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Bourke J, Munteanu S, Garofolini A, Taylor S, Malliaras P. Efficacy of heel lifts for mid-portion Achilles tendinopathy (the LIFT trial): study protocol for a randomised controlled trial. Trials 2024; 25:345. [PMID: 38790025 PMCID: PMC11127406 DOI: 10.1186/s13063-024-08185-8] [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: 06/19/2023] [Accepted: 05/20/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Mid-portion Achilles tendinopathy is a common condition, characterised by localised Achilles tendon load-related pain and dysfunction. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. Heel lifts have also been advocated as a treatment for Achilles tendinopathy, but the efficacy and mechanism of action of this intervention is unclear. This proposal describes a randomised controlled trial comparing the effectiveness of heel lifts versus sham heel lifts for reducing pain associated with mid-portion Achilles tendinopathy, with an embedded biomechanical analysis. METHODS One hundred and eight men and women aged 18 to 65 years with mid-portion Achilles tendinopathy (who satisfy the inclusion and exclusion criteria) will be recruited. Participants will be randomised, using the website Sealed Envelope, to either a control group (sham heel lifts) or an experimental group (heel lifts). Both groups will be provided with education regarding acceptable pain levels to ensure all participants receive some form of treatment. The participants will be instructed to use their allocated intervention for at least 8 h every day for 12 weeks. The primary outcome measure will be pain intensity (numerical rating scale) at its worst over the previous week. The secondary outcome measures will be additional measures of Achilles tendon pain and disability, participant-perceived global ratings of change, function, level of physical activity and health-related quality of life. Data will be collected at baseline and the primary endpoint (week 12). Data will be analysed using the intention-to-treat principle. In addition, the acute kinetic and kinematic effects of the interventions will be examined at baseline in a subpopulation of the participants (n = 40) while walking and running using three-dimensional motion analysis. DISCUSSION The LIFT trial (efficacy of heeL lIfts For mid-portion Achilles Tendinopathy) will be the first randomised trial to compare the efficacy of heel lifts to a sham intervention in reducing pain and disability in people with Achilles tendinopathy. The biomechanical analysis will provide useful insights into the mechanism of action of heel lifts. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12623000627651 . Registered 7 June 2023.
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Affiliation(s)
- Jaryd Bourke
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
| | - Shannon Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | | | - Simon Taylor
- Institute for Health and Sport (IHES), Victoria University, Victoria, Australia
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
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Menz HB, Lim PQX, Hurn SE, Mickle KJ, Buldt AK, Cotchett MP, Roddy E, Wluka AE, Erbas B, Batra M, Munteanu SE. Nonsurgical management of hallux valgus: findings of a randomised pilot and feasibility trial. J Foot Ankle Res 2023; 16:78. [PMID: 37957676 PMCID: PMC10642001 DOI: 10.1186/s13047-023-00677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Hallux valgus is a common and disabling condition. This randomised pilot and feasibility trial aimed to determine the feasibility of conducting a parallel group randomised trial to evaluate the effectiveness of a nonsurgical intervention for reducing pain associated with hallux valgus. METHODS Twenty-eight community-dwelling women with painful hallux valgus were randomised to receive either a multifaceted, nonsurgical intervention (footwear, foot orthoses, foot exercises, advice, and self-management) or usual care (advice and self-management alone). Outcome measures were obtained at baseline, 4, 8 and 12 weeks. The primary outcome was feasibility, evaluated according to demand (recruitment rate and conversion rate), acceptability, adherence, adverse events, and retention rate. Limited efficacy testing was conducted on secondary outcome measures including foot pain, foot muscle strength, general health-related quality of life, use of cointerventions, and participants' perception of overall treatment effect. RESULTS Between July 8, 2021, and April 22, 2022, we recruited and tested 28 participants (aged 44 to 80 years, mean 60.7, standard deviation 10.7). This period encompassed two COVID-related stay-at-home orders (July 16 to July 27, and August 5 to October 21, 2021). The predetermined feasibility thresholds were met for retention rate, foot pain, mental health-related quality of life, and use of cointerventions, partly met for acceptability, adverse events, and muscle strength, and not met for demand (recruitment rate or conversion rate), adherence, physical health-related quality of life and perception of overall treatment effect. CONCLUSION In its current form, a randomised trial of footwear, foot orthoses, foot exercises, advice and self-management for relieving pain associated with hallux valgus is not feasible, particularly due to the low adherence with the intervention. However, it is difficult to determine whether the trial would be feasible under different circumstances, particularly due to COVID-19 stay-at-home orders. Future trials will need to consider improving the aesthetics of the footwear and making the exercise program less burdensome. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry (ACTRN12621000645853).
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Affiliation(s)
- Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Polly Q X Lim
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
| | - Karen J Mickle
- Applied Sport Science and Exercise Testing Laboratory, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, NSW, 2258, Australia
| | - Andrew K Buldt
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Matthew P Cotchett
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, UK
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Mehak Batra
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Shannon E Munteanu
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
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Marriott KA, Birmingham TB. Fundamentals of osteoarthritis. Rehabilitation: Exercise, diet, biomechanics, and physical therapist-delivered interventions. Osteoarthritis Cartilage 2023; 31:1312-1326. [PMID: 37423596 DOI: 10.1016/j.joca.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Insights related to the pathogenesis of osteoarthritis (OA) have informed rehabilitative treatments that aim to mitigate the influence of several known impairments and risk factors for OA, with the goal to improve pain, function, and quality of life. The purpose of this invited narrative review is to provide fundamental knowledge to non-specialists about exercise and education, diet, biomechanical interventions, and other physical therapist-delivered treatments. In addition to summarizing the rationale for common rehabilitative therapies, we provide a synthesis of current core recommendations. Robust evidence based on randomized clinical trials supports exercise with education and diet as core treatments for OA. Structured, supervised exercise therapy is advised. The mode of exercise may vary but should be individualized. The dose should be based on an initial assessment, the desired physiological changes, and progressed when appropriate. Diet combined with exercise is strongly recommended and studies demonstrate a dose-response relationship between the magnitude of weight loss and symptom improvement. Recent evidence suggests the use of technology to remotely deliver exercise, diet and education interventions is cost-effective. Although several studies support the mechanisms for biomechanical interventions (e.g., bracing, shoe inserts) and physical therapist-delivered (passive) treatments (e.g., manual therapy, electrotherapeutic modalities) fewer rigorous randomized trials support their clinical use; these therapies are sometimes recommended as adjuncts to core treatments. The mechanisms of action for all rehabilitative interventions include contextual factors such as attention and placebo effects. These effects can challenge our interpretation of treatment efficacy from clinical trials, yet also provide opportunities to maximize patient outcomes in clinical practice. When evaluating rehabilitative interventions, the field may benefit from increased emphasis on research that considers contextual factors while evaluating mechanistic, longer-term, clinically-important and policy-relevant outcome measures.
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Affiliation(s)
- Kendal A Marriott
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.
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Menz HB, Allan JJ, Buldt AK, Landorf KB, Cicuttini FM, Roddy E, Munteanu SE. Neuropathic Pain Associated With First Metatarsophalangeal Joint Osteoarthritis: Frequency and Associated Factors. Arthritis Care Res (Hoboken) 2023; 75:2127-2133. [PMID: 37013633 PMCID: PMC10952225 DOI: 10.1002/acr.25125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/23/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To determine whether neuropathic pain is a feature of first metatarsophalangeal (MTP) joint osteoarthritis (OA). METHODS A total of 98 participants (mean ± SD age 57.4 ± 10.3 years) with symptomatic radiographic first MTP joint OA completed the PainDETECT questionnaire (PD-Q), which has 9 questions regarding the intensity and quality of pain. The likelihood of neuropathic pain was determined using established PD-Q cutoff points. Participants with unlikely neuropathic pain were then compared to those with possible/likely neuropathic pain in relation to age, sex, general health (Short Form 12 [SF-12] health survey), psychological well-being (Depression, Anxiety and Stress Scale), pain characteristics (self-efficacy, duration, and severity), foot health (Foot Health Status Questionnaire [FHSQ]), first MTP dorsiflexion range of motion, and radiographic severity. Effect sizes (Cohen's d coefficient) were also calculated. RESULTS A total of 30 (31%) participants had possible/likely neuropathic pain (19 possible [19.4%], 11 likely [11.2%]). The most common neuropathic symptoms were sensitivity to pressure (56%), sudden pain attacks/electric shocks (36%) and burning (24%). Compared to those with unlikely neuropathic pain, those with possible/likely neuropathic pain were significantly older (d = 0.59, P = 0.010), had worse SF-12 physical scores (d = 1.10, P < 0.001), pain self-efficacy scores (d = 0.98, P < 0.001), FHSQ pain scores (d = 0.98, P < 0.001), and FHSQ function scores (d = 0.82, P < 0.001), and had higher pain severity at rest (d = 1.01, P < 0.001). CONCLUSION A significant proportion of individuals with first MTP joint OA report symptoms suggestive of neuropathic pain, which may partly explain the suboptimal responses to commonly used treatments for this condition. Screening for neuropathic pain may be useful in the selection of targeted interventions and may improve clinical outcomes.
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Affiliation(s)
| | | | | | | | | | - Edward Roddy
- Keele University, Keele, Staffordshire, UK, and Haywood HospitalBurslemStaffordshireUK
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