Matthews Wesley, Ellis Richard, Furness James, Hing Wayne A
Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.
Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
PeerJ. 2021 Sep 28;9:e12166. doi: 10.7717/peerj.12166. eCollection 2021.
Achilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains.
A scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures.
A total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured.
There is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.
跟腱病描述了局限于跟腱的疼痛临床表现以及与肌腱负荷活动相关的功能丧失。然而，由于临床术语不一致、对病理生理学的认识不断演变以及缺乏被认为是诊断跟腱病金标准的临床检查的共识，临床医生对跟腱病的诊断方法存在差异。本范围综述的主要目的是提供一种与九个核心健康领域相一致的临床诊断跟腱病的方法。
进行了一项范围综述，以综合关于跟腱病临床诊断和临床结局测量的现有证据。提取的数据包括作者、出版年份、参与者特征、诊断跟腱病的方法和结局测量。
本范围综述共纳入159篇文章。最常用的主观测量方法是自我报告的疼痛部位，其他测量方法包括肌腱负荷活动时的疼痛、症状持续时间和肌腱僵硬。最常确定的跟腱病客观临床检查是肌腱触诊（包括触诊时疼痛、局限性肌腱增厚或局限性肿胀）。用于评估跟腱病的进一步客观检查包括负荷活动时的肌腱疼痛（单腿提踵和跳跃）以及皇家伦敦医院试验和疼痛弧征。VISA-A问卷是监测跟腱病最常用的结局测量方法。然而，心理因素（PES、TKS和PCS）和总体生活质量（SF-12、SF-36和EQ-5D-5L）的测量频率较低。
用于诊断跟腱病的方法和结局测量存在显著差异。提出了一种诊断跟腱病的方法，该方法包括范围综述的结果以及近期关于肌腱病报告结果的建议。
