12 Identification of prognostic factors for patient outcomes during exercise intervention for achilles tendinopathy: a systematic review and meta-analysis. (19th April 2018) - Färnqvist, Kenneth
Abstract : Introduction: Achilles tendinopathy (AT) is common among athletes and non-athletes and can impact physical function. Progressive rehabilitation is a common treatment and there is large variation in response both between individuals and studies. This systematic review aimed to synthesise current evidence on prognostic factors in AT exercise management. Materials and methods: Studies investigating prognostic factors during exercise intervention for AT were included. Risk of bias was assessed, effect sizes were calculated and where there was clinical homogeneity, data were pooled in meta-analyses. Results: Of 19 studies included average score for methodological quality was 6.4/12. Abnormal imaging did not predict returning to preinjury status (RR 1.38 [0.91, 2.08]. Absence of doppler signal did not predict better patient satisfaction SMD 0.27 [-0.10, 1.08], VISA MD 6.05 [-0.99, 13.10], or VAS outcomes SMD 0.22 [-0.18, 0.63]. Other ultrasound and MRI parameters in single studies did not predict outcome, including focal intratendinous lesion RR 1.02 [0.49, 2.15], focal lesion with high-intensity centre RR 1.30 [0.36, 4.68], spindle shape RR 1.39 [0.72, 2.67]. Only heterogeneous tendon structure predicted worse VAS outcome for pain during activity VAS SMD 0.54 [0.28, 0.79] and VAS palpation SMD 0.44 [0.35, 0.52]. Male gender was associated with greater reduction in VAS SMD 0.75 [0.46, 1.03] but overall gender showed conflicting evidence. There was strong evidence that age and duration of symptoms were not associated with outcome. Conclusion: One out of eight imaging measures predictive value. No psychosocial predictors were investigated and this is a gap in current knowledge.