Self-reported pain with single leg heel raise or single leg hop offer distinct information as measures of severity in men with midportion and insertional Achilles tendinopathy: An observational cross-sectional study

Vallance, Patrick; Hasani, Fatmah; Crowley, Liam; Malliaras, Peter

doi:10.1016/j.ptsp.2020.10.009

Cited by 6 publications

(6 citation statements)

References 30 publications

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“…Thirdly, the factor of load tolerance was not expected to emerge from the analysis, but pain with loading is a hallmark of Achilles tendinopathy and was expected to be part of a symptoms factor. A recent study suggested that pain with loading is independent from VISA-A scores [56], and our results expand on that result by establishing pain with loading as an independent factor of the clinical presentation. Pain on the 20 consecutive hops test was the highest loading variable on this factor.…”

Section: Deviations From Expected Modelsupporting

confidence: 88%

Data driven model of midportion achilles tendinopathy health created with factor analysis

Sigurðsson

Couppé

Silbernagel

2022

BMC Musculoskelet Disord

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Background Achilles tendinopathy is a complex injury and the clinical presentation spans multiple different domains: physical and psychological symptoms, lower extremity function and tendon structure. A conceptual model of Achilles tendon health comprising these domains has been proposed in the literature. The aim of the study was to fit a model of Achilles tendinopathy using factor analysis and compare that to the conceptual model. An inclusive approach using a wide range of variables spanning multiple potential domains were included. Methods Participants (N = 99) with midportion Achilles tendinopathy were assessed with variables representing symptoms, physical function, tendon structure, metabolic syndrome, and psychologic symptoms. A Kaiser-Mayer-Olkin index was used to determine suitable variables for a subsequent exploratory factor analysis. Results A model emerged with an acceptable fit to the data (standardized root mean square of residuals = 0.078). Five uncorrelated factors emerged from the model and were labelled as biopsychosocial, lower extremity function, body size, load tolerance, and tendon structure. The total explained variance was 0.51 with the five factors explaining 0.14, 0.12, 0.10, 0.08, and 0.07 respectively. The results differed from the conceptual model as the factors of psychological variables and metabolic variables did not emerge from the analysis. Conclusion A data driven model of Achilles tendon health supports assessment of the clinical presentation over multiple domains. As the factors are uncorrelated, the results of assessment of, for example, tendon structure should not be expected to be associated with lower extremity function or biopsychosocial limitations. The results suggest that the Patient Reported Outcomes Measurement Information System, counter-movement jump height, body mass index, pain with hopping, and the tendon cross-sectional area can evaluate the five factors, respectively. Trial registration Registered on clinicaltrials.gov (Medicine NL of. ClinicalTrials.gov [Internet], 2018), ID number NCT03523325.

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Section: Deviations From Expected Modelsupporting

confidence: 88%

Data driven model of midportion achilles tendinopathy health created with factor analysis

Sigurðsson

Couppé

Silbernagel

2022

BMC Musculoskelet Disord

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“…Table 9 provides an overview of the 17 included cross-sectional studies, with 10 studies (De Jonge et al, 2011;De Marchi et al, 2018;Divani et al, 2010;Finnamore et al, 2019;Praet et al, 2018;Santamato et al, 2019;Scholes et al, 2018;Wang et al, 2012) investigating midportion Achilles tendinopathy, four studies Kragsnaes et al, 2014;Turner et al, 2020;Vallance et al, 2020) investigating both insertional and midportion Achilles tendinopathy, and three studies (Aiyegbusi, Tella & Sanusi, 2020;Mantovani et al, 2020) not specifying tendinopathy location. Once again, location of pain was the most common subjective measure to diagnose Achilles tendinopathy, with 12 studies utilising it as a diagnostic criteria (De Jonge et al, 2011;De Marchi et al, 2018;Kragsnaes et al, 2014;Mantovani et al, 2020;Praet et al, 2018;Chester et al, 2008;Scholes et al, 2018;Turner et al, 2020;Vallance et al, 2020;Wang et al, 2012). Midportion Achilles tendinopathy was defined as 2-6 cm above the calcaneal insertion in four studies (De Marchi et al, 2018;Praet et al, 2018; Wang et al, 2012), and 2-7 cm above the calcaneal insertion in one study .…”

Section: Cross-sectional Studiesmentioning

confidence: 99%

“…Midportion Achilles tendinopathy was defined as 2-6 cm above the calcaneal insertion in four studies (De Marchi et al, 2018;Praet et al, 2018; Wang et al, 2012), and 2-7 cm above the calcaneal insertion in one study . Similarly, 12 studies included duration of symptoms as a diagnostic criteria, with durations of symptoms including greater than four weeks (Santamato et al, 2019), greater than two months (Praet et al, 2018;, greater than three months (Finnamore et al, 2019;Mantovani et al, 2020;Scholes et al, 2018;Turner et al, 2020;Vallance et al, 2020;Wang et al, 2012), greater than four months (Kragsnaes et al, 2014), and greater than six months (De Marchi et al, 2018). Pain with tendon loading was the next most common subjective diagnostic measure, with nine studies including it as a diagnostic measure (De Marchi et al, 2018;Finnamore et al, 2019;Scholes et al, 2018;Turner et al, 2020;Vallance et al, 2020;Wang et al, 2012).…”

Section: Cross-sectional Studiesmentioning

confidence: 99%

“…One study did not specify objective clinical tests (Hasani et al, 2020). Papa, 2012;Post et al, 2020;Syvertson et al, 2017;Vallance et al, 2020) being used in 17% of studies reporting outcome measures. Outcome measures related to quality of life were utilised within 12 studies, with the most common outcome measures used being the 12-Item Short Form Survey (SF-12) (Duthon et al, 2011;Habets et al, 2017;Mansur et al, 2017;Murawski et al, 2014;Stenson et al, 2018), EuroQol 5 Dimension 5 Level Questionnaire (EQ-5D-5L) (Chester et al, 2008;De Marchi et al, 2018;Habets et al, 2017;Hasani et al, 2020) and 36-Item Short Form Survey (SF-36) (Hutchison et al, 2011;Maffulli et al, 2019;Petersen, Welp & Rosenbaum, 2007).…”

Section: Protocolsmentioning

confidence: 99%

“…Outcome measures related to quality of life were utilised within 12 studies, with the most common outcome measures used being the 12-Item Short Form Survey (SF-12) (Duthon et al, 2011;Habets et al, 2017;Mansur et al, 2017;Murawski et al, 2014;Stenson et al, 2018), EuroQol 5 Dimension 5 Level Questionnaire (EQ-5D-5L) (Chester et al, 2008;De Marchi et al, 2018;Habets et al, 2017;Hasani et al, 2020) and 36-Item Short Form Survey (SF-36) (Hutchison et al, 2011;Maffulli et al, 2019;Petersen, Welp & Rosenbaum, 2007). Similarly, psychosocial outcomes were poorly measured, being utilised on 11 occasions, with the most common outcome measures being the Pain Catastrophizing Scale (PCS) (Chimenti et al, 2020;Eckenrode, Kietrys & Stackhouse, 2019;Hasani et al, 2020;Post et al, 2020;Vallance et al, 2020), Tampa Kinesiophobia Scale (TKS) (Chimenti et al, 2020;Hasani et al, 2020;Post et al, 2020;Vallance et al, 2020), Pain Disability Index (PDI) (Mayer et al, 2007;Scott, Huisman & Khan, 2011) and Pain Efficacy Scale (PES) (Mayer et al, 2007;Scott, Huisman & Khan, 2011).…”

Section: Protocolsmentioning

confidence: 99%

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The clinical diagnosis of Achilles tendinopathy: a scoping review

Matthews

Ellis

Furness

et al. 2021

PeerJ

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Background Achilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains. Methodology A scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures. Results A total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured. Conclusions There is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.

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Putting the fear-avoidance model into practice – what can patients with chronic low back pain learn from patients with Achilles tendinopathy and vice versa?

Smitheman,

Lundberg,

Härnesand

et al. 2023

Brazilian Journal of Physical Therapy

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Self-reported pain with single leg heel raise or single leg hop offer distinct information as measures of severity in men with midportion and insertional Achilles tendinopathy: An observational cross-sectional study

Cited by 6 publications

References 30 publications

Data driven model of midportion achilles tendinopathy health created with factor analysis

Data driven model of midportion achilles tendinopathy health created with factor analysis

The clinical diagnosis of Achilles tendinopathy: a scoping review

Putting the fear-avoidance model into practice – what can patients with chronic low back pain learn from patients with Achilles tendinopathy and vice versa?

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