Rate of Improvement of Pain and Function in Mid-Portion Achilles Tendinopathy with Loading Protocols: A Systematic Review and Longitudinal Meta-Analysis

Murphy, Myles; Travers, Mervyn; Gibson, William; Chivers, Paola; Debenham, James; Docking, Sean; Rio, Ebonie

doi:10.1007/s40279-018-0932-2

Cited by 84 publications

(71 citation statements)

References 70 publications

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“…This study failed to demonstrate a greater improvement in symptoms of Achilles tendinopathy in patients who received IMS (intramuscular dry needling, using filiform needles) and exercise, compared either to sham IMS and exercise, or to exercise alone. The magnitude of improvement observed in all three groups in the primary outcome measure (VISA-A) was as expected, based on previous studies with similar exercise programs [39].…”

Section: Discussionsupporting

confidence: 88%

Intramuscular stimulation vs sham needling for the treatment of chronic midportion Achilles tendinopathy: A randomized controlled clinical trial

Solomons

Lee

Bruce³

et al. 2020

PLoS ONE

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Background The insertion of filiform needles intramuscularly (a.k.a. intramuscular stimulation/dry needling) has been suggested as a possible treatment for various painful musculoskeletal conditions. Our aim was to answer the question, is intramuscular stimulation more effective than sham intramuscular stimulation/dry needling for the treatment of Achilles tendinopathy? Methods 52 participants with persistent midportion Achilles tendinopathy began and 46 completed one of three treatment protocols which were randomly assigned: (G3) a 12-week rehabilitation program of progressive tendon loading plus intramuscular stimulation (n = 25), (G2) the same rehabilitation program but with sham intramuscular stimulation (n = 19), or (G1) a reference group of rehabilitation program alone (as an additional control) (n = 8). The a priori primary outcome measure was change in VISA-A score at 12 weeks-VISA-A was also measured at 6 weeks, and at 6 and 12 months. Secondary outcome measures include the proportion of patients who rated themselves as much or very much improved (%), dorsiflexion range of motion (degrees), and tendon thickness (mm). Results The study retention was 94% at 12 weeks and 88% at 1 year. VISA-A score improved in all three groups over time (p<0.0001), with no significant difference among the three groups in VISA-A score at the start of the study (mean ± SD: G3 59 ± 13, G2 57 ± 17, G1 56 ± 22), at 12 weeks (G3 76 ± 14, G2 76 ± 15, G1 82 ± 11) or at any other timepoint. The percentage of patients who rated themselves as much or very much improved (i.e. treatment success) was not different after 12 weeks (G3 70%, G2 89%, G1 86% p = 0.94), or at 26 (p = 0.62) or

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Section: Discussionsupporting

confidence: 88%

Intramuscular stimulation vs sham needling for the treatment of chronic midportion Achilles tendinopathy: A randomized controlled clinical trial

Solomons

Lee

Bruce³

et al. 2020

PLoS ONE

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“…Responses from electronic versions of the measures in the form of a questionnaire were collected on three occasions; at baseline, at 6 and finally at 12 weeks following completion of the first questionnaire. Twelve weeks represents a clinically meaningful timepoint; response to exercise may plateau after this (Murphy et al, ), leading to the consideration of a change in treatment for non‐responders. Consequently, determining predictive factors early in the rehabilitation (such as baseline and 6 weeks) would seem important.…”

Section: Methodsmentioning

confidence: 99%

The association of working alliance, outcome expectation, adherence and self‐efficacy with clinical outcomes for Achilles tendinopathy: A feasibility cohort study (the MAP study)

Mallows

Jackson

Littlewood

et al. 2020

Musculoskeletal Care

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Introduction:This study evaluated the feasibility of a large longitudinal cohort study utilizing an online platform to investigate the association and predictive relationship of working alliance, outcome expectations, adherence and self-efficacy with outcome in Achilles tendinopathy. The objectives were: (1) to determine the recruitment and retention rate and (2) to carry out preliminary data analysis of the selected variables and clinical outcomes. Methods:A multi-centred, longitudinal feasibility cohort study was used. Eligible participants were directed to a bespoke online platform hosting study information and the outcome measures in the form of an online questionnaire. Responses from the online questionnaire were collected on three occasions: at baseline, at 6 and at 12 weeks following completion of the first questionnaire. Feasibility outcomes (recruitment and retention rates) were described using descriptive statistics. Results:The website recorded a total 55 views. These 55 views resulted in 24 participants consenting to join the study. The questionnaire at baseline was started 63 times and completed on 60 separate occasions resulting in a 95% conversion rate.Retainment for completion of the questionnaire for a second time was 83.3% and for the third time was 66.6%. All questionnaires were completed fully yielding a missing data indicator of 0%. Conclusions:Feasibility studies ask the question 'can this be done'? Based on the data from recruitment and rates and exploratory correlation analysis a future study can be done; this previously untested online platform appears feasible, but changes could be useful before proceeding to a much larger study. K E Y W O R D Smusculoskeletal, physiotherapy, self-Efficacy

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“…12,38,55,68,69 Regardless of the mode of contraction, strength interventions have been reasonably effective in improving pain and disability in those with midportion AT; the average reduction in pain was approximately 55%. 34,68,[70][71][72][73][74][75][76][77][78] Despite the relative success of loading interventions for improving pain and disability, AT is associated with a high recurrence rate (27%). 20,35 One potential reason for the high recurrence rate and persistence of symptoms may be the nonresolution of the strength deficits associated with AT.…”

Section: Current Rehabilitation Programs and Adequately Addressing Dementioning

confidence: 99%

Altered Strength Profile in Achilles Tendinopathy: A Systematic Review and Meta-Analysis

Auliffe

Tabuena

McCreesh

et al. 2019

Journal of Athletic Training

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Background Persistent strength deficits secondary to Achilles tendinopathy (AT) have been postulated to account for difficulty engaging in tendon-loading movements, such as running and jumping, and may contribute to the increased risk of recurrence. To date, little consensus exists on the presence of strength deficits in AT. Consequently, researchers are uncertain about the appropriate methods of assessment that may inform rehabilitation in clinical practice. Objective To evaluate and synthesize the literature investigating plantar-flexion (PF) strength in individuals with AT. Study Selection Two independent reviewers searched 9 electronic databases using an agreed-upon set of key words. Data Extraction Data were extracted from studies comparing strength measures (maximal, reactive, and explosive strength) between individuals with AT and healthy control participants or between the injured and uninjured sides of people with AT. The Critical Appraisal Skills Programme Case-Control Study Checklist was used to assess the risk of bias for the included studies. Data Synthesis A total of 19 studies were eligible. Pooled meta-analyses for isokinetic dynamometry demonstrated reductions in maximal strength (concentric PF peak torque [PT] slow [Hedges g = 0.52, 44% deficit], concentric PF PT fast [Hedges g = 0.61, 38% deficit], and eccentric PF PT slow [Hedges g = 0.26, 18% deficit]). Reactive strength, particularly during hopping, was also reduced (Hedges g range = 0.32–2.61, 16%–35% deficit). For explosive strength, reductions in the rate of force development (Hedges g range = 0.31–1.73, 10%–21% deficit) were observed, whereas the findings for ground reaction force varied but were not consistently altered. Conclusions Individuals with AT demonstrated strength deficits compared with the uninjured side or with asymptomatic control participants. Deficits were reported across the strength spectrum for maximal, reactive, and explosive strength. Clinicians and researchers may need to adapt their assessment of Achilles tendon function, which may ultimately help to optimize rehabilitation outcomes.

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Rate of Improvement of Pain and Function in Mid-Portion Achilles Tendinopathy with Loading Protocols: A Systematic Review and Longitudinal Meta-Analysis

Cited by 84 publications

References 70 publications

Intramuscular stimulation vs sham needling for the treatment of chronic midportion Achilles tendinopathy: A randomized controlled clinical trial

Intramuscular stimulation vs sham needling for the treatment of chronic midportion Achilles tendinopathy: A randomized controlled clinical trial

The association of working alliance, outcome expectation, adherence and self‐efficacy with clinical outcomes for Achilles tendinopathy: A feasibility cohort study (the MAP study)

Altered Strength Profile in Achilles Tendinopathy: A Systematic Review and Meta-Analysis

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