Ram Rithesh, Meeuwisse Willem, Patel Chirag, Wiseman David A, Wiley J Preston
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Clin Invest Med. 2013 Aug 1;36(4):E197-206. doi: 10.25011/cim.v36i4.19953.
Objective was to evaluate the outcome of a standardized heavy load eccentric training program in adults with chronic painful Achilles tendinopathy, and the presence of increased Colour Doppler activity in diseased and non-diseased adults. The hypothesis was that patient satisfaction would fall within the range of average satisfaction present in the literature (60 to 90%).
Twenty patients were instructed on a training program based on the Alfredson protocol of straight leg followed by bent knee heel drops and raises. Patient satisfaction was recorded as the primary outcome. Secondary outcomes included the VISA-A and Tegner scales. Twenty one subjects without present or history of lower extremity pain and seven patients presenting at the clinic but without Achilles tendinopathy were included as controls.
Patient satisfaction was significantly lower when compared to the literature as two patients reported that they were satisfied with the treatment while the remaining 15 reported that they were unsatisfied. Three patients were excluded from the analysis as they were unable to complete the exercises. Increased Colour Doppler activity was present in only one participant without the disease and in all patients with the disease at the end of the study (increased Colour Doppler activity was present in 40% of patients with the disease at the beginning of the study).
Although some patients' symptoms improved over time, eccentric training did not satisfy patient expectations of improvement following treatment despite compliance with the home based program. Although it is a mainstay of treatment, other options, which are both efficacious and effective, need to be provided for patients who prefer a conservative and relatively non-invasive treatment option from the start.
评估标准化重负荷离心训练方案对患有慢性疼痛性跟腱病的成年人的治疗效果，以及患病和未患病成年人中彩色多普勒活动增加的情况。假设患者满意度将落在文献中报道的平均满意度范围内（60%至90%）。
20名患者接受了基于阿尔弗雷德森方案的训练计划，即直腿后屈膝足跟下降和抬起。将患者满意度记录为主要结果。次要结果包括VISA - A和特格纳量表。21名无下肢疼痛史或当前无下肢疼痛的受试者以及7名到诊所就诊但无跟腱病的患者作为对照。
与文献相比，患者满意度显著较低，因为只有2名患者报告对治疗满意，其余15名患者报告不满意。3名患者因无法完成练习而被排除在分析之外。研究结束时，仅1名无疾病的参与者以及所有患病患者出现了彩色多普勒活动增加（研究开始时，40%的患病患者存在彩色多普勒活动增加）。
尽管随着时间推移一些患者的症状有所改善，但离心训练并未满足患者对治疗后改善的期望，尽管患者遵守了家庭训练计划。尽管它是治疗的主要方法，但对于一开始就倾向于保守且相对无创治疗选择的患者，需要提供其他有效且高效的选择。
