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The impact of surgery on the surgeon's well-being encompasses both physical and psychological aspects. Physically, surgeons are at risk of work-related musculoskeletal symptoms due to the nature of their work, and this risk can be impacted by theater environment, equipment design, and workload. Many symptoms will be self-limiting, but work related musculoskeletal symptoms can lead to the development of an injury, which can have far reaching effects, including the need for medical or surgical treatment, time away from work, or a change in clinical duties. Additionally, surgery can place a significant cognitive workload on the lead operator and this can be exacerbated, or alleviated, by the surgical environment, experience of the assistance, surgical modality, and case complexity. Measuring and quantifying the impact of surgery on the surgeon is a challenging undertaking. Tools such as motion capture, physiological markers, including heart rate variability and salivary cortisol, and questionnaires can provide insights into understanding the overall impact of surgery on the surgeon. A holistic approach that incorporates injury prevention strategies, communication, and support, is vital in assessing and mitigating risk factors. Injury prevention assessment tools and interventions that can be used within the busy surgical environment are needed, alongside increased ergonomic awareness. Addressing the impact of surgery on the surgeon is a multifaceted challenge, and long term positive changes can only be sustained with the support of the whole surgical team and healthcare organizations by developing and maintaining a supportive working environment.
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Examen Físico , Cirujanos , Humanos , Comunicación , Diseño de Equipo , HidrocortisonaRESUMEN
The objective of the study was to obtain adjusted ultrasonographic reference values of the Achilles tendon thickness (maximum anterior-posterior distance) in adults without (previous) Achilles tendinopathy (AT) and to compare these reference values with AT patients. Six hundred participants were consecutively included, comprising 500 asymptomatic individuals and 100 patients with clinically diagnosed chronic AT. The maximum tendon thickness was assessed using Ultrasound Tissue Characterization. A multiple quantile regression model was developed, incorporating covariates (personal characteristics) that were found to have a significant impact on the maximum anterior-posterior distance of the Achilles tendon. A 95% reference interval (RI) was derived (50th, 2.5th-97.5th percentile). In asymptomatic participants median (95% RI) tendon thickness was 4.9 (3.8-6.9) mm for the midportion region and 3.7 (2.8-4.8) mm for the insertional region. Age, height, body mass index, and sex had a significant correlation with maximum tendon thickness. Median tendon thickness for the midportion region was calculated with the normative equation -2.1 + AGE × 0.021 + HEIGHT × 0.032+ BMI × 0.028 + SEX × 0.05. For the insertional region, the normative equation was -0.34 + AGE × 0.010+ HEIGHT × 0.018 + BMI × 0.022 + SEX × -0.05. In the equations, SEX is defined as 0 for males and 1 for females. Mean (95% CI) difference in tendon thickness compared to AT patients was 2.7 mm (2.3-3.2, p < 0.001) for the midportion and 1.4 mm (1.1-1.7, p < 0.001) for the insertional region. Compared to the asymptomatic population 73/100 (73%) AT patients exhibited increased tendon thickening, with values exceeding the 95% RI. This study presents novel reference values for the thickness of midportion and insertional region of the Achilles tendon, which were adjusted for personal characteristics. Our novel web-based openly accessible calculator for determining normative Achilles tendon thickness (www.achillestendontool.com) will be a useful resource in the diagnostic process. Trial registration number: This trial is registered in the Netherlands Trial Register (NL9010).
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Tendón Calcáneo , Tendinopatía , Ultrasonografía , Humanos , Tendón Calcáneo/diagnóstico por imagen , Tendón Calcáneo/anatomía & histología , Tendón Calcáneo/patología , Masculino , Femenino , Tendinopatía/diagnóstico por imagen , Tendinopatía/patología , Estudios Transversales , Adulto , Persona de Mediana Edad , Valores de Referencia , Anciano , Índice de Masa Corporal , Adulto Joven , Factores SexualesRESUMEN
INTRODUCTION: Ultrasound is the preferred imaging method in the diagnostic process of Achilles tendinopathy (AT). Ultrasound tissue characterization (UTC) is a frequently used, standardized and valid method to assess tendon geometry in AT patients. It is unknown whether UTC is reliable for measuring Achilles tendon thickness. The aim of the study was to assess intra- and inter-rater reliability of Achilles tendon thickness measurements using UTC in both asymptomatic individuals and patients with AT, and to evaluate if the reliability of thickness measurements differs between the midportion and insertional area. METHODS: Exactly 50 patients with AT and 50 asymptomatic individuals were included. Using the conventional US and standardized UTC procedure maximum thickness was measured in the midportion and insertion region. To determine inter- and intra-rater reliabilities, the intraclass correlation coefficient (ICC) was used. RESULTS: The ICC values for inter- and intra-rater reliability were classified as "excellent," for the AT group (0.93 [95% CI: 0.88-0.96] and 0.95 [0.92-0.97]) and asymptomatic participants (0.91 [0.87-0.94] and 0.94 [0.92-0.96]). The reliability of measuring tendon thickness in the midportion region was "excellent," with both inter-rater (0.97 [0.95-0.98]) and intra-rater (0.98 [0.96-0.99]) ICC values indicating high levels of agreement. In the insertional region, ICC values for inter-rater (0.79 [0.69-0.87]) and intra-rater (0.89 [0.84-0.93]) reliability were "moderate to good." CONCLUSION: We showed excellent reliability for measuring the US thickness of the midportion and good reliability of measuring the insertional region in patients with AT. Significantly lower ICCs were observed for the reliability of thickness measurements in the insertional region when compared with the midportion.
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Tendón Calcáneo , Tendinopatía , Humanos , Tendón Calcáneo/diagnóstico por imagen , Reproducibilidad de los Resultados , Tendinopatía/diagnóstico por imagen , Ultrasonografía/métodosRESUMEN
OBJECTIVE: To develop and evaluate a modified version of the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire, for use in sedentary patients with Achilles tendinopathy, using the Consensus-based Standards for the selection of health Measurement Instruments recommendations. METHODS: Twenty-two sedentary patients with Achilles tendinopathy completed the VISA-A and provided feedback regarding the relevance, comprehensiveness and comprehensibility of each item, response options and instructions. Patient and professional feedback was used to develop the VISA-A (sedentary) questionnaire. Reliability, validity and responsiveness of the VISA-A (sedentary) was evaluated in 51 sedentary patients with Achilles tendinopathy: 47.1% women, mean age 64.8 (SD 11.24). RESULTS: Factor analysis identified two dimensions (symptoms and activity) for the VISA-A (sedentary). Test-retest reliability was excellent for symptoms (intraclass correlation coefficient, ICC=0.991) and activity (ICC=0.999). Repeatability was 1.647 for symptoms and 0.549 for activity. There was a significant difference between the VISA-A and VISA-A (sedentary) scores both pretreatment and post-treatment. There was stronger correlation between the pretreatment to post-treatment change in the VISA-A (sedentary) scores (r=0.420 for symptoms, r=0.407 for activity) and the global rating of change than the VISA-A scores (r=0.253 for symptoms, r=0.186 for activity). CONCLUSION: The VISA-A (sedentary) demonstrates adequate reliability, validity and responsiveness in sedentary patients with Achilles tendinopathy. The VISA-A (sedentary) is a more appropriate measure than the VISA-A for this cohort and is recommended for clinical and research purposes.
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Tendón Calcáneo , Tendinopatía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Lista de Verificación , Reproducibilidad de los Resultados , Conducta Sedentaria , Encuestas y Cuestionarios , Tendinopatía/terapia , Tendinopatía/diagnóstico , AncianoRESUMEN
OBJECTIVE: To determine the role of ultrasound tissue characterization (UTC) in predicting, diagnosing, and monitoring tendon structure and/or tendinopathy. In addition, this study aims to provide recommendations for standardized methodology of UTC administration and analysis. DATA SOURCE: The PubMed, Embase, and Web of Science databases were searched (up to September 2018). All scientific literature concerning the use of UTC in assessing tendons was collected. The initial search resulted in a total of 1972 hits, and after screening by eligibility criteria, 27 articles were included. RESULTS: In total, 18 investigating the Achilles tendon, 5 the patellar tendon, and 4 both Achilles and patellar tendons were included. The methods of UTC administration and analysis differed and were not uniform. The studies showed that the use of UTC to predict Achilles tendinopathy (AT) is inconclusive, but that a higher amount of tendon disorganization increases the risk of developing patellar tendinopathy (PT). In terms of diagnosis, UTC might provide additional information in AT cases. In addition, promising results were found for the use of UTC in both AT and PT in monitoring the effect of load or treatment on tendon structure. CONCLUSION: More research regarding the use of UTC in predicting tendon pathology is required. Ultrasound tissue characterization seems useful as an adjunct diagnostic modality because it can be used to differentiate symptomatic from asymptomatic tendons. In addition, UTC is a promising device to be used to monitor changes in tendon structure in response to load or treatment. Moreover, we provide recommendations of a standardized protocol concerning the methods of UTC measurement and analysis.
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Tendón Calcáneo , Ligamento Rotuliano , Tendinopatía , Tendón Calcáneo/diagnóstico por imagen , Humanos , Rótula , Ligamento Rotuliano/diagnóstico por imagen , Tendinopatía/diagnóstico por imagen , UltrasonografíaRESUMEN
BACKGROUND: This randomised crossover study with repeated measures examined the influence of the three most common foot starting positions used in conducting the calf raise test (CRT) on test outcomes. This study also accounted for the potential influence of gender, age, body mass index (BMI), and level of physical activity on test outcomes. METHODS: Forty-nine healthy individuals (59 % female, 21 ± 4 years) performed single-leg calf raise repetitions in a human movement laboratory in three randomised foot starting positions: flat, 10° incline, and step. The validated Calf Raise application was used to track the vertical displacement of a marker placed on the foot using computer vision. The application extracted the following CRT outcomes from the vertical displacement curve: number of repetitions, peak vertical height, total vertical displacement, and total positive work. Data were analysed using mixed-effects models and stepwise regression. RESULTS: There was a significant main effect (P < 0.001) of foot starting position on all outcomes, with all paired comparisons being statistically significant (P ≤ 0.023). Repetitions, total vertical displacement, and total positive work were greatest in flat and lowest in step, whereas peak vertical height was greatest in incline and lowest in step. Gender (P = 0.021; males>females) and BMI (P = 0.002; lower BMI>higher BMI) significantly influenced the number of repetitions. Gender (P < 0.001; males>females) also influenced total positive work. Age and physical activity levels did not significantly influence CRT outcomes. CONCLUSIONS: CRT foot starting position mattered and significantly affected all CRT outcomes. CRT foot starting position needs consideration when contrasting data in research and practice.
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BACKGROUND: Quadriceps strength testing is recommended to guide rehabilitation and mitigate the risk of second injury following anterior cruciate ligament (ACL) reconstruction. Hand-held dynamometry is a practical alternative to electromechanical dynamometry but demonstrates insufficient reliability and criterion validity in healthy and ACL-reconstructed participants respectively. The purpose of this study is to investigate the reliability and concurrent validity of inline dynamometry for measuring quadriceps strength. The hypotheses are that intra-class correlation coefficient (ICC) values will be >0.90 for reliability and concurrent validity. METHODS: This was a cross sectional study using a within-participant, repeated measures design. Isometric quadriceps testing was performed at 60° knee flexion in 50 healthy and 52 ACL-reconstructed participants. Interrater reliability, intrarater reliability, and concurrent validity of inline dynamometry was investigated through calculation of ICCs, Bland-Altman analysis, linear regression, standard error of measurement (SEM) and minimal detectable change (MDC). RESULTS: The lower bounds of the 95% confidence intervals were >0.90 for all reliability and validity ICCs in healthy and ACL-reconstructed participants, except for intrarater reliability in healthy participants using absolute scores (ICC = 0.936 [95% CI 0.890-0.963]). In ACL-reconstructed participants, Bland-Altman bias was 0.01 Nm/kg for absolute and average scores, limits of agreement were -11.74% to 12.59% for absolute scores, the SEM was 0.13Nm/kg (95% CI 0.10-0.17) and the MDC was 0.36Nm/kg (95% CI 0.28 - 0.47). CONCLUSION: Inline dynamometry is a reliable and economical alternative to electromechanical dynamometry for the assessment of quadriceps strength following ACL-reconstruction. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT05109871).
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Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Humanos , Estudios Transversales , Reproducibilidad de los Resultados , Fuerza Muscular , Músculo Cuádriceps , Lesiones del Ligamento Cruzado Anterior/cirugíaRESUMEN
BACKGROUND: Achilles tendon rupture (ATR) account for 10.7% of all tendon and ligament injuries and causes lasting muscular deficits and have a profound impact on patients' quality of life. The incidence, characteristics and management of ATR in the United Kingdom (UK) is poorly understood. This investigation aims to understand the incidence of ATR in the UK. METHODS: Prospective data collection of ATR incidence from a United Kingdom Emergency department. Retrospective review of management protocols and immobilisation duration from electronic medical records. RESULTS: ATR incidence is 8 per 100,000 people per annum. Participants were predominately male (79.2%) and primarily reported a sporting mechanism of injury (65.2%). Mean immobilisation duration was 63.1 days. 97.1% were non-surgically managed post ATR. 46.2% of participants had experienced a previous ATR or Achilles tendinopathy prior to their current ATR. CONCLUSION: The incidence of ATR found was 8. cases per 100,000 people per annum. Most ATR were managed non-surgically in this cohort. The majority of ruptures occurred during sporting activity. Almost one quarter (23.3%) of individuals report Achilles pain prior to ATR.
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Tendón Calcáneo , Traumatismos de los Tendones , Humanos , Tendón Calcáneo/lesiones , Masculino , Femenino , Rotura , Incidencia , Adulto , Persona de Mediana Edad , Reino Unido/epidemiología , Traumatismos de los Tendones/epidemiología , Traumatismos de los Tendones/terapia , Anciano , Estudios Retrospectivos , Adulto Joven , Estudios Prospectivos , Traumatismos en Atletas/epidemiología , Traumatismos en Atletas/terapia , AdolescenteRESUMEN
OBJECTIVES: To determine the feasibility of completing a definitive randomised controlled trial (RCT), evaluating the clinical and cost-effectiveness of Cognitive Functional Therapy (CFT) in comparison to usual physiotherapy care (UPC), for people with persistent low back pain (LBP). DESIGN AND SETTING: A two-arm parallel feasibility RCT completed in a United Kingdom (UK) Secondary Care National Health Service (NHS) physiotherapy service. PARTICIPANTS: Sixty adult participants who reported LBP lasting for more than three months, that was not attributable to a serious (e.g. cancer) or specific (e.g. radiculopathy) underlying cause, were invited to participate. Participants were allocated at random to receive CFT or UPC. INTERVENTIONS: Cognitive Functional Therapy and Usual Physiotherapy Care for persistent LBP. MAIN OUTCOME MEASURES: The primary outcome was the feasibility of completing a definitive RCT, defined by recruitment of at least 5 participants per month, delivery of CFT per protocol and securing relevant and acceptable outcome measures. Data concerning study processes, resources, management and participant reported outcome measures were collected at baseline, 3, 6 and 12-month follow-up. RESULTS: Sixty participants (nâ¯=â¯30 CFT and nâ¯=â¯30 UPC) were recruited with 80% (nâ¯=â¯48), 72% (nâ¯=â¯43) and 53% (nâ¯=â¯32) retained at 3, 6 and 12-month follow-up respectively. NHS physiotherapists were trained to competence and delivered CFT with fidelity. CFT was tolerated by participants with no adverse events. Relevant and clinically important outcome data were collected at all time points (0.4%, 3%, 1% and 0.8% of data was missing from the returned outcome measure booklets at baseline and 3, 6 and 12-month follow-up respectively). The Roland-Morris disability questionnaire was considered the most suitable primary outcome measure with a proposed sample size of 540 participants for a definitive cluster RCT. CONCLUSION: It is feasible to conduct a randomised study of CFT in comparison to UPC for NHS patients. A future study should incorporate an internal pilot to address aspects of feasibility further, including participant retention strategies. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN12965286 CONTRIBUTION OF THE PAPER.
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Terapia Cognitivo-Conductual , Análisis Costo-Beneficio , Estudios de Factibilidad , Dolor de la Región Lumbar , Modalidades de Fisioterapia , Medicina Estatal , Humanos , Dolor de la Región Lumbar/rehabilitación , Dolor de la Región Lumbar/terapia , Masculino , Femenino , Reino Unido , Persona de Mediana Edad , Adulto , Terapia Cognitivo-Conductual/métodosRESUMEN
OBJECTIVE: To identify which psychological and psychosocial constructs to include in a core outcome set to guide future clinical trials in the tendinopathy field. DESIGN: Modified International Delphi study. METHODS: In 3 online Delphi rounds, we presented 35 psychological and psychosocial constructs to an international panel of 38 clinician/researchers and people with tendinopathy. Using a 9-point Likert scale (1 = not important to include, 9 = critical to include), consensus for construct inclusion required ≥70% of respondents rating "extremely critical to include" (score ≥7) and ≤15% rating "not important to include" (score ≤3). Consensus for exclusion required ≥70% of respondents rating "not important to include" (score ≤3) and ≤15% of rating "critical to include" (score ≥7). RESULTS: Thirty-six participants (95% of 38) completed round 1, 90% (n = 34) completed round 2, and 87% (n = 33) completed round 3. Four constructs were deemed important to include as part of a core outcome set: kinesiophobia (82%, median: 8, interquartile range [IQR]: 1.0), pain beliefs (76%, median: -7, IQR: 1.0), pain-related self-efficacy (71%, median: 7, IQR: 2.0), and fear-avoidance beliefs (73%, median: -7, IQR: 1.0). Six constructs were deemed not important to include: perceived injustice (82%), individual attitudes of family members (74%), social isolation and loneliness (73%), job satisfaction (73%), coping (70%), and educational attainment (70%). Clinician/researchers and people with tendinopathy reached consensus that kinesiophobia, pain beliefs, pain self-efficacy, and fear-avoidance beliefs were important psychological constructs to measure in tendinopathy clinical trials. J Orthop Sports Phys Ther 2024;54(1):1-12. Epub 20 September 2023. doi:10.2519/jospt.2023.11903.
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Dolor , Tendinopatía , Humanos , Técnica Delphi , Miedo , Autoeficacia , Tendinopatía/terapiaRESUMEN
OBJECTIVES: To examine the strength of the relationship between plantarflexor power and strength-endurance metrics and 10-m sprint times in male Rugby Union players. A secondary aim was to examine the strength of the relationship within calf muscle metrics. DESIGN: Observational cross-sectional correlational. SETTING: Field-based. PARTICIPANTS: Sixteen male Rugby Union players in the National Provincial Championship. MAIN OUTCOME MEASURES: Participants completed three single-leg calf muscle tests: bodyweight power, weighted power, and strength-endurance. Data were recorded using the Calf Raise application. Three-to-four days later, average and best 10-m sprint performances were collected using timing lights. RESULTS: There were large significant correlations between 10-m sprint performances (average and best times) and calf muscle power (weighted) and strength-endurance (total displacement and work) metrics (r = -0.503 to -0.628). There were large significant correlations between bodyweight and weighted power, weighted power and strength-endurance (total displacement and work), and most strength-endurance metrics (r = 0.520 to 0.943). CONCLUSIONS: Our findings emphasise the importance of triceps surae muscle power and strength-endurance for maximal-effort accelerations and sprint performances in Rugby Union. Our data indicate that weighted power and total work from strength-endurance tests are the most useful metrics for further investigation in the context of short sprints and acceleration.
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Rendimiento Atlético , Fútbol Americano , Carrera , Humanos , Masculino , Rendimiento Atlético/fisiología , Carrera/fisiología , Pierna , Fútbol Americano/fisiología , Estudios Transversales , Rugby , Fuerza Muscular/fisiología , Músculo Esquelético/fisiologíaRESUMEN
INTRODUCTION: Exercise therapy is usually prescribed as first-line treatment for lower limb tendinopathies. The multitude of exercise- and non-exercise-based management options can be overwhelming for the treating sports professional and patient alike. We chose to investigate the comparative effectiveness of exercise therapy with or without adjuncts for managing the commonest lower limb tendinopathies. METHODS: Through an extensive systematic literature search using multiple databases, we aimed to identify eligible randomised controlled trials (RCTs) on Achilles tendinopathy, patellar tendinopathy or greater trochanteric pain syndrome (GTPS) that included at least one exercise intervention in their treatment arms. Our primary outcomes were patient-reported pain and function (Victorian Institute of Sport Assessment; VISA). Follow-up was defined as short-term (≤ 12 weeks), mid-term (> 12 weeks to < 12 months) and long-term (≥ 12 months). The risk of bias and strength of evidence were assessed with the Cochrane Collaboration and GRADE-NMA tools, respectively. Analyses were performed separately for each one of the three tendinopathies. RESULTS: A total of 68 RCTs were included in the systematic review. All pairwise comparisons that demonstrated statistically and clinically significant differences between interventions were based on low or very low strength of evidence. Based on evidence of moderate strength, the addition of extracorporeal shockwave therapy to eccentric exercise in patellar tendinopathy was associated with no short-term benefit in pain or VISA-P. From the network meta-analyses, promising interventions such as slow resistance exercise and therapies administered alongside eccentric exercise, such as topical glyceryl trinitrate for patellar tendinopathy and high-volume injection with corticosteroid for Achilles tendinopathy were based on low/very low strength of evidence. CONCLUSION: In this network meta-analysis, we found no convincing evidence that any adjuncts administered on their own or alongside exercise are more effective than exercise alone. Therefore, we recommend that exercise monotherapy continues to be offered as first-line treatment for patients with Achilles and patellar tendinopathies and GTPS for at least 3 months before an adjunct is considered. We provide treatment recommendations for each tendinopathy. PROSPERO registration number CRD42021289534.
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INTRODUCTION: Plantar flexor weakness is an identified prospective factor for developing Achilles tendinopathy. Various authors have reported relationships between symptoms and weakness of this muscle group. Despite this relationship, many clinicians and researchers fail to examine Plantar flexor strength due to the cumbersome, stationary and expensive nature of an isokinetic dynamometer (IKD), known as the "Gold Standard". This study examined the validity and reliability of a fast, easy and portable device for assessing plantarflexion. METHODS: Validity between the Cybex NORM® by Humac and the C-Station by Fysiometer was explored using Pearson correlation coefficient. Participants were randomly selected to start in the Cybex NORM® or the FysioMeter C-Station. Intra-rater reliability on the C-station was investigated by test-retest two days apart using Intraclass Correlation Coefficient (ICC). All testing involved isometric maximal force of the soleus muscle with the knee at 90 degrees flexion. RESULTS: 40 healthy university students were recruited for the validity part, while 65 healthy university students were recruited for the reliability part of the study. The mean peak torque on the IKD was 198.55Nm (SD 94.45) versus 1443.88 (412.82)N on the C-Station. The results of the Pearson correlation revealed an r-value of r = 0.72 with a 95%CI 0.52-0.84. The test re-test reliability was calculated as an ICC of 0.91 with a (95%CI 0.86-0.94). CONCLUSIONS: The C-Station by Fysiometer appears to provide valid measures and have excellent reliability for Plantar flexor isometric strength. It would appear suitable for both clinical and research work.
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Tendón Calcáneo , Tendinopatía , Humanos , Reproducibilidad de los Resultados , Estudios Prospectivos , Fuerza Muscular/fisiología , Dinamómetro de Fuerza Muscular , Músculo Esquelético/fisiología , Contracción Isométrica/fisiologíaRESUMEN
OBJECTIVES: The primary aim was to establish normative values of isometric plantarflexor muscle strength in professional male rugby union players and compare forwards with backs. The secondary aims were to examine how individual playing position or age influences isometric plantarflexor strength. DESIGN: Cross-sectional. SETTING: Testing at professional rugby clubs. PARTICIPANTS: 355 players (201 forwards and 154 backs) from 9 clubs in the English Premiership club competition. MAIN OUTCOME MEASURES: Maximal unilateral isometric plantarflexion strength was measured, using a Fysiometer C-Station, in a seated position with a flexed knee and in maximal available dorsiflexion. Values are reported normalised to body mass and specific to playing position. RESULTS: Mean combined limb isometric plantarflexion strength for the group was 193.1 kg (SD 32) or 1.86 xBW. (SD 0.31). Forwards were significantly weaker than backs (forwards = 1.75xBW (SD 0.26), backs = 2.00xBW (SD 0.28) (p=<0.0001)). Age category revealed no influence on plantarflexor strength. CONCLUSION: This study presents normative isometric plantarflexion strength values for professional male rugby union players. Forwards are typically relatively weaker than backs.
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Fútbol Americano , Fuerza Muscular , Humanos , Masculino , Fuerza Muscular/fisiología , Estudios Transversales , Rugby , Fútbol Americano/fisiología , AtletasRESUMEN
Tendinopathy describes a spectrum of changes that occur in damaged tendons, leading to pain and reduced function that remains extremely challenging for all clinicians. There is an increasing awareness of the influence that psychological and psychosocial components, such as self-efficacy and fear-avoidance, have on rehabilitation outcomes in musculoskeletal medicine. Although it is widely accepted that psychological/psychosocial factors exist in tendinopathy, there is currently a distinct lack of trials measuring how these factors affect clinical outcomes. Biopsychosocial treatments acknowledge and address the biological, psychological and social contributions to pain and disability are currently seen as the most efficacious approach to chronic pain. Addressing and modulating these factors are crucial in the pathway of personalised treatments in tendinopathy and offer a real opportunity to drive positive outcomes in patients. In this education review, we also provide the current evidence-based guidance on psychological and psychosocial developments in musculoskeletal medicine and how these may be translated to treating tendinopathy using a biopsychosocial model.
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OBJECTIVE: To identify and describe the psychological and psychosocial constructs and outcome measures used in tendinopathy research. DESIGN: Scoping review. LITERATURE SEARCH: We searched the PubMed, EMBASE, Scopus, Web of Science, PEDro, CINAHL, and APA PsychNet databases on July 10, 2021, for all published studies of tendinopathy populations measuring psychological and psychosocial factors. STUDY SELECTION: Studies using a clinical diagnosis of tendinopathy or synonyms (eg, jumper's knee or subacromial impingement) with or without imaging confirmation. DATA SYNTHESIS: We described the volume, nature, distribution, and characteristics of psychological and psychosocial outcomes reported in the tendinopathy field. RESULTS: Twenty-nine constructs were identified, including 16 psychological and 13 psychosocial constructs. The most frequently-reported constructs were work-related outcomes (32%), quality of life (31%), depression (30%), anxiety (18%), and fear (14%). Outcome measures consisted of validated and nonvalidated questionnaires and 1-item custom questions (including demographics). The number of different outcome measures used to assess an individual construct ranged between 1 (emotional distress) and 11 (quality of life) per construct. CONCLUSION: There was a large variability in constructs and outcome measures reported in tendinopathy research, which limits conclusions about the relationship between psychological and psychosocial constructs, outcome measures, and tendinopathies. Given the wide range of psychological and psychosocial constructs reported, there is an urgent need to develop a core outcome set in tendinopathy. J Orthop Sports Phys Ther 2022;52(6):375-388. doi:10.2519/jospt.2022.11005.
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Calidad de Vida , Tendinopatía , Ansiedad/psicología , Miedo , Humanos , Evaluación de Resultado en la Atención de Salud , Tendinopatía/terapiaRESUMEN
BACKGROUND: Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated. OBJECTIVE: To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains. DESIGN: Systematic review. DATA SOURCES: Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series. RESULTS: 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain. CONCLUSION: 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures. PROSPERO REGISTRATION: CRD42020156763.
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Tendón Calcáneo , Tendinopatía , Humanos , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Tendinopatía/terapiaRESUMEN
BACKGROUND: Achilles tendinopathy (AT) is common, and can be traumatic or insidious in onset and short-lasting or persistent in nature. Factors influencing the experience of pain are poorly understood; little is known about mechanisms driving pain and the response (or lack of) to rehabilitation. Despite this, there is a growing body of evidence supporting the use of exercise to manage AT. Interestingly, variation in exercise approach does not appear to significantly impact outcome. Patients' perceptions of factors related to rehabilitation that may influence outcome could provide a valuable addition to help guide future research and practice. OBJECTIVES: The aim of this study is to gain an insight into patients' experiences of participating in an exercise-based rehabilitation programme for AT. METHOD: A qualitative interpretive description design. Data generated from semi-structured interviews were analysed thematically using the guidelines set out by Braun and Clarke. FINDINGS: This is the first study to use a qualitative method of inquiry to gain data on the experiences of people undertaking exercise-based rehabilitation for AT. The four major themes that were identified from the data were: (1) 'understanding the impact' (2) 'expectations' (3) 'what matters' and (4) 'the burden of exercise'. CONCLUSIONS: Given the uncertainty surrounding the mechanisms of effect of our treatments, the insights provide a platform from which researchers and clinicians can consider further in the management of people with Achilles tendinopathy. Specifically, it has highlighted that patients value a flexible, supportive approach embracing the biopsychosocial impact of AT on the individual.
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Tendón Calcáneo , Tendinopatía , Ejercicio Físico , Terapia por Ejercicio , Humanos , Investigación CualitativaRESUMEN
BACKGROUND: Greater Trochanteric Pain syndrome (GTPS) is a condition causing lateral hip pain, which can be both persistent and debilitating. Data suggests that NHS patients with GTPS often have complex presentations with greater risk of developing persistent pain. No research to date has looked to understand the lived experience of patients with GTPS. OBJECTIVES: This data may help inform a programme of intervention development for testing in a future randomised controlled trial. Hence, this qualitative study aimed to provide insight into the experiences and perceptions of patients suffering with GTPS. DESIGN: Qualitative study using semi-structured interviews. METHODS: Ten patients diagnosed with GTPS in consultant-led clinic at one NHS Hospital. Patients were identified from the physiotherapy waiting list and approached via a postal letter. Once informed consent was gained, semi-structured telephone interviews were conducted, transcribed verbatim and analysed using the Framework Method. RESULTS: Data were analysed with reference to five pre-determined themes (1) living with persistent pain; (2) understanding the problem and pain; (3) experiences of previous treatment; (4) beliefs about activity and exercise; (5) the future. CONCLUSION: The participants with GTPS, interviewed in this study commonly suffered from debilitating pain, affecting them during activity and at rest. They were confused about the diagnoses they were given and the meaning of their pain in relation to activity. Furthermore, participants were often either uncertain or pessimistic about their potential to recover. CLINICAL TRIALS REGISTRY: ClinicalTrials.gov Identifier: NCT03720587.
Asunto(s)
Dolor Crónico/fisiopatología , Dolor Crónico/psicología , Fémur/lesiones , Fémur/fisiopatología , Dolor Musculoesquelético/psicología , Adulto , Anciano , Anciano de 80 o más Años , Dolor Crónico/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Musculoesquelético/epidemiología , Dolor Musculoesquelético/fisiopatología , Encuestas y Cuestionarios , Reino Unido/epidemiologíaRESUMEN
OBJECTIVES: Determine how the strength and endurance of the plantar flexors are affected by Achilles tendinopathy and whether one muscle is more affected than another. DESIGN: Case control study. SETTING: University Laboratory. PARTICIPANTS: 39 Runners with mid-portion Achilles tendinopathy and 38 healthy runners participated in this study. MAIN OUTCOME MEASURES: Isokinetic dynamometry was completed bilaterally in two knee positions on all subjects to assess the torque and endurance capacity of the plantar flexors. RESULTS: Subjects with Achilles tendinopathy were statistically weaker (by 26.1Nm Concentric 90°/sec, 14,8Nm Concentric 225°/sec and 55.5Nm Eccentric 90°/sec for knee extended testing and 17.3Nm, 10.1Nm and 52.3Nm for the flexed knee respectively) than healthy controls at all isokinetic test speeds and contraction modes irrespective of knee position (p value = <0.001). The endurance capacity of the plantar flexors was significantly reduced (Total work done 613.5Nm less) in subjects with Achilles tendinopathy when compared to the healthy controls (p value = <0.001). CONCLUSIONS: Achilles tendinopathy is associated with large deficits in plantar flexor torque and endurance. The deficits are bilateral in nature and appear to be explained by a greater loss of the soleus force generating capacity rather than the gastrocnemius.