Factors associated with outcome following exercise interventions for Achilles tendinopathy: A systematic review

Abstract

Objective This systematic review aimed to synthesize current evidence on contributing factors influencing outcome following exercise management for Achilles tendinopathy (AT). Data Sources Databases (PubMed, Embase, and Cochrane Library) were searched from inception to February 2020. Study Selection Studies investigating factors (e.g., age, BMI) associated with outcome (e.g., pain and function questionnaires) following exercise interventions for AT were included. Data Extraction Data were extracted into a standardized form, including patient demographics, population sample, study type, factors associated with outcome, and outcome measures. Data Synthesis Meta‐analysis was planned to be performed, where appropriate. Where data could not be pooled, we summarized the findings descriptively. Results Six studies investigating 11 different factors were included; overall the quality of evidence was poor. There was conflicting evidence that imaging measures had an association with a change in VISA‐A outcome. These included signal intensity and tendon size determined by MRI, and Ultrasound Tissue Characterization echopattern. Three studies found that duration of symptoms was not associated with a change in VISA‐A. Also, three studies found that age, and one study found that prior sporting activity level, were not associated with outcome. Baseline pain with activity, baseline VISA‐A, sex, and BMI were inconsistently associated with specific outcomes. Conclusion Due to the poor quality of evidence overall, no firm conclusions can be drawn. At best, there was inconsistent evidence that imaging factors, baseline pain and function, BMI, and sex showed some associations with outcomes, but these findings need to be confirmed in more extensive studies.

The relationship between psychological, cognitive, and contextual factors and rehabilitation outcomes in Achilles tendinopathy: A prospective feasibility cohort study

“…Outcomes of a particular intervention may be influenced by specific patient-related characteristics/factors, also known as treatment effect modifiers. 11 In patients with musculoskeletal pain conditions such as chronic low back pain and fibromyalgia, it is well documented that rehabilitation outcomes such as self-reported pain and function are influenced by psychological factors (i.e., depression, anxiety, and fear-avoidance beliefs), 9,33,46 and by cognitive and contextual factors (i.e., pain self-efficacy, outcome expectations, and working alliance). 27,29 The varied responses to first-line treatments for Achilles tendinopathy may be explained by the presence of these factors, however, this is yet to be investigated.…”

ICON 2020—International Scientific Tendinopathy Symposium Consensus: A Scoping Review of Psychological and Psychosocial Constructs and Outcome Measures Reported in Tendinopathy Clinical Trials

“…24,36,95,115 The long-held belief that improved clinical outcomes are associated with structural alterations following exercise interventions in tendinopathy is not supported. 60,128,172 These findings highlight the need to view tendinopathy from a multidimensional biopsychosocial perspective.…”