ABSTRACT
OBJECTIVES: To determine whether baseline physical tests have a prognostic value on patient-reported outcomes in Achilles tendinopathy. DESIGN: Prospective cohort study, secondary analysis of data from a randomized trial. METHODS: Patients with chronic midportion Achilles tendinopathy performed a progressive calf muscle exercise program. At baseline and after 2, 6, 12 and 24â¯weeks, patients completed the Victorian Institute of Sports Assessment-Achilles questionnaire and performed the following physical tests: ankle dorsiflexion range of motion with a bent knee or an extended knee, calf muscle strength, jumping height and pain on palpation (Visual Analogue Scale; 0-100) and after 10 hops (Visual Analogue Scale-10-hops). Associations between baseline test results and improvement (Victorian Institute of Sports Assessment-Achilles scores) were determined using a Mixed Linear Model. RESULTS: 80 patients were included. The mean Victorian Institute of Sports Assessment-Achilles score improved 20 points (95â¯% confidence interval, 16-25, Pâ¯<â¯.001) after 24â¯weeks. There were significant associations between the baseline ankle dorsiflexion range of motion with a bent knee (ß 0.2, 95â¯% confidence interval 0.001 to 0.3, Pâ¯=â¯.049), the baseline pain provocation tests (Visual Analogue Scale palpation: ß -0.2; 95â¯% confidence interval: -0.4 to -0.1; Pâ¯<â¯.001, Visual Analogue Scale-10-hops: ß -0.3; 95â¯% confidence interval: -0.4 to -0.2; Pâ¯<â¯.001) and the change in the Victorian Institute of Sports Assessment-Achilles score. CONCLUSIONS: In patients with chronic midportion Achilles tendinopathy, easy-to-perform pain provocation tests have a clinically relevant prognostic value on patient-reported improvement. Patients with less pain during pain provocation tests at baseline have a better improvement in pain, function and activities after 24â¯weeks than patients with high baseline pain scores.
