Outcomes of Achilles tendinopathy

NewsBot · Jan 11, 2023

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One fifth of patients with Achilles tendinopathy have symptoms after 10 years: A prospective cohort study
Iris F. Lagas et al
Journal of Sports Sciences 08 Jan 2023

Patients with midportion Achilles tendinopathy (AT) are thought to experience a gradual symptomatic improvement over time. The aim of this study was to prospectively investigate if patients with midportion AT have symptoms at 10-year follow-up. Patients withmidportion AT were invited to complete an online questionnaire 10 years after inclusion in an intervention trial. The primary outcomewas the presence of AT symptoms. Secondary outcomes were: the Victorian Institute of Sports Assessment-Achilles tendinopathy (VISA-A, 0–100) score and sports activity level. Of the 54 patientsincluded, 43 (80%) completed the questionnaire at an average follow-up of 10.4 years. Persisting symptoms were reported by 19%. The mean (standard deviation-SD) VISA-A score improved from 52 (17) at baseline to 79 (21) at 10-years follow-up with a mean change of 27 points (95% confidence interval: 21; 35, p < 0.001). Of the 38 active patients, 16 (42%) returned to their pre-injury level sports,of whom 14 (37%) performed them pain free. One-fifth of patients with conservatively treated midportion AT still have symptoms after 10years. One-third of patients were able to perform sports pain-free atpre-injury level. Patients should be adequately counselled to giverealistic expectations
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NewsBot · Jan 11, 2023

Related Thread:
Recurrence of Achilles tendonitis in football

NewsBot · Jan 23, 2023

Differences in Recovery of Tendon Health Explained by Midportion Achilles Tendinopathy Subgroups: A 6-Month Follow-up
Shawn L Hanlon et al
J Orthop Sports Phys Ther. 2023 Jan 23

OBJECTIVES: To (i) evaluate whether the defining characteristics of previously-reported Achilles tendinopathy subgroups were reproducible in a cohort with midportion Achilles tendinopathy and, (ii) compare recovery trajectories and outcomes. DESIGN: Prospective single cohort study METHODS: Participants (n=114, (Mean±SD) age 47±12, 57F) received the Silbernagel protocol and were evaluated at baseline, 8-, 16-, and 24 weeks. Subgroups were identified using mixture modeling. Main effects of group and time, and interaction effects were evaluated using linear mixed models for 23 outcome measures representing symptoms, lower extremity function, tendon structure, psychological factors, and patient-related factors. Recovery trajectories were reported descriptively to reflect clinically-meaningful change for outcomes. RESULTS: Activity-Dominant (n=34), Function-Dominant (n=38), Psychosocial-Dominant (n=27), and Structure-Dominant (n=15) subgroups were identified. There were significant effects of group and time for all primary outcome measures, except heel-rise limb symmetry index (LSI) and viscosity LSI. The Activity- and Function-Dominant subgroups achieved functional recovery despite persisting symptoms. The Psychosocial-Dominant subgroup reported the greatest impairments in symptom and foot and ankle-related quality of life at all timepoints. The Structure-Dominant subgroup experienced delayed improvement in symptoms and was the only subgroup to not achieve structural recovery. No subgroup met our criteria for complete recovery. CONCLUSION: The defining characteristics of Achilles tendinopathy subgroups were reproduced in a cohort with midportion Achilles tendinopathy. Activity- and Function-Dominant subgroups had superior outcomes compared to Psychosocial- and Structure-Dominant for symptomatic, functional, and structural recovery.
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NewsBot · Feb 13, 2023

Assessing calf exercise fidelity among people with Achilles tendinopathy using videos recorded via Zoom®: an observational study
Rhiannon Whale et al
Disabil Rehabil. 2023 Feb 8;1-8

Purpose: Exercise fidelity is a fundamental aspect of exercise prescription by physiotherapists. Assessing exercise fidelity via telehealth (videoconference) is potentially useful but its reproducibility has not been assessed. The objective was to evaluate agreement (reproducibility) of video rating of calf exercise fidelity within (over four weeks) and between telehealth raters and compared with live rating.

Methods: Nineteen videos of participants with AT undertaking calf exercises were rated by physiotherapists in person (live) and by watching pre-recorded videos (replicating telehealth). Three forms of agreement were assessed: (i) between live assessment and recorded video (telehealth) assessment; (ii) between telehealth raters (inter-rater); (iii) agreement within telehealth raters over four weeks (intra-rater).

Results: There was weak to almost perfect agreement (Kappa = 0.65 to 1.00, rater 1, Kappa = 0.57 to 1.00, rater 2) between the telehealth and live raters. There was moderate to almost perfect agreement (Kappa = 0.65 to 1.00) when assessing intra-rater reliability, aside from one of the six criteria (quality of movement).

Conclusion: Assessing calf exercise fidelity via videos recorded on Zoom® appears to demonstrate weak or greater agreement versus live rating and over time. Inter-rater agreement was lower, suggesting that the criteria developed may be better suited to use by individual raters over time.Implications for rehabilitationTelehealth assessment (when compared with live, in person assessment) shows a moderate or greater agreement for the majority of assessment criteria when assessing calf exercise fidelity.The calf exercise fidelity criteria developed can be used as an adjunct to assessment and management of people with Achilles Tendinopathy.Intra-rater assessment was shown to be moderately or more consistent over a four-week period when assessing calf exercise fidelity.
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NewsBot · May 14, 2023

Efficacy of Telehealth for Movement-Evoked Pain in People With Chronic Achilles Tendinopathy: A Noninferiority Analysis
Andrew A Post et al
Phys Ther. 2023 Mar 3;103(3)

Objective: The purpose of this study was to compare the efficacy of physical therapy delivered via an all telehealth or hybrid format with an all in-person format on movement-evoked pain for individuals with chronic Achilles tendinopathy (AT).

Methods: Sixty-six individuals with chronic AT participated (age, 43.4 [SD = 15.4] years; 56% female; body mass index, 29.9 [SD = 7.7] kg/m2). Participants completed all in-person visits from the initiation of recruitment in September 2019 to March 16, 2020 (in-person group). From March 17 to July 15, 2020, participants completed all telehealth visits (telehealth group). From July 16, 2020, to enrollment completion in December 2020, participants could complete visits all in-person, all telehealth, or a combination of in-person and telehealth (hybrid group) based on their preference. A physical therapist provided 6 to 7 visits, including an exercise program and patient education. Noninferiority analyses of the telehealth and hybrid groups compared with the in-person group were completed for the primary outcome of movement-evoked pain during single-limb heel raises.

Results: All groups demonstrated decreases in movement-evoked pain beyond the minimal clinically important difference from baseline to 8 weeks (2 out of 10 on a numeric pain rating scale). Lower bounds of the 95% CIs for mean differences between groups did not surpass the preestablished noninferiority margin (2 out of 10) for movement-evoked pain in both the telehealth and hybrid groups (telehealth vs in-person: 0.45 [-1.1 to 2.0]; hybrid vs in-person: 0.48 [-1.0 to 1.9]).

Conclusion: Individuals with chronic AT who completed a tendon-loading program with patient education through a telehealth or hybrid format had no worse outcomes for pain than those who received the same intervention through in-person visits.

Impact: Physical therapist-directed patient care delivered via telehealth may enhance accessibility to best practice AT rehabilitation, including exercise and education. Use of telehealth technology may also provide an opportunity to prioritize patient preference for physical therapy visit format.

Lay summary: If you are a patient with chronic AT, physical therapist-directed patient care delivered via telehealth may improve your accessibility to best practice AT rehabilitation, including exercise and education. Use of telehealth technology may also prioritize your preferences regarding the format of the physical therapy visit
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NewsBot · Jun 15, 2023

Effect of Symptom Duration on Injury
Severity and Recovery in Patients
With Achilles Tendinopathy
Shawn L. Hanlon et al
Source

Background: Achilles tendinopathy is a common overuse condition. Distinguishing between early- and late-stage tendinopathy
may have implications on treatment decisions and recovery expectations.
Purpose: To compare the effects of time and baseline measures of tendon health on outcomes among patients with varying
symptom durations after 16 weeks of comprehensive exercise treatment.
Study Design: Cohort study; Level of evidence, 3.
Methods: Participants (N ¼ 127) were categorized into 4 groups based on the number of months since symptom onset: 3 months (n
¼ 24); between >3 and 6 months (n ¼ 25); between >6 and 12 months (n ¼ 18); or >12 months (n ¼ 60). All participants received 16
weeks of standardized exercise therapy and pain-guided activity modification. Outcomes representing symptoms, lower extremity
function, tendon structure, mechanical properties, psychological factors, and patient-related factors were assessed at baseline and at
8 and 16 weeks after the initiation of exercise therapy. Chi-square tests and 1-way analysis of variance were used to compare baseline
measures between groups.Time, group, and interaction effects were evaluated using linear mixed models.
Results: The mean age of the participants was 47.8 ± 12.6 years, 62 participants were women, and symptoms ranged from 2
weeks to 274 months. No significant differences were found among symptom duration groups at baseline for any measure of
tendon health. At 16 weeks, all groups demonstrated improvements in symptoms, psychological factors, lower extremity function,
and tendon structure, with no significant differences among the groups (P > .05)
Conclusion: Symptom duration did not influence baseline measures of tendon health. Additionally, no differences were observed
among the different symptom duration groups in response to 16 weeks of exercise therapy and pain-guided activity modification.
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NewsBot · Jul 18, 2023

Do Physical Tests Have a Prognostic Value in Chronic Midportion Achilles Tendinopathy?
Céline F.L. Mulder ET AL
Journal of Science and Medicine in Sport; 4 July 2023

Objective
To determine whether baseline physical tests have a prognostic value on patient reported outcomes in Achilles tendinopathy (AT).

Study design
Prospective cohort study, secondary analysis of data from a randomized controlled trial (RCT)

Background
Physical tests are used for diagnosing or monitoring AT but may also have prognostic value. It is currently unknown if certain physical tests have a prognostic value.

Methods
Patients with chronic midportion AT performed a progressive calf muscle exercise program. At baseline and after 2, 6, 12 and 24 weeks, patients completed the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire and performed the following physical tests: ankle dorsiflexion ROM with a bent knee or an extended knee, calf muscle strength, jumping height and pain on palpation (visual analogue scale;VAS,0-100) and after 10 hops (VAS-10-hops). Associations between baseline test results and improvement (VISA-A scores) were determined using a Mixed Linear Model (MLM).

Results
80 patients were included. The mean VISA-A score improved 20 points (95%CI,16-25,P < .001) after 24 weeks. There were significant associations between the baseline ankle dorsiflexion ROM with a bent knee (β0.2,95%CI 0.001 to 0.3,P = .049), the baseline pain provocation tests (VAS palpation:β-0.2;95%CI:-0.4 to -0.1;P < .001, VAS-10-hops:β -0.3; 95%CI:-0.4 to -0.2;P < .001) and the change in VISA-A score.

Conclusion
In patients with chronic midportion AT, easy-to-perform pain provocation tests have a clinically relevant prognostic value on patient-reported improvement. Patients with less pain during pain provocation tests at baseline have a better improvement in pain, function and activities (VISA-A score) after 24 weeks than patients with high baseline pain scores.
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