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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  
  1. CI = confidence interval; ID = insufficient data; NR = not reported; PES = Pain Experience Index; SD = standard deviation; SMD = standard mean difference; wk = week; VAS = visual analogue scale; VISA-A = Victorian Institute of Sports Assessment – Achilles; VISA-A-S Victorian Institute of Sports Assessment – Achilles Swedish; VASa = pain during activity; VASj = pain during jumping; VASm = pain in the morning; VASo = pain overall; VASs = pain after sport & recreation; VASw = pain during walking.