O efeito da terapia manual na intensidade da dor e incapacidade em indivíduos com dor patelofemoral: uma revisão narrativa de ensaios clínicos randomizados

Abstract

Introduction: Patellofemoral pain is a prevalent musculoskeletal condition, frequently treated in orthopedic rehabilitation. It affects between 23% and 29% of adults and adolescents, being more prevalent in women and children. This condition limits daily activities, reduces quality of life and can persist for years, with 50% of patients reporting continuous symptoms for up to 8 years and a high rate of dissatisfaction with conventional treatments. Manual therapy has been proposed as a promising approach, despite the need for more evidence to confirm its effectiveness. Objective: to investigate the effect of manual therapy on pain intensity and disability in individuals with patellofemoral pain. Methods: Narrative review of randomized clinical trials by searching October 31, 2023 in the PEDro database (Physiotherapy Evidence Database), without language restrictions with studies published in the last 10 years. Randomized clinical trials that investigated the effectiveness of manual therapy on pain intensity and disability in individuals over 18 years of age with patellofemoral pain were considered. The methodological quality of the included trials was assessed by one reviewer (PHM) using the Physiotherapy Evidence Database (PEDro) 0-10 scale (MAHER, et al 2003). Questions were resolved by a third reviewer (VCO). Results: The study by Kim et al. demonstrated that the combined intervention was superior to knee mobilization therapy alone in improving lower limb function and correcting knee valgus. However, the study by Nunes et al. showed that although there was a reduction in hip internal rotation during single-leg squats, there were no significant differences in other kinematic and kinetic parameters. The average methodological quality of the 8 included trials was 5 points on the PEDro scale of 0 to 10 points, with scores ranging from 4 to 8 points. Of the 8 trials included in the analysis, 4 studies (50%) were considered to have low risk of bias (i.e., PEDro score ≥6 out of 10). Conclusion: Combined and specific physiotherapeutic interventions, such as manual therapy, both spinal and local, demonstrated effectiveness in reducing pain and improving joint function and lower limb function and correcting biomechanical imbalances, while specific interventions, such as stretching and mobilizations , showed notable improvements in flexibility and pain at rest.