Assessment and Monitoring of Achilles Tendinopathy in Clinical Practice: A Qualitative Exploration of the Barrier’s Clinicians Face.

Abstract

Background: A plethora of different assessment tools exist to diagnose and monitor Achilles tendinopathy, however there is little consensus within the literature and what is performed in clinical practice is unknown. The aims of this study were: 1) Describe the assessments employed by clinicians in their own practice to aid with a) diagnosis and b) monitoring progress in Achilles tendinopathy, 2) explore which ICON health domains clinicians believe to be the most, and least important when managing patients with Achilles tendinopathy, and 3) explore the barriers preventing clinicians from implementing what they think is ideal practice as it relates to utilising tools to aid diagnosis and monitor progress in mid-portion Achilles tendinopathy.Methods: We employed a Qualitative Descriptive study design to capture the clinical assessments and ICON health domains participants deemed important when assessing and monitoring mid-portion Achilles tendinopathy over time. Thirteen participants (eight female, five male) from across Australia, consisting of two junior physiotherapists, five senior physiotherapists working in private practice, four senior physiotherapists working within elite sports organizations and two Sport and Exercise Medicine Doctors were included and one-on-one interviews were performed. Audio was transcribed then entered into NVIVO for coding and analysis.Results: Assessments related to Function, Pain On Loading, Pain Over A Specified Timeframe And Palpation are commonly used to assist diagnosis. Assessments related to Disability, Pain On Loading, Pain Over A Specified Timeframe and Physical Function Capacity are used to monitor progress over time. Furthermore, Pain On Loading and Pain Over A Specified Timeframe were considered the most important core health domains for assisting diagnosis whereas Pain On Loading, Patient Rating Of The Condition and Physical Function Capacity were the most important health domains for monitoring progress. Finally, four main themes were perceived as barriers to implementing ideal practice of assessment and monitoring in people with Achilles tendinopathy: Financial Constraints, Time Constraints, Access To Equipment and Patient Symptom Severity.Conclusions: A number of barriers exist that prevent clinicians from implementing what they view as ideal assessment and monitoring for Achilles tendinopathy. These barriers should be considered when developing new assessments and in clinical practice recommendations.