Effectiveness of Exercise for Lower Extremity Injuries
For some reason the research suggests limited high-quality evidence for exercise. We know through practice based evidence that exercise intervention and adherence to home exercise programs increases outcomes in rehabilitation. Granted practice based evidence are not randomized controlled trials which would mean these types of studies would not be included in the systematic review.
Interesting to see that clinical group exercise was beneficial. Sadly, here in the States, if clinicians decide to provide services in this manner, they have a huge financial hit because payers either 1) pay very, very low for group treatment intervention or 2) deny payment for this type of service.
Maybe one day, in the future, when payments are not tied to codes and instead tied to outcomes, rehabilitation clinicians may have true autonomy to deliver care in a manner that provides the highest outcome possible.
Here's a quick view of the abstract.
The Effectiveness of Exercise on Recovery and Clinical Outcomes in Patients With Soft Tissue Injuries of the Hip, Thigh, or Knee: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
The purpose of this systematic review was to determine the effectiveness of exercise for the management of soft tissue injuries of the hip, thigh, and knee.
We conducted a systematic review and searched MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, and CINAHL Plus with Full Text from January 1, 1990, to April 8, 2015, for randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effect of exercise on pain intensity, self-rated recovery, functional recovery, health-related quality of life, psychological outcomes, and adverse events. Random pairs of independent reviewers screened titles and abstracts and assessed risk of bias using the Scottish Intercollegiate Guidelines Network criteria. Best evidence synthesis methodology was used.
We screened 9494 citations. Eight RCTs were critically appraised, and 3 had low risk of bias and were included in our synthesis. One RCT found statistically significant improvements in pain and function favoring clinic-based progressive combined exercises over a "wait and see" approach for patellofemoral pain syndrome. A second RCT suggests that supervised closed kinetic chain exercises may lead to greater symptom improvement than open chain exercises for patellofemoral pain syndrome. One RCT suggests that clinic-based group exercises may be more effective than multimodal physiotherapy in male athletes with persistent groin pain.
We found limited high-quality evidence to support the use of exercise for the management of soft tissue injuries of the lower extremity. The evidence suggests that clinic-based exercise programs may benefit patients with patellofemoral pain syndrome and persistent groin pain. Further high-quality research is needed.