A national survey of the physiotherapy management of patients following first time patellar dislocation

Objective:

To determine how musculoskeletal physiotherapists in acute NHS hospitals manage patients following a first time patellar dislocation.

Relevance:

Patellar dislocation is a disabling musculoskeletal disorder. Whilst textbooks and review papers have suggested how physiotherapists should assess and treat this patient group, there remains little consensus to distinguish the optimal management strategies used for patients following a first time (first occurrence) patellar dislocation.

Methods:

Following research ethics and governance committee approval, 306 United Kingdom NHS hospitals were surveyed with a self-administered questionnaire. This tool was developed in order to cover topics including:  grade of physiotherapist, frequency of patellar instability referrals, assessment, treatment, onward referral of patients, and discharge destination following treatment.

Results:

The survey response rate was 59%. The respondents indicated that patellar dislocation is not a common musculoskeletal disorder managed by acute hospital NHS physiotherapists, constituting 4% of respondent's caseload. Respondents reported that patients following a first time patellar dislocation are most commonly diagnosed through a convincing history of patellar dislocation, quadriceps strength and the detection of a positive apprehension test. They are most frequently treated with quadriceps specific VMO or range of motion exercises, reassurance and proprioceptive exercises.

Conclusions:

A variety of generic lower limb assessment methods and treatment strategies are used to manage patients following a first time patellar dislocation. Given the previous paucity of literature in this area, further study is now recommended to assess the efficacy of specific patellofemoral interventions to provide physiotherapists with an evidence-base to justify their management of this complex patient group.