Table 1 Summary – Characteristics of included studies 643 records identified through database searching

Lower Limb Problem

Knee pain of no known aetiology

Arthralgia for at least 3 months preceding

Intervention Groups

1. Physiotherapist supervised 8-week physical therapy program, including exercises to address muscle strength and motion control performed into the neutral range of knee extension

2. Physiotherapist supervised 8-week physical therapy program, including exercises to address muscle strength and motion control performed into the full range of knee hyperextension

1. Physiotherapist supervised 6-week generalised physiotherapy programme, aimed at improving muscle strength and fitness

2. Physiotherapist supervised 6-week targeted physiotherapy programme, specifically addressing functional stability of symptomatic joints

N participants

29

57

Age Range

7–16 years

7–16 years

Recruitment Source

Children referred to The Children’s Hospital at Westmead’s Physiotherapy, Sports Medicine, Orthopaedic Knee, Connective tissue Dysplasia and Rheumatology clinics (January 2007 – February 2011)

Children treated at Alder Hey Children’s Hospital NHS Foundation, Liverpool (June 2004 – May 2007)

Follow-up Period

8 weeks

5 months

Outcomes

1. Pain

 • Child-reported mean knee pain (over one week) (VAS)

 • Parent-reported maximum knee pain (over one week) (Parental-VAS)

2. Patients global impression of change (PGIC)

3. Functional ability (CHAQ) ^a

4. Quality of life (Child Health Questionnaire)

5. Functional impairment (Mean quadriceps and Hamstring Strength)

6. Functional ability (Number of flights of stairs climbable in 2 min)

1. Pain

 • Improvements in child’s pain assessment score (VAS for > 11 years of age/Wong-Baker Faces < 11 years of age)

 • Parent’s assessment of child’s pain (Parental-VAS)

2. Parents global evaluation of the impact of their child’s hypermobility over the previous week (Global-VAS)

3. Functional Ability (CHAQ)^a

4. Functional ability (Six-minute shuttle level assessment) ^b