The Effectiveness of Multimodal Care for Soft Tissue Injuries of the Lower Extremity: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Deborah A Sutton; Margareta Nordin; Pierre Côté; Kristi Randhawa; Hainan Yu; Jessica J Wong; Paula Stern; Sharanya Varatharajan; Danielle Southerst; Heather M Shearer; Maja Stupar; Chadwick Chung; Rachel Goldgrub; Linda J Carroll; Anne Taylor-Vaisey

doi:10.1016/j.jmpt.2016.01.004

The Effectiveness of Multimodal Care for Soft Tissue Injuries of the Lower Extremity: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

J Manipulative Physiol Ther. 2016 Feb;39(2):95-109.e2. doi: 10.1016/j.jmpt.2016.01.004.

Authors

Affiliations

¹ Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada. Electronic address: [email protected].
² Professor, Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York, NY; Professor, Department of Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York, NY.
³ Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, ON, Canada.
⁴ Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
⁵ Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
⁶ Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Associate Clinical Research Scientist, Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Instructor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
⁷ Director, Graduate Education Program, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Assistant Clinical Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
⁸ Research Coordinator, Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON, Canada.
⁹ Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Clinical Research Manager, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Senior Clinical Research Scientist, Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
¹⁰ Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Postdoctoral Fellow, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
¹¹ Assistant Professor, Division of Clinical Education, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
¹² Graduate Student, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada.
¹³ Professor, Injury Prevention Centre and School of Public Health, University of Alberta, Edmonton, AB, Canada.
¹⁴ Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.

PMID: 26976373
DOI: 10.1016/j.jmpt.2016.01.004

Abstract

Objective: The purpose of this systematic review was to evaluate the effectiveness of multimodal care for the management of soft tissue injuries of the lower extremity.

Methods: We systematically searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Random pairs of independent reviewers screened studies for relevance and critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. We included studies with a low risk of bias in our best evidence synthesis.

Results: We screened 6794 articles. Six studies had a low risk of bias and addressed the following: plantar heel pain (n = 2), adductor-related groin pain (n = 1), and patellofemoral pain (n = 3). The evidence suggests that multimodal care for the management of persistent plantar heel pain may include mobilization and stretching exercise. An intensive, clinic-based, group exercise program (strengthening, stretching, balance, agility) is more effective than multimodal care for the management of adductor-related groin pain in male athletes. There is inconclusive evidence to support the use of multimodal care for the management of persistent patellofemoral pain. Our search did not identify any low risk of bias studies examining multimodal care for the management of other soft tissue injuries of the lower extremity.

Conclusion: A multimodal program of care for the management of persistent plantar heel pain may include mobilization and stretching exercise. Multimodal care for adductor-related groin pain is not recommended based on the current evidence. There is inconclusive evidence to support the use of multimodal care for the management of persistent patellofemoral pain.

Keywords: Combined Modality Therapy; Fasciitis; Lower Extremity; Pain; Patellofemoral Pain Syndrome; Plantar; Review Literature as Topic; Soft Tissue Injuries; Sprains and Strains.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Combined Modality Therapy
Humans
Lower Extremity / injuries*
Patient Outcome Assessment
Physical Therapy Modalities
Soft Tissue Injuries / therapy*
Systematic Reviews as Topic

Grants and funding

Canadian Institutes of Health Research/Canada