Abdelkader Nasr Awad, Helmy Mohamed Nasser Kise, Fayaz Nadia Abdelazem, Saweeres Emad S B
Faculty of Physical Therapy, Cairo University, Giza, Egypt.
October 6th Hospital, Ministry of Health, Giza, Egypt.
Foot Ankle Int. 2021 Jun;42(6):788-797. doi: 10.1177/1071100720982613. Epub 2021 Jan 15.
Earlier randomized controlled trials (RCTs) reported only midterm (3-4 months) results of extracorporeal shockwave therapy (ESWT) as a treatment for noninsertional Achilles tendinopathy (NAT). This study compared the effectiveness of an eccentric loading program followed by stretching exercises combined with ESWT (study group) or sham ESWT (control group) for treating chronic NAT in both the short and long term.
This double-blind RCT was conducted between 2018 and 2020. Adult patients with unilateral NAT who failed standard conservative treatment were randomly allocated to either group. Function and pain were assessed at baseline, 1 month, and 16 months using the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) and visual analog scale (VAS), respectively. Mixed-design analysis of variance and nonparametric statistics were performed. Twenty-two men and 28 women aged 18 to 40 years were allocated into 2 equally matched groups.
Function and pain scores in the study group were not significantly different from control group scores at baseline (VISA-A: 22.2 ± 6.5 vs 21.0 ± 5.2 and VAS: 8 ± 1 vs 8 ± 1, respectively). Both groups significantly improved posttreatment (VISA-A: 85 ± 6.2 vs 53.4 ± 7.7 and VAS: 1 ± 2 vs 7 ± 2, respectively). At the 16-month follow-up, outcome scores declined slightly but significantly in the study group (VISA-A: 80 ± 5.3; VAS: 3 ± 2) and improved in the control group (VISA-A: 67 ± 5.6; VAS: 5 ± 1). However, both groups were significantly better than baseline. At both time points, the study group had significantly superior scores (statistically and clinically) than the control group ( = .0001).
Combining calf eccentric loading with stretching exercises resulted in significant improvements in the pain and functional scores in patients with NAT. Adding ESWT to this combined protocol resulted in significantly greater improvements in both the short and long term.
Level I, randomized controlled trial.
早期的随机对照试验（RCT）仅报告了体外冲击波疗法（ESWT）治疗非插入性跟腱病（NAT）的中期（3 - 4个月）结果。本研究比较了离心负荷训练结合拉伸运动联合ESWT（研究组）或假ESWT（对照组）在短期和长期治疗慢性NAT中的有效性。
这项双盲RCT于2018年至2020年进行。将标准保守治疗失败的单侧NAT成年患者随机分配到两组。分别在基线、1个月和16个月时，使用维多利亚运动评估 - 跟腱问卷（VISA - A）和视觉模拟量表（VAS）评估功能和疼痛情况。进行了混合设计方差分析和非参数统计。将22名男性和28名年龄在18至40岁之间的女性分为两个匹配度相当的组。
研究组的功能和疼痛评分在基线时与对照组评分无显著差异（VISA - A分别为：22.2 ± 6.5对21.0 ± 5.2；VAS分别为：8 ± 1对8 ± 1）。两组治疗后均有显著改善（VISA - A分别为：85 ± 6.2对53.4 ± 7.7；VAS分别为：1 ± 2对7 ± 2）。在16个月的随访中，研究组的结果评分略有下降但仍显著（VISA - A：80 ± 5.3；VAS：3 ± 2），而对照组有所改善（VISA - A：67 ± 5.6；VAS：5 ± 1）。然而，两组均显著优于基线水平。在两个时间点，研究组的评分（在统计学和临床上）均显著高于对照组（P = .0001）。
小腿离心负荷训练与拉伸运动相结合可使NAT患者的疼痛和功能评分显著改善。在此联合方案中加入ESWT在短期和长期均能带来更显著的改善。
I级，随机对照试验。
