Habets Bas, van Cingel Robert E H, Backx Frank J G, Huisstede Bionka M A
Papendal Sports Medical Center, Papendallaan 7, 6816 VD, Arnhem, The Netherlands.
Department of Rehabilitation, Physical Therapy Science and Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, P.O. Box 85500, Utrecht, 3508 GA, The Netherlands.
BMC Musculoskelet Disord. 2017 Jul 11;18(1):296. doi: 10.1186/s12891-017-1656-4.
Midportion Achilles tendinopathy (AT) is a common overuse injury, usually requiring several months of rehabilitation. Exercise therapy of the ankle plantar flexors (i.e. tendon loading) is considered crucial during conservative rehabilitation. Alfredson's isolated eccentric and Silbernagel's combined concentric-eccentric exercise programs have both shown beneficial results, but it is unknown whether any of these programs is superior for use in clinical practice. Therefore, the primary objective of this study is to compare the effectiveness of both programs on clinical symptoms. Secondary objectives are to compare the effectiveness of both programs on quality of life and functional outcome measures, to investigate the prognostic value of baseline characteristics, to investigate differences in cost-effectiveness.
METHODS/DESIGN: Eighty-six recreational athletes (21-60 years of age) with unilateral chronic midportion AT (i.e. ≥ 3 months) will be included in this multicenter assessor blinded randomized controlled trial. They will be randomly allocated to either a group performing the Alfredson isolated eccentric training program (n = 43), or a group performing the Silbernagel combined concentric-eccentric program (n = 43). In the Alfredson group, participants will perform eccentric heel-drops on their injured side, twice daily for 12 weeks, whereas in the Silbernagel group, participants perform various concentric-eccentric heel-raise exercises, once daily for 12 weeks. Primary outcome measure will be the Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaire. Secondary outcomes will be a visual analogue scale (VAS) for pain during daily activities and sports, duration of morning stiffness, global perceived effect, the 12-item Short Form Health Survey and the Euroqol instrument, and functional performance measured with the heel-raise test and the countermovement jump. Additionally, alongside the RCT, a cost-effectiveness analysis will be performed. Assessments will be performed at baseline and after 12, 26, and 52 weeks.
This study is the first to directly compare the Alfredson and the Silbernagel exercise program in a randomized trial. The results can further enlarge the evidence base for choosing the most appropriate exercise program for patients with midportion AT.
Dutch Trial register: NTR5638 . Date of registration: 7 January 2016.
跟腱中段肌腱病（AT）是一种常见的过度使用损伤，通常需要数月的康复治疗。在保守康复期间，踝跖屈肌的运动疗法（即肌腱负荷）被认为至关重要。阿尔弗雷德森的孤立离心运动方案和西尔贝纳格尔的同心-离心联合运动方案均已显示出有益效果，但尚不清楚这些方案在临床实践中是否有更优者。因此，本研究的主要目的是比较这两种方案对临床症状的有效性。次要目的是比较这两种方案对生活质量和功能结局指标的有效性，研究基线特征的预后价值，以及研究成本效益差异。
方法/设计：86名年龄在21至60岁之间、患有单侧慢性跟腱中段肌腱病（即≥3个月）的休闲运动员将被纳入这项多中心、评估者盲法的随机对照试验。他们将被随机分配到两组，一组进行阿尔弗雷德森孤立离心训练方案（n = 43），另一组进行西尔贝纳格尔同心-离心联合方案（n = 43）。在阿尔弗雷德森组中，参与者将在患侧进行离心足跟下降练习，每天两次，共12周；而在西尔贝纳格尔组中，参与者进行各种同心-离心足跟抬高练习，每天一次，共12周。主要结局指标将是维多利亚运动评估机构跟腱问卷（VISA-A）。次要结局将包括日常活动和运动时疼痛的视觉模拟量表（VAS）、晨僵持续时间、整体感知效果、12项简短健康调查问卷和欧洲生活质量量表，以及通过足跟抬高试验和反向纵跳测量的功能表现。此外，在随机对照试验之外，还将进行成本效益分析。评估将在基线、12周、26周和52周后进行。
本研究是首次在随机试验中直接比较阿尔弗雷德森和西尔贝纳格尔运动方案。研究结果可进一步扩大为跟腱中段肌腱病患者选择最合适运动方案的证据基础。
荷兰试验注册库：NTR5638。注册日期：2016年1月7日。
