1
|
Saarensilta A, Aufwerber S, Grävare Silbernagel K, Ackermann P. Early Tendon Morphology as a Biomarker of Long-term Patient Outcomes After Surgical Repair of Achilles Tendon Rupture: A Prospective Cohort Study. Orthop J Sports Med 2023; 11:23259671231205326. [PMID: 37941888 PMCID: PMC10629330 DOI: 10.1177/23259671231205326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 11/10/2023] Open
Abstract
Background Patient outcome after acute Achilles tendon rupture (ATR) varies and is difficult to predict. Whether early variations in healing, visualized with ultrasonography, can predict long-term patient outcome is unclear. Purpose To (1) examine the associations of Achilles tendon cross-sectional area (CSA) and elongation (TE) during healing of ATR repair with patient outcomes at 12 months postoperatively and (2) investigate the predictive or diagnostic capacity of the morphological biomarkers. Study Design Cohort study; Level of evidence, 2. Methods This study was based on previously collected data from 86 patients who underwent acute standardized ATR repair between 2013 and 2018 and who were included in a prior randomized trial investigating early functional mobilization (EFM). In the EFM group, loading was allowed immediately after surgery, while in the comparison group, loading was allowed first at 2 weeks postoperatively. Achilles tendon CSA and length were measured with ultrasound at 6 weeks, 6 months, and 12 months postoperatively. CSA ratio and absolute difference in the length of the healthy and injured tendons were calculated. Patient-reported outcome was registered with the validated Achilles tendon Total Rupture Score and functional outcome with the heel-rise endurance test at 12 months postoperatively. The limb symmetry index (LSI) was calculated for maximum heel-rise height (HRHmax) and total concentric work. Multiple linear regression adjusted for age was used, and the area under the receiver operating characteristic curve (AUC) was calculated to evaluate predictive capacity. Results A larger CSA ratio at 6 weeks was associated with higher LSI HRHmax at 12 months (R2, 0.35; P < .001) and exhibited good predictive capacity (AUC, 0.82). More TE at 12 months was associated with lower LSI total concentric work at 12 months (R2, 0.21; P = .001) and exhibited acceptable predictive capacity (AUC, 0.71). Conclusion Greater Achilles tendon CSA seen on ultrasound 6 weeks after surgical repair had good clinical prediction for long-term functional outcome. TE at 12 months was predictive of inferior functional outcome. Registration NCT02318472 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Annukka Saarensilta
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Aufwerber
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | | | - Paul Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
2
|
Fernandez MR, Hébert-Losier K. Devices to measure calf raise test outcomes: A narrative review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e2039. [PMID: 37440324 DOI: 10.1002/pri.2039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/10/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND The calf raise test (CRT) is commonly administered without a device in clinics to measure triceps surae muscle function. To standardise and objectively quantify outcomes, researchers use research-grade or customised CRT devices. To incorporate evidence-based practice and apply testing devices effectively in clinics, it is essential to understand their design, applicability, psychometric properties, strengths, and limitations. Therefore, this review identifies, summarises, and critically appraises the CRT devices used in science. METHODS Four electronic databases were searched in April 2022. Studies that used devices to measure unilateral CRT outcomes (i.e., number of repetitions, work, height) were included. RESULTS Thirty-five studies met inclusion, from which seven CRT devices were identified. Linear encoder (n = 18) was the most commonly used device, followed by laboratory equipment (n = 6) (three-dimensional motion capture and force plate). These measured the three CRT outcomes. Other devices used were electrogoniometer, Häggmark and Liedberg light beam device, Ankle Measure for Endurance and Strength (AMES), Haberometer, and custom-made. Devices were mostly used in healthy populations or Achilles tendon pathologies. AMES, Haberometer, and custom-made devices were the most clinician-friendly, but only quantified repetitions were completed. In late 2022, a computer vision mobile application appeared in the literature and offered clinicians a low-cost, research-grade alternative. CONCLUSION This review details seven devices used to measure CRT outcomes. The linear encoder is the most common in research and quantifies all three CRT outcomes. Recent advances in computer-vision provide a low-cost research-grade alternative to clinicians and researchers via a n iOS mobile application.
Collapse
Affiliation(s)
- Ma Roxanne Fernandez
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| |
Collapse
|
3
|
Dao M, Mosby H, Westphalen E, Post AA, Wilken JM, de Cesar Netto C, Hall MM, Danielson J, Sluka KA, Chimenti RL. Reliability and validity of two-dimensional motion capture to assess ankle dorsiflexion motion and heel raise work. Phys Ther Sport 2023; 62:10-16. [PMID: 37300968 PMCID: PMC10526702 DOI: 10.1016/j.ptsp.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To determine the inter-rater reliability and criterion validity of two-dimensional (2D) measures of ankle function in the sagittal plane for participants with Achilles tendinopathy (AT). DESIGN Cohort study. SETTING University Laboratory, Participants, Adults with AT (N = 18, Women: 72.2%, Age = 43.4 ± 15.8 years, BMI = 28.7 ± 8.9 kg/m2) MAIN OUTCOME MEASURES: Reliability and validity were determined with intra-class correlation coefficients (ICC), standard error of the measurement (SEM), minimal detectable change (MDC), and Bland-Altman plots for ankle dorsiflexion and positive work during heel raises. RESULTS Inter-rater reliability between three raters for all 2D motion analysis tasks was good to excellent (ICC = 0.88 to 0.99). Criterion validity between 2D and 3D motion analyses for all tasks was good to excellent (ICC = 0.76 to 0.98). 2D motion analysis overestimated ankle dorsiflexion motion by 1.0-1.7° (3% of mean sample value) and positive ankle joint work by 76.8 J (9% of mean) compared to 3D motion analysis. CONCLUSION Although 2D and 3D measures are not interchangeable, the good to excellent reliability and validity of 2D measures in the sagittal plane support the use of video analysis to quantify ankle function for individuals with foot and ankle pain.
Collapse
Affiliation(s)
- Megan Dao
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Hadley Mosby
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Emma Westphalen
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Andrew A Post
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Cesar de Cesar Netto
- Department of Orthopaedics & Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Mederic M Hall
- Department of Orthopaedics & Rehabilitation, University of Iowa, Iowa City, IA, USA; University of Iowa Sports Medicine, University of Iowa, Iowa City, IA, USA
| | - Jessica Danielson
- Institute for Clinical and Translational Science, University of Iowa Hospital and Clinics, IA, USA
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA.
| |
Collapse
|
4
|
Fernandez MR, Athens J, Balsalobre-Fernandez C, Kubo M, Hébert-Losier K. Concurrent validity and reliability of a mobile iOS application used to assess calf raise test kinematics. Musculoskelet Sci Pract 2023; 63:102711. [PMID: 36604270 DOI: 10.1016/j.msksp.2022.102711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/04/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Calf raise test (CRT) is used in rehabilitation and sports medicine to evaluate calf muscle function. The Calf Raise application (CRapp) uses computer-vision algorithms to objectively measure CRT outcomes and replicate laboratory-based metrics that are difficult to measure clinically. OBJECTIVE To validate the CRapp by examining its concurrent validity and agreement levels against laboratory-based equipment, and its intra- and inter-rater reliability. DESIGN Observational cross-sectional validation study. METHODS CRT outcomes (i.e., repetitions, positive work, total height, peak height, fatigue index, and peak power) were assessed in thirteen individuals (6 males, 7 females) on three occasions on both legs using the CRapp, 3D motion capture, and force plate simultaneously. Data were extracted from two markers: below lateral malleolus (n = 77) and on the heel (n = 77). Concurrent validity and agreement were determined from 154 data files using intraclass correlation coefficients (ICC3,k), typical errors expressed as coefficient of variations (CV), and Bland-Altman plots to assess biases and precision. Reliability was assessed using ICC3,1 and CV values. RESULTS Validity of CRapp outcomes was good to excellent across measures for both markers (mean ICC ≥0.878), precision plots showing good agreement and precision. CV ranged from 0% (repetitions) to 33.3% (fatigue index) and were on average better for the lateral malleolus marker. Inter- and intra-rater reliability were excellent (ICC≥0.949, CV ≤ 5.6%). CONCLUSION CRapp is valid and reliable within and between users for measuring CRT outcomes in healthy adults. CRapp provides a tool to objectivise CRT outcomes in research and practice, aligning with recent advances in mobile technologies and their increased use in healthcare.
Collapse
Affiliation(s)
- Ma Roxanne Fernandez
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, New Zealand; Department of Physical Therapy, College of Rehabilitation Sciences, University of Santo Tomas, Philippines.
| | - Josie Athens
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | | | - Masayoshi Kubo
- Department of Physical Therapy, Niigata University of Health and Welfare, Japan.
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, New Zealand.
| |
Collapse
|
5
|
Tenforde AS, Vogel KEL, Tam J, Silbernagel KG. Research protocol to evaluate the effectiveness of shockwave therapy, photobiomodulation and physical therapy in the management of non-insertional Achilles tendinopathy in runners: a randomised control trial with elective cross-over design. BMJ Open Sport Exerc Med 2022; 8:e001397. [PMID: 36187084 PMCID: PMC9516084 DOI: 10.1136/bmjsem-2022-001397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Achilles tendinopathy (AT) is a common overuse injury in runners. While the mainstay of treatment for AT is tendon loading exercises (physical therapy and exercise programme (EXER)), some patients have refractory symptoms. Extracorporeal shockwave therapy (ESWT) and photobiomodulation therapy (PBMT) have each been evaluated to facilitate tendon healing; the influence of combining treatments is unknown and limited studies have been completed in runners. This randomised control study, with an elective cross-over at 3 months, will evaluate the efficacy of three forms of treatment of non-insertional AT: (1) EXER (loading programme specific to Achilles tendon combined with physical therapy); (2) EXER and ESWT; (3) EXER, ESWT and PBMT. Sixty runners will be assigned using block randomisation into one of three treatment groups (n=20). After 3 months, each participant may elect a different treatment than previously assigned and will be followed for an additional 3 months. The EXER Achilles loading programme will be standardised using the Silbernagel at-home programme. The primary outcome of interest is treatment group responses using the Victorian Institute of Sports Assessment—Achilles (VISA-A) Score. Secondary outcomes include the Patient-Reported Outcomes Measurement Information System—29 questions, the University of Wisconsin Running Injury and Recovery Index, heel raise to fatigue test, hopping test and ultrasound measurements. We will also capture patient preference and satisfaction with treatment. We hypothesise that the cohorts assigned EXER+ESWT+PBMT and EXER+ESWT will see greater improvements in VISA-A than the EXER cohort, and the largest gains are anticipated in combining ESWT+PBMT. The elective cross-over phase will be an exploratory study and will inform us whether patient preference for treatment will impact the treatment response. Trial registration number NCT04725513.
Collapse
Affiliation(s)
- Adam S Tenforde
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | | | - Joshua Tam
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | | |
Collapse
|
6
|
Rendek Z, Bon Beckman L, Schepull T, Dånmark I, Aspenberg P, Schilcher J, Eliasson P. Early Tensile Loading in Nonsurgically Treated Achilles Tendon Ruptures Leads to a Larger Tendon Callus and a Lower Elastic Modulus: A Randomized Controlled Trial. Am J Sports Med 2022; 50:3286-3298. [PMID: 36005394 PMCID: PMC9527451 DOI: 10.1177/03635465221117780] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Early tensile loading improves material properties of healing Achilles tendon ruptures in animal models and in surgically treated human ruptures. However, the effect of such rehabilitation in patients who are nonsurgically treated remains unknown. HYPOTHESIS In nonsurgically treated Achilles tendon ruptures, early tensile loading would lead to higher elastic modulus 19 weeks after the injury compared with controls. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Between October 2015 and November 2018, a total of 40 nonsurgically treated patients with acute Achilles tendon rupture were randomized to an early tensile loading (loaded group) or control group. Tantalum bead markers were inserted percutaneously into the tendon stumps 2 weeks after the injury to allow high-precision measurements of callus deformation under mechanical testing. The loaded group used a training pedal twice daily to produce a gradual increase in tensile load during the following 5 weeks. Both groups were allowed full weightbearing in an ankle orthosis and unloaded range of motion exercises. Patients were followed clinically and via roentgen stereophotogrammetric analysis and computed tomography at 7, 19, and 52 weeks after the injury. RESULTS The mean ± standard deviation elastic modulus at 19 weeks was 95.6 ± 38.2 MPa in the loaded group and 108 ± 45.2 MPa in controls (P = .37). The elastic modulus increased in both groups, although it was lower in the loaded group at all time points. Tendon cross-sectional area increased from 7 weeks to 19 weeks, from 231 ± 99.5 to 388 ± 142 mm2 in the loaded group and from 188 ± 65.4 to 335 ± 87.2 mm2 in controls (P < .001 for the effect of time). Cross-sectional area for the loaded group versus controls at 52 weeks was 302 ± 62.4 mm2 versus 252 ± 49.2 mm2, respectively (P = .03). Gap elongation was 7.35 ± 13.9 mm in the loaded group versus 2.86 ± 5.52 mm in controls (P = .27). CONCLUSION Early tensile loading in nonsurgically treated Achilles tendon ruptures did not lead to higher elastic modulus in the healing tendon but altered the structural properties of the tendon via an increased tendon thickness. REGISTRATION NCT0280575 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Zlatica Rendek
- Orthopedic Department, Linköping University Hospital, Linköping, Sweden
| | - Leo Bon Beckman
- Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden
| | - Thorsten Schepull
- Orthopedic Department, Linköping University Hospital, Linköping, Sweden
| | - Ida Dånmark
- Orthopedic Department, Linköping University Hospital, Linköping, Sweden
| | - Per Aspenberg
- Author deceased,Orthopedic Department, Linköping University Hospital, Linköping, Sweden,Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden
| | - Jörg Schilcher
- Orthopedic Department, Linköping University Hospital, Linköping, Sweden,Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden
| | - Pernilla Eliasson
- Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden,Pernilla Eliasson, MSc, PhD, Department of Biomedical and Clinical Sciences, Division of Cell Biology, Linköping University, Cell Biology Building Floor 10, Linköping, SE-58183, Sweden ()
| |
Collapse
|
7
|
Hébert-Losier K, Ngawhika TM, Gill N, Balsalobre-Fernandez C. Validity, reliability, and normative data on calf muscle function in rugby union players from the Calf Raise application. Sports Biomech 2022:1-22. [PMID: 36121030 DOI: 10.1080/14763141.2022.2118158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
Abstract
We examined the validity and reliability of biomechanical outcomes extracted using the Calf Raise application of three calf muscle tests. We then established normative calf muscle function values for male rugby union players accounting for rugby-related factors (position, level) alone and together with clinical factors (age, leg dominance, BMI, previous injury). In total, 120 athletes performed three single-leg calf muscle tests. Twenty athletes participated in application validation; 18 in test-retest reliability; and all in establishing normative equations. Validity of application outcomes against 3D motion and force plate data was good-to-excellent (CV ≤ 6.6%, ICC ≥0.84). Test-retest reliability was good across outcomes following familiarisation (CV < 10%, ICC ≥0.83). Forwards produced superior power than backs during the bodyweight (59 W, p = 0.007) and weighted (73 W, p < 0.001) power tests. Playing level influenced power outcomes (p < 0.009). Super Rugby players were more powerful than Club (both power tests), Provincial (both power tests), and International (bodyweight power). Backs completed more repetitions (3 repetitions, p = 0.001) and positive displacement (30 cm, p = 0.001) than forwards during endurance testing. When accounting for clinical factors; BMI, age, and previous injury explained some of the differences observed between positions and levels. This study provides initial benchmark values of calf muscle function in rugby union.
Collapse
Affiliation(s)
- Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Tauranga, New Zealand
| | - Te Manawa Ngawhika
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Tauranga, New Zealand
| | - Nicholas Gill
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Tauranga, New Zealand
- New Zealand Rugby Union, Wellington, New Zealand
| | | |
Collapse
|
8
|
Bohannon RW. The heel-raise test for ankle plantarflexor strength: a scoping review and meta-analysis of studies providing norms. J Phys Ther Sci 2022; 34:528-531. [PMID: 35784604 PMCID: PMC9246404 DOI: 10.1589/jpts.34.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The heel-raise test (HRT) is sometimes used to quantify ankle plantarflexion
strength. However, descriptions of the test vary and normative values are limited. This
paper, therefore was generated to summarize procedures and provide normative values for
the HRT in a younger and older age group of adults. [Methods] Electronic and hand searches
were conducted to identify relevant literature. Meta-analysis was used to provide norms.
[Results] Among 439 nonduplicative articles identified, 13 qualifying articles were
ultimately included. Procedures for the HRT described in the studies varied considerably.
The mean number of HRT repetitions was 28.7 for adults with a mean age less than 40 years
and 11.8 for adults with a mean age greater than 60 years. [Conclusion] This study
provides information on HRT performance and norms derived with them for younger and older
adults.
Collapse
|
9
|
Alghamdi NH, Pohlig RT, Lundberg M, Silbernagel KG. The Impact of the Degree of Kinesiophobia on Recovery in Patients With Achilles Tendinopathy. Phys Ther 2021; 101:6324957. [PMID: 34289066 PMCID: PMC8801001 DOI: 10.1093/ptj/pzab178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/28/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Kinesiophobia has been proposed to influence recovery in individuals with Achilles tendinopathy. However, whether there are differences in outcomes in individuals with different levels of kinesiophobia is unknown. The purpose of this study was to compare the characteristics of patients at baseline and recovery over time in individuals with Achilles tendinopathy and various levels of kinesiophobia. METHODS This study was a secondary analysis of a prospective observational cohort study of 59 individuals with Achilles tendinopathy. The participants were divided into 3 groups on the basis of scores on the Tampa Scale for Kinesiophobia (TSK) (those with low TSK scores [≤33; low TSK group], those with medium TSK scores [34-41; medium TSK group], and those with high TSK scores [≥42; high TSK group]). All participants were evaluated with self-reported outcomes, clinical evaluation, tendon morphology, viscoelastic property measurements, and a calf muscle endurance test at baseline, 6 months, and 12 months. No treatment was provided throughout the study period. RESULTS There were 16 participants (8 women) in the low TSK group (age = 51.9 [SD = 15.3] years, body mass index [BMI] = 24.3 [22.3-25.4]), 28 participants (13 women) in the medium TSK group (age = 52.7 [SD = 15.2] years, BMI = 26.4 [22.5-30.8]), and 15 participants (8 women) in the high TSK group (age = 61.1 [SD = 11.1] years, BMI = 28.1 [25.2-33.6]). Among the groups at baseline, the high TSK group had significantly greater BMI and symptom severity and lower quality of life. All groups showed significant improvement over time for all outcomes except tendon viscoelastic properties and tendon thickening when there was an adjustment for baseline BMI. The high and medium TSK groups saw decreases in kinesiophobia at 6 months, but there was no change for the low TSK group. CONCLUSION Despite the high TSK group having the highest BMI and the worse symptom severity and quality of life at baseline, members of this group showed improvements in all of the outcome domains similar to those of the other groups over 12 months. IMPACT Evaluating the degree of kinesiophobia in individuals with Achilles tendinopathy might be of benefit for understanding how they are affected by the injury. However, the degree of kinesiophobia at baseline does not seem to affect recovery; this finding could be due to the patients receiving education about the injury and expectations of recovery.
Collapse
Affiliation(s)
- Nabeel Hamdan Alghamdi
- Department of Physical Therapy, King Abdulaziz University, Jeddah, Saudi Arabia,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Ryan T Pohlig
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Mari Lundberg
- Department of Health and Rehabilitation, University of Gothenburg, Göteborg, Sweden,Department of Health Promotion Sciences, Sophiahemmet University, Stockholm, Sweden
| | | |
Collapse
|
10
|
Abstract
Strokes are a constant concern for people and pose a major health concern. Tests that allow detection and the rehabilitation of patients have started to become more important and essential. There are several tests used by physiotherapists to speed up the recovery process of patients. This article presents a systematic review of existing studies using the Heel-Rise Test and sensors (i.e., accelerometers, gyroscopes, pressure and tilt sensors) to estimate the different levels and health statuses of individuals. It was found that the most measured parameter was related to the number of repetitions, and the maximum number of repetitions for a healthy adult is 25 repetitions. As for future work, the implementation of these methods with a simple mobile device will facilitate the different measurements on this subject.
Collapse
|
11
|
Corrigan P, Cortes DH, Pohlig RT, Grävare Silbernagel K. Tendon Morphology and Mechanical Properties Are Associated With the Recovery of Symptoms and Function in Patients With Achilles Tendinopathy. Orthop J Sports Med 2020; 8:2325967120917271. [PMID: 32426410 PMCID: PMC7218994 DOI: 10.1177/2325967120917271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/22/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Achilles tendinopathy is a debilitating overuse injury characterized by pain, altered Achilles tendon structure, and impaired functional performance. Evaluating tendon structure as part of the physical examination may help establish a well-defined prognosis. However, the usefulness of measuring tendon structure for developing a prognosis has been questioned since structural abnormalities can exist without symptoms. Purpose: To determine whether initial measures of tendon morphology and mechanical properties were associated with patient-reported symptoms and calf muscle endurance at baseline, 6-month follow-up, and 1-year follow-up by prospectively following a cohort of individuals with Achilles tendinopathy. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 59 participants with midportion or insertional Achilles tendinopathy completed an initial assessment and follow-up assessments at 6 months and 1 year. At the initial assessment, patient-reported symptoms, calf muscle endurance, and Achilles tendon thickening were evaluated, and Achilles tendon mechanical properties were estimated. At the 6-month and 1-year follow-up assessments, patient-reported symptoms and calf muscle endurance were reevaluated. Results: Greater Achilles tendon thickening at the initial assessment was consistently associated with worse patient-reported symptoms and calf muscle endurance at each assessment. Changes in symptoms over the year were moderated by the initial shear modulus of the tendon, with a lower shear modulus associated with less improvement in symptoms. Lower viscosity at the initial assessment was also associated with worse calf muscle endurance at each assessment. Conclusion: Measures of tendon morphology and mechanical properties appear to be associated with patient-reported symptoms and calf muscle function for patients with Achilles tendinopathy.
Collapse
Affiliation(s)
- Patrick Corrigan
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Daniel H Cortes
- Department of Mechanical and Nuclear Engineering, Penn State University, State College, Pennsylvania, USA
| | - Ryan T Pohlig
- College of Health Sciences Biostatistics Core Facility, University of Delaware, Newark, Delaware, USA
| | | |
Collapse
|
12
|
Maritz CA, Pigman J, Grävare Silbernagel K, Crenshaw J. Effects of Backward Walking Training on Balance, Mobility, and Gait in Community-Dwelling Older Adults. ACTIVITIES ADAPTATION & AGING 2020. [DOI: 10.1080/01924788.2020.1757329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Carol A. Maritz
- Physical Therapy, University of the Sciences, Philadelphia, Pennsylvania, USA
| | - Jaime Pigman
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, New Jersey, USA
| | | | - Jeremy Crenshaw
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, New Jersey, USA
| |
Collapse
|
13
|
Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. J Athl Train 2020; 55:438-447. [PMID: 32267723 DOI: 10.4085/1062-6050-356-19] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Achilles tendinopathy is a painful overuse injury that is extremely common in athletes, especially those who participate in running and jumping sports. In addition to pain, Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties, altered lower extremity function, and fear of movement. Cumulatively, these impairments limit sport participation and performance. A thorough evaluation and comprehensive treatment plan, centered on progressive tendon loading, is required to ensure full recovery of tendon health and to minimize the risk of reinjury. In this review, we will provide an update on the evidence-based evaluation, outcome assessment, treatment, and return-to-sport planning for Achilles tendinopathy. Furthermore, we will provide the strength of evidence for these recommendations using the Strength of Recommendation Taxonomy system.
Collapse
Affiliation(s)
| | - Shawn Hanlon
- Department of Physical Therapy, University of Delaware, Newark
| | - Andrew Sprague
- Department of Physical Therapy, University of Delaware, Newark
| |
Collapse
|
14
|
Zellers JA, Pohlig RT, Cortes DH, Grävare Silbernagel K. Achilles tendon cross-sectional area at 12 weeks post-rupture relates to 1-year heel-rise height. Knee Surg Sports Traumatol Arthrosc 2020; 28:245-252. [PMID: 31267192 PMCID: PMC6939153 DOI: 10.1007/s00167-019-05608-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/26/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Achilles tendon rupture leads to long-term plantar flexor deficits, but some patients recover functional performance better than others. Early indicators of tendon healing could be helpful in establishing patient prognosis and making individualized decisions regarding rehabilitation progression. The purpose of this study was to investigate relationships between early tendon morphology and mechanical properties to long-term heel-rise and jumping function in individuals after Achilles tendon rupture. METHODS Individuals after Achilles tendon rupture were assessed at 4, 8, 12, 24, and 52 weeks post-injury. Tendon cross-sectional area, length, and mechanical properties were measured using ultrasound. Heel-rise and jump tests were performed at 24 and 52 weeks. Correlation and regression analysis were used to identify relationships between tendon structural variables in the first 12 weeks to functional outcomes at 52 weeks, and determine whether the addition of tendon structural characteristics at 24 weeks strengthened relationships between functional performance at 24 and 52 weeks. Functional outcomes of individuals with < 3 cm of elongation were compared to those with > 3 cm of elongation using a Mann-Whitney U test. RESULTS Twenty-two participants [mean (SD) age = 40 (11) years, 17 male] were included. Tendon cross-sectional area at 12 weeks was the strongest predictor of heel-rise height (R2 = 0.280, p = 0.014) and work symmetry (R2 = 0.316, p = 0.008) at 52 weeks. Jumping performance at 52 weeks was not significantly related to any of the tendon structural measures in the first 12 weeks. Performance of all functional tasks at 24 weeks was positively related to performance on the same task at 52 weeks (r = 0.456-0.708, p < 0.05). The addition of tendon cross-sectional area improved the model for height LSI (R2 = 0.519, p = 0.001). Tendon elongation > 3 cm significantly reduced jumping symmetry (p < 0.05). CONCLUSION Tendon cross-sectional area and excessive elongation related to plantar flexor performance on functional testing after Achilles tendon rupture. Once an individual is able to perform function-based testing, tendon structural measures may inform long-term prognosis. Ultrasound-based measures of tendon structure early in recovery seem to relate to later performance on functional testing. Clinically, assessing tendon structure has the potential to be used as a biomarker of tendon healing early in recovery and better predict patients at risk of negative functional outcome. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Jennifer A Zellers
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Ryan T Pohlig
- College of Health Sciences biostatistics Core Facility, University of Delaware, Newark, DE, USA
| | - Daniel H Cortes
- Department of Mechanical and Nuclear Engineering, Penn State University, State College, PA, USA
| | - Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware, 540 South College Ave, Newark, DE, 19713, USA.
| |
Collapse
|
15
|
Arch ES, Colon S, Silbernagel KG, Crenshaw JR. Evaluating the relationship between gait and clinical measures of plantar flexor function. J Electromyogr Kinesiol 2018; 43:41-47. [DOI: 10.1016/j.jelekin.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/15/2018] [Accepted: 09/10/2018] [Indexed: 01/13/2023] Open
|