Plaster cast versus functional bracing for Achilles tendon rupture: the UKSTAR RCT

Costa, Matthew L.; Achten, Juul; Wagland, Susan; Marian, Ioana R; Maredza, Mandy; Schlüssel, Michael Maia; Liew, Anna S; Parsons, Nicholas R.; Dutton, Susan; Kearney, Rebecca S.; Lamb, Sarah E; Ollivere, B.; Petrou, Stavros

doi:10.3310/hta24080

Cited by 12 publications

(12 citation statements)

References 40 publications

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“…In 2015, McCormack confirmed not only that dynamic functional rehabilitation, including weightbearing initiated within first two weeks, is safe, but presents higher patient satisfaction and earlier return to activity [ 15 ]. Many authors [ 20 , 25 , 26 , 27 ] suggest that fast rehabilitation programs after open Achilles tenorrhaphy help to accelerate and facilitate the physiological repair process of the tendon suture, encouraging faster recovery of daily life activities, and a return to preinjury sports performance. According to Huang et al [ 28 ], faster mobilization of the ankle joint produces a better restoration of the articular range of motion, with an improvement in local edema, and prevents stiffness and calf atrophy [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…From the anatomopathological point of view, when a repaired tendon is subjected to tension during healing, orientation of collagen fibers, strength of the calf muscles, breaking strength of the tendon, number of collagen filaments, and tendon vascularity are all improved [ 26 ]. In addition, the use of supplements and/or drugs (e.g., palmitoylethanolamide, triamcinolone acetonide, or Curcuma) can modulate the human-tendon-derived stem cell activity with potential implications on the tendon healing process [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

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Fast Functional Rehabilitation Protocol versus Plaster Cast Immobilization Protocol after Achilles Tendon Tenorrhaphy: Is It Different? Clinical, Ultrasonographic, and Elastographic Comparison

et al. 2022

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Background: the incidence of Achilles tendon (AT) rupture is rising; however, there is no clear consensus regarding the optimal treatment. The aim of this retrospective study was to compare instrumental and patient-reported outcome scores after fast functional rehabilitation (group A) versus plaster cast immobilization (group B) programs in patients who underwent AT tenorrhaphy. Methods: 33 patients, with similar clinical and demographic features, underwent open AT tenorrhaphy between January and July 2018. Of these, 15 patients were treated with fast functional rehabilitation program (group A), and 18 patients were treated with plaster cast immobilization protocol (group B). Sural triceps hypotrophy and functional scores (American Orthopaedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot Score, and Achilles tendon Total Rupture Score (ATRS)) were recorded at a 12-month follow-up. Ultrasonography (US) and elastosonography (ES) were used to compare the characteristics of the tendons after surgery. Results: At 12 months, no significant differences in any of the patient-reported outcomes or the instrumental measurement tests were seen between the two groups. Conclusions: fast functional rehabilitation after AT surgical repair is safe, effective, and may be the first choice of treatment, especially in young, collaborative, and active patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fast Functional Rehabilitation Protocol versus Plaster Cast Immobilization Protocol after Achilles Tendon Tenorrhaphy: Is It Different? Clinical, Ultrasonographic, and Elastographic Comparison

et al. 2022

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“…Imputation for data missingness did not change the strength or direction of our estimates. Unlike other surgical trials, we did not undertake a modified ITT 142 (excluding the 10 randomisations in error and those withdrawn at point of randomisation) or a per-protocol analysis, although the compliance-based approach does provide a realistic estimate of those who complied with treatment.…”

Section: Participant Retentionmentioning

confidence: 99%

Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT

Bruce

Mazuquin

Mistry

et al. 2022

Health Technol Assess

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Background Upper limb problems are common after breast cancer treatment. Objectives To investigate the clinical effectiveness and cost-effectiveness of a structured exercise programme compared with usual care on upper limb function, health-related outcomes and costs in women undergoing breast cancer surgery. Design This was a two-arm, pragmatic, randomised controlled trial with embedded qualitative research, process evaluation and parallel economic analysis; the unit of randomisation was the individual (allocated ratio 1 : 1). Setting Breast cancer centres, secondary care. Participants Women aged ≥ 18 years who had been diagnosed with breast cancer and were at higher risk of developing shoulder problems. Women were screened to identify their risk status. Interventions All participants received usual-care information leaflets. Those randomised to exercise were referred to physiotherapy for an early, structured exercise programme (three to six face-to-face appointments that included strengthening, physical activity and behavioural change strategies). Main outcome measures The primary outcome was upper limb function at 12 months as assessed using the Disabilities of Arm, Hand and Shoulder questionnaire. Secondary outcomes were function (Disabilities of Arm, Hand and Shoulder questionnaire subscales), pain, complications (e.g. wound-related complications, lymphoedema), health-related quality of life (e.g. EuroQol-5 Dimensions, five-level version; Short Form questionnaire-12 items), physical activity and health service resource use. The economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit gained from an NHS and Personal Social Services perspective. Participants and physiotherapists were not blinded to group assignment, but data collectors were blinded. Results Between 2016 and 2017, we randomised 392 participants from 17 breast cancer centres across England: 196 (50%) to the usual-care group and 196 (50%) to the exercise group. Ten participants (10/392; 3%) were withdrawn at randomisation and 32 (8%) did not provide complete baseline data. A total of 175 participants (89%) from each treatment group provided baseline data. Participants’ mean age was 58.1 years (standard deviation 12.1 years; range 28–88 years). Most participants had undergone axillary node clearance surgery (327/392; 83%) and 317 (81%) had received radiotherapy. Uptake of the exercise treatment was high, with 181 out of 196 (92%) participants attending at least one physiotherapy appointment. Compliance with exercise was good: 143 out of 196 (73%) participants completed three or more physiotherapy sessions. At 12 months, 274 out of 392 (70%) participants returned questionnaires. Improvement in arm function was greater in the exercise group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 16.3 (standard deviation 17.6)] than in the usual-care group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 23.7 (standard deviation 22.9)] at 12 months for intention-to-treat (adjusted mean difference Disabilities of Arm, Hand and Shoulder questionnaire score of –7.81, 95% confidence interval –12.44 to –3.17; p = 0.001) and complier-average causal effect analyses (adjusted mean difference –8.74, 95% confidence interval –13.71 to –3.77; p ≤ 0.001). At 12 months, pain scores were lower and physical health-related quality of life was higher in the exercise group than in the usual-care group (Short Form questionnaire-12 items, mean difference 4.39, 95% confidence interval 1.74 to 7.04; p = 0.001). We found no differences in the rate of adverse events or lymphoedema over 12 months. The qualitative findings suggested that women found the exercise programme beneficial and enjoyable. Exercise accrued lower costs (–£387, 95% CI –£2491 to £1718) and generated more quality-adjusted life years (0.029, 95% CI 0.001 to 0.056) than usual care over 12 months. The cost-effectiveness analysis indicated that exercise was more cost-effective and that the results were robust to sensitivity analyses. Exercise was relatively cheap to implement (£129 per participant) and associated with lower health-care costs than usual care and improved health-related quality of life. Benefits may accrue beyond the end of the trial. Limitations Postal follow-up was lower than estimated; however, the study was adequately powered. No serious adverse events directly related to the intervention were reported. Conclusions This trial provided robust evidence that referral for early, supported exercise after breast cancer surgery improved shoulder function in those at risk of shoulder problems and was associated with lower health-care costs than usual care and improved health-related quality of life. Future work Future work should focus on the implementation of exercise programmes in clinical practice for those at highest risk of shoulder problems. Trial registration This trial is registered as ISRCTN35358984. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 15. See the NIHR Journals Library website for further project information.

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“…Costa et al (Costa et al, 2020) measured the Achilles Tendon Rupture Score, quality of life, complications and resource use of patients receiving non-operative treatment for an Achilles tendon rupture treated with plaster cast compared with those treated with functional bracing. They found that early weightbearing in a functional brace provides similar outcomes to traditional plaster casting and is safe for patients receiving nonoperative treatment of Achilles tendon rupture.…”

Section: Conservative Management Of Achilles Tendon Rupturementioning

confidence: 99%

Achilles tendon pathologies: How to choose the best treatment

Tarantino¹,

Palermi²,

Sirico³

et al. 2020

Journal of Human Sport and Exercise - 2020 - Summer Conferences of Sports Science

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The Achilles tendon is the thickest and strongest tendon of the human body and it gets frequently injured during sports activity. The incidence of Achilles tendon pathologies has increased over the last decades, especially in the last few years, as a result of the increased sports participation among general population and for the diffusion of competitive sports at a high level. Although the increased interest and number of studies about Achilles tendon pathologies, at the moment there is not a consensual point of view on which is the best treatment for Achilles tendon injuries, and its management is still controversial. Treatment options mainly include conservative treatment and surgical repair. The decision for treatment in patients with an Achilles tendon pathology should be tailored on patient's needs and level of activity, since patients with high activity levels may accept the risk of a higher complication rate to rapidly return to previous activity, while less active patients or those who cannot undergo surgery due to comorbidities may choose the non-operative option to decrease the risk of infection and other complications. The aim of this article is to give an insight about the most used and recent treatment options for Achilles tendon pathologies.

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Plaster cast versus functional bracing for Achilles tendon rupture: the UKSTAR RCT

Cited by 12 publications

References 40 publications

Fast Functional Rehabilitation Protocol versus Plaster Cast Immobilization Protocol after Achilles Tendon Tenorrhaphy: Is It Different? Clinical, Ultrasonographic, and Elastographic Comparison

Fast Functional Rehabilitation Protocol versus Plaster Cast Immobilization Protocol after Achilles Tendon Tenorrhaphy: Is It Different? Clinical, Ultrasonographic, and Elastographic Comparison

Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT

Achilles tendon pathologies: How to choose the best treatment

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