Patellar taping and bracing for the treatment of chronic knee pain : a systematic review and meta-analysis

Objective. To evaluate the evidence for patellar taping and bracing in the management of chronic knee pain. Methods. Randomized or quasi-randomized studies assessing patellar taping or bracing effects on chronic knee pain were sourced from 7 electronic databases (to November 2006), and assessed using the Physiotherapy Evidence Database scale. Weighted mean differences were determined, and pooled estimates of taping and bracing effects were obtained using random-effects models. Results. Of 16 eligible trials, 13 investigated patellar taping or bracing effects in individuals with anterior knee pain, and 3 investigated taping effects in individuals with knee osteoarthritis (OA). The methodologic quality of the taping studies was significantly higher than the bracing studies (mean ± SD 4.8 ± 2.1 versus 2.8 ± 0.8; P < 0.05). On a 100-mm scale, tape applied to exert a medially-directed force on the patella decreased chronic knee pain compared with no tape by 16.1 mm (95% confidence interval [95% CI] -22.2, -10.0; P < 0.001) and sham tape by 10.9 mm (95% CI -18.4, -3.4; P < 0.001). For anterior knee pain and OA, medially-directed tape decreased pain compared with no tape by 14.7 mm (95% CI -22.8, -6.9; P < 0.001) and 20.1 mm (95% CI -26.0, -14.3; P < 0.001), respectively. There was disputable evidence from low-quality studies for patellar bracing benefits. Conclusion. There was evidence that tape applied to exert a medially-directed force on the patella produces a clinically meaningful change in chronic knee pain. There was limited evidence to demonstrate the efficacy of patellar bracing. These outcomes were limited by the presence of high heterogeneity between study outcomes and significant publication bias.