Table 3 Physical therapies for Achilles tendinopathy
From: Physical therapies for Achilles tendinopathy: systematic review and meta-analysis
| Study | Intervention(s) | Sample size | Intervention duration (wk) | Comparison and outcome measure | SMD (95% CI) | Study conclusions (where SMD unable to be calculated) |
|---|---|---|---|---|---|---|
| ECCENTRIC EXERCISE | ||||||
| Mafi 2001 | A: Eccentric exercise | A: 22 | 12 | A vs B | 12wk: ID | Between groups comparisons of pain not presented; Significant within-group improvement in pain VAS for both eccentric and concentric exercise in those who were satisfied with treatment (p < 0.05) |
| B: Concentric exercise | B: 22 | VASa | ||||
| Niesen-Vertommen 1992 | A: Eccentric exercise | A: 8 | 12 | A vs B | 4wk: ID | Eccentric exercise had a greater reduction of pain (p < 0.01) |
| B: Concentric exercise | B: 9 | VASo | 8wk: ID | |||
| 12wk: ID | ||||||
| Rompe 2007 | A: Eccentric exercise | A: 25 | 12 | A vs B | 16wk:–1.26 (–1.87:–0.65) | |
| B: Wait and see approach | B: 25 | VISA-A | ||||
| Knobloch 2007 | A: Eccentric exercise | A: 15 | 12 | A vs B | 12wk: -1.67 (−2.83: -0.50) | |
| B: Cryotherapy | B: 5 | VASo | ||||
| Petersen 2007 | A: Eccentric exercise | A: 37 | 12 | A vs B | 6wk: ID | No difference between groups (p < 0.05) |
| B: Heel brace | B: 35 | VASa | 12wk: ID | |||
| 54wk: ID | ||||||
| Rompe 2008 | A: Shock wave therapy | A: 25 | A: 3 | B vs A | 16wk: -1.40 (−0.74: -2.06) | |
| B: Eccentric exercise | B: 25 | B: 12 | VISA-A | |||
| Chester 2008 | A: Eccentric exercise | A: 8 | A: 12 | A vs B | 6wk: 0.63 (−0.33: 1.58) | |
| B: Ultrasound | B: 8 | B: ≤6 | VASs | 12wk: 0.24 (−0.69: 1.17) | ||
| Silbernagel 2001 | A: Rehabilitation programme including single leg eccentric loading | A: 22 | 12 | A vs B | 6wk: ID | Eccentric loading had better strength and pain outcomes (p < 0.05) |
| B: 18 | VASj | 12wk: ID | ||||
| B: Rehabilitation programme | 26wk: ID | |||||
| 52wk: ID | ||||||
| Herrington 2007 | A: Eccentric exercise + deep friction massage + ultrasound + calf stretches | A: 13 | 12 | A vs B | 4wk: ID | Eccentric exercise produced superior pain and function outcomes (p = 0.01) |
| B: Deep friction massage + ultrasound + calf stretches | B: 12 | VISA-A | 8wk: ID | |||
| 12wk: ID | ||||||
| SHOCK WAVE THERAPY | ||||||
| Costa 2005 | A: Shock wave therapy | A: 22 | 12 | A vs B | 12wk: -0.44 (−1.01: 0.13) | |
| B: Sham shock wave therapy | B: 27 | VASw | 52 wk: ID | |||
| Rompe 2007 | A: Shock wave therapy | A: 25 | A: 3 | A vs B | 16wk: -1.03 (−1.62:-0.44) | |
| B: Wait and see approach | B: 25 | B: 12 | VISA-A | |||
| C: Eccentric exercise | C: 25 | C: 12 | A vs C | 16 wk: 0.29 (−0.27: 0.85) | ||
| VISA-A | ||||||
| Rompe 2008 | A: Shock wave therapy | A: 25 | A: 3 | A vs B | 16wk: -1.40 (−2.03: -0.78) | |
| B: Eccentric exercise | B: 25 | B: 12 | VISA-A | |||
| Rompe 2009 | A: Shock wave therapy + eccentric exercise | A: 34 | A: 12 | A vs B | 16wk: -0.76 (−1.28: -0.24) | |
| B: Eccentric exercise | B: 34 | B: 12 | VISA-A | |||
| Rasmussen 2008 | A: Shock wave therapy + conservative therapy | A: 24 | 4 | A vs B | 4wk: -0.52 (−1.10: 0.06) | |
| B: Sham shock wave therapy + conservative therapy | B: 24 | AOFAS | 8wk: ID | |||
| 12wk: ID | ||||||
| LASER THERAPY | ||||||
| Stergioulas 2008 | A: Laser therapy + eccentric exercise | A: 20 | 8 | A vs B | 4wk: -1.07 (−1.65: -0.49) | |
| B: Placebo laser therapy + eccentric exercise | B: 20 | VASa | 8wk: -1.14 (−1.82: -0.47) | |||
| 12wk: -0.78 (−1.42: -0.13) | ||||||
| Tumilty 2008 | A: Laser therapy + eccentric exercise | A: 10 | 12 | A vs B | 4wk: 0.53 (−0.36: 1.43) | |
| B: Placebo laser therapy + eccentric exercise | B: 10 | VASm | 12wk: -0.25 (−1.13: 0.64) | |||
| MICROCURRENT THERAPY | ||||||
| Chapman-Jones 2002 | A: Microcurrent therapy + eccentric exercise | A: 24 | 12 | A vs B | 12wk: ID | Microcurrent therapy produced superior pain, stiffness and function outcomes (p < 0.001) |
| B: Eccentric exercise11 | B: 24 | VASa | 26wk: ID | |||
| 52wk: ID | ||||||
| CONTINUED TENDON LOADING | ||||||
| Silbernagel 2007 | A: Rehabilitation programme + continued tendon loading activity | A: 26 | 12- 26 | A vs B | 6wk: -0.32 (−0.88: 0.25) | |
| B: Rehabilitation programme + no tendon loading activity (running or jumping) | B: 25 | VISA-A-S | 12wk: -0.17 (−0.73: 0.39) | |||
| 26wk: -0.12 (−0.68: 0.44) | ||||||
| 52wk: -0.55 (−1.11: 0.02) | ||||||
| NIGHT SPLINT | ||||||
| de Jonge 2010 | A: Night splint + eccentric exercise | A: 36 | 12 | A vs B | 4wk: -0.12 (−0.61: 0.37) | |
| B: Eccentric exercise | B: 34 | VISA-A | 12wk: 0.07 (−0.43: 0.56) | |||
| 52wk: -0.10 (−0.60: 0.40) | ||||||
| McAleenan 2010 | A: Night splint + eccentric exercise | A: 5 | 12 | A vs B | 12wk: -1.09 (−2.41: 0.22) | |
| B: Eccentric exercise | B: 6 | VISA-A | ||||
| HEEL BRACE | ||||||
| Knobloch 2008 | A: Heel brace + eccentric exercise | A: 43 | 12 | A vs B | 12wk: -0.29 (−0.70: 0.12) | |
| B: Eccentric exercise | B: 54 | VASo | ||||
| Petersen 2007 | A: Heel brace + eccentric exercise | A: 28 | 12 | A vs B | 6wk: ID | No difference between groups (p < 0.05) |
| B: Eccentric exercise | B: 37 | VASw | 12wk: ID | |||
| 54wk: ID | ||||||