School of Physiotherapy, University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA, 6959, Australia.
SportsMed Subiaco, St John of God Health Care, Subiaco, WA, Australia.
Sports Med. 2018 Aug;48(8):1875-1891. doi: 10.1007/s40279-018-0932-2.
Mid-portion Achilles tendinopathy is prevalent within both the athletic and non-athletic populations and loading protocols for Achilles tendinopathy are effective over time, though the rate of symptom change throughout rehabilitation is unknown.
The objective of this study was to determine the rate of change in pain and function over time in patients while completing a loading protocol for mid-portion Achilles tendinopathy.
A systematic review and longitudinal meta-analysis was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases PubMed, CINAHL (Ovid) and CINAHL (EBSCO) were searched for articles published from inception until 31 July, 2017. Our search focused on clinical trials and cohort studies examining changes in pain and function when completing a loading protocol for mid-portion Achilles tendinopathy. The primary outcome measure assessing pain and function was the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire.
A total of 31 separate cohorts (24 studies) were eligible, with follow-up ranging from 2 weeks to 6 months. The data were pooled to create the mean (standard deviation) of change from baseline at each time point. The data demonstrated an improvement in pain and function as early as 2 weeks that appeared to peak at 12 weeks with a mean (standard deviation) of 21.11 (6.61) points of change on the VISA-A.
The improvement in pain and function during rehabilitation suggests future research should be directed toward investigating contributing mechanisms as tendon structure on imaging does not change within 2 weeks and muscular hypertrophy is not seen for at least 4 weeks following the inception of a loading protocol. Systematic Review Registry: PROSPERO registration number: CRD42017062737 ( https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=62737 ).
中段跟腱病在运动员和非运动员人群中都很常见，而且随着时间的推移，跟腱病的负荷方案是有效的，尽管在康复过程中症状的变化率尚不清楚。
本研究的目的是确定在完成中段跟腱病负荷方案的过程中，患者的疼痛和功能随时间的变化率。
根据系统评价和荟萃分析的首选报告项目进行系统评价和纵向荟萃分析。从建库开始到 2017 年 7 月 31 日，在 PubMed、CINAHL（Ovid）和 CINAHL（EBSCO）数据库中搜索关于在完成中段跟腱病负荷方案时疼痛和功能变化的文章。我们的搜索重点是临床试验和队列研究，评估在完成中段跟腱病负荷方案时疼痛和功能的变化。评估疼痛和功能的主要指标是维多利亚运动评估-跟腱（VISA-A）问卷。
共有 31 个单独的队列（24 项研究）符合条件，随访时间从 2 周到 6 个月不等。数据被汇总以创建每个时间点从基线开始的变化的平均值（标准差）。数据显示，疼痛和功能早在 2 周内就有所改善，在 12 周时达到峰值，VISA-A 的平均（标准差）变化为 21.11（6.61）分。
康复过程中疼痛和功能的改善表明，未来的研究应该针对研究潜在的机制，因为在 2 周内，肌腱结构在影像学上没有改变，而且在负荷方案开始至少 4 周后才会出现肌肉肥大。系统评价登记号：PROSPERO 注册编号：CRD42017062737（https://www.crd.york.ac.uk/PROSPERO/display_record.php？RecordID=62737）。
