant reports. Two researchers will appraise the study eligibility and perform data extraction. Risk of bias will be assessed with the Cochrane Risk of Bias Tool V.2.0.

Bayesian network meta-analyses will be constructed for global rating of change scale and patient-rated pain. Consistency between direct and indirect comparisons will be assessed. Between study variability will be explored, and a threshold analysis for the credibility of the network meta-analyses’ conclusions will be performed.

Ethics and dissemination Ethical approval is not required, as this study will be based on published data. The study commenced at 1 February 2018, and its expected completion date is 15 January 2019. Full publication of the work will be sought in an international peer-reviewed journal, as well as translational articles to disseminate the work to clinical practitioners.

PROSPERO registration number CRD42018079502.

  • knee
  • musculoskeletal disorders
  • sports medicine

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors MW, AW and MSR came up with the study idea. MW, SH, BV, AW and MSR designed the study. MW and CBL designed the risk of bias approach, and MW, SH, NJW, DMC and MSR designed the statistical analysis plan. MW, SH and MSR drafted the manuscript. All authors provided feedback and gave important intellectual input. All authors read and consented to the content of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MW receives funding outside this project from Trygfonden, a non-profit organisation in Denmark.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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