O'Neill Seth, Watson Paul J, Barry Simon
University of Leicester, Leicester, UK.
Coventry University, Coventry, UK.
Int J Sports Phys Ther. 2016 Oct;11(5):684-697.
Achilles tendinopathy can be a debilitating chronic condition for both active and inactive individuals. The identification of risk facors is important both in preventing but also treating tendinopathy, many factors have been proposed but there is a lack of primary epidemiological data. The purpose of this study was to develop a statement of expert consensus on risk factors for Achilles tendinopathy in active and sedentary patient populations to inform a primary epidemiological study.
Delphi study.
An online Delphi study was completed inviting participation from world tendon experts. The consensus was developed using three rounds of the Delphi technique. The first round developed a complete list of potential risk factors, the second round refined this list but also separated the factors into two population groups - active/athletic and inactive/sedentary. The third round ranked this list in order of perceived importance.
Forty-four experts were invited to participate, 16 participated in the first round (response rate 40%) and two dropped out in the second round (resulting in a response rate of 35%). A total of 27 intrinsic and eight extrinsic risk factors were identified during round one. During round two only 12 intrinsic and five extrinsic risk factors were identified as important in active/athletic tendinopathy while 14 intrinsic and three extrinsic factors were identified as important for inactive/sedentary tendinopathy.
Risk factors for Achilles tendinopathy were identified based on expert consensus, and these factors provide a basis for primary epidemiological studies. Plantarflexor strength was identified as the primary modifiable factor in the active/athletic group while systemic factors were identified as important in the inactive/sedentary group, many of the potential factors suggested for either group were non-modifiable. Non-modifiable factors include: previous tendinopathy, previous injury, advancing age, sex, steroid exposure, and antibiotic treatment.
Level V.
跟腱病对于活跃和不活跃的个体而言，都可能是一种使人衰弱的慢性疾病。识别风险因素对于预防和治疗跟腱病都很重要，虽然已经提出了许多因素，但缺乏原发性流行病学数据。本研究的目的是就活跃和久坐不动患者群体中跟腱病的风险因素制定一份专家共识声明，以为原发性流行病学研究提供参考。
德尔菲研究。
完成了一项在线德尔菲研究，邀请全球肌腱专家参与。通过三轮德尔菲技术达成共识。第一轮列出了潜在风险因素的完整清单，第二轮对该清单进行了完善，并将因素分为两个群体组——活跃/运动员群体和不活跃/久坐群体。第三轮按感知重要性对该清单进行排序。
邀请了44位专家参与，16位参与了第一轮（回复率40%），第二轮有2位退出（回复率为35%）。第一轮共识别出27个内在风险因素和8个外在风险因素。在第二轮中，仅12个内在风险因素和5个外在风险因素被确定为活跃/运动员跟腱病的重要因素，而14个内在风险因素和3个外在因素被确定为不活跃/久坐跟腱病的重要因素。
基于专家共识确定了跟腱病的风险因素，这些因素为原发性流行病学研究提供了基础。跖屈力量被确定为活跃/运动员组中的主要可改变因素，而全身因素在不活跃/久坐组中被确定为重要因素，两组中提出的许多潜在因素都是不可改变的。不可改变因素包括：既往跟腱病、既往损伤、年龄增长、性别、类固醇暴露和抗生素治疗。
V级。
