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. 2024 Apr 17;19(4):e0302215.
doi: 10.1371/journal.pone.0302215. eCollection 2024.

Clinical value of questionnaires & physical tests for patellofemoral pain: Validity, reliability and predictive capacity

Gema Chamorro-Moriana  1   2 , Fernando Espuny-Ruiz  1 , Carmen Ridao-Fernández  1   2 , Eleonora Magni  3
Affiliations

Clinical value of questionnaires & physical tests for patellofemoral pain: Validity, reliability and predictive capacity

Gema Chamorro-Moriana et al. PLoS One. .

Abstract

Objectives: To determine the most appropriate method of functional assessment for "patellofemoral pain" (PFP)/"chondromalacia patella" for its diagnostic value, (validity, reliability, sensitivity, specificity, predictive value and clinical applicability); to outline initial interpretations of the questionnaires and their appropriateness, through the cut-off points determined in their scores based on physical test and Magnetic Resonance Imaging (MRI); to establish which methods should be used in conjunction with each other to obtain clinical diagnoses that are robust effective and efficient.

Methods: (1)Intra- and inter-observer reliability and of the relationship among PFP questionnaires/physical tests validated. (2)Predictive capacity of the questionnaires. Subject: 113 knees with PFP, assessed using "Knee-injury-and-Osteoarthritis Outcome-Score-for-Patellofemoral-pain-and-osteoarthritis" (KOOS-PF), "Kujala-Patellofemoral-Score" (KPS), "Victorian-Institute-of-Sports-Assessment-for-Patellar-tendons-questionnaire" (VISA-P), and the physical tests: "patellar-palpation", "patellar-tilt", "patellar-apprehension", "Clarke" and "squat".

Results: Questionnaires correlations themselves was 0.78<r<0.86. Tests intra-rater reliability was "excellent". Squat inter-rater reliability was "excellent"/"good". Palpation, tilt, Clarke and squat showed a statistically significant relationship (p<0.05) with all questionnaires/specific items. AUC of the questionnaires showed a "useful" accuracy, except for Tilt. No statistically significant differences were found between grades 0 and 1 chondromalacia (by MRI) knee scores, but between 1 and ≥2. AUC of the questionnaires showed "useful" accuracy.

Conclusions: KOOS-PF, KPS and VISA-P demonstrated their diagnostic value in PFP/chondromalacia (validity, reliability, sensitivity, specificity, predictive value and clinical applicability). KOOS-PF was the most versatile, and the most appropriate in mild cases and for early detection and prevention. Squat was the best due to its reliability and clinical relationship with the questionnaires, which predicted it correctly. The functional assessment tools discussed should be applied by combining them with each other.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. ROC curves of the questionnaires in general and of the specific items associated with the Clarke and squat tests.
**Diagonal segments are generated by ties. Items: VISA-P-3, “Do you have pain at the knee with full active non weight bearing knee extension?”; KOOS-PF-4, “Rising from sitting”; KOOS-PF-6, “Squatting”; KPS-4, “Stairs”; KPS-5, “Squatting”; VISA-P-2, “Do you have pain walking down stairs with a normal gait cycle?”; VISA-P-5, “Do you have problems squatting?”. Note: reference lines are marked with dashes.
Fig 2
Fig 2. ROC curves of the questionnaires according to the degrees of chondromalacia patella.
* Diagonal segments are generated by ties.
Fig 3
Fig 3. Cluster quality as measured by the cohesion and separation silhouette.
Interpretation: red = poor, yellow = sufficient, green = good.
Fig 4
Fig 4. Clusters derived from cluster analysis.
*The boxes indicate values for the whole sample (centre line = median, lateral ends = IQR) and the horizontal segments indicate values for the corresponding group (centre point = median, lateral ends = IQR).
See this image and copyright information in PMC

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Grants and funding

The author(s) received no specific funding for this work.