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ICON 2020—International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy

  • Systematic Review
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Abstract

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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Acknowledgements

The authors wish to thank W.M. Bramer from the Erasmus MC Medical Library for developing and updating the search strategies. This research was supported by the National Institutes of Health under award number R01AR07203401A1 for SH and KS.

Author information

Author notes

  1. Karin Grävare Silbernagel, Peter Malliaras, Robert-Jan de Vos and Shawn Hanlon make up the first author team.

Authors and Affiliations

  1. Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA

    Karin Grävare Silbernagel, Shawn Hanlon & Kayla Seymore

  2. Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia

    Peter Malliaras

  3. Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands

    Robert-Jan de Vos

  4. Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    Mitchel Molenaar

  5. Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden

    Håkan Alfredson

  6. Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Inge van den Akker-Scheek

  7. Department of Bioengineering, School of Engineering, Imperial College, London, UK

    Jarrod Antflick

  8. Department of Physiotherapy, School of Health Care Studies, Hanze University of Applied Sciences and Peescentrum, Centre of Expertise Primary Care Groningen (ECEZG), Groningen, The Netherlands

    Mathijs van Ark

  9. Stockholm, Sweden

    Kenneth Färnqvist

  10. Sports and Exercise Medicine, Queen Mary University of London, London, UK

    Zubair Haleem, Dylan Morrissey & Igor Sancho

  11. Arsenal Football Club, London, UK

    Zubair Haleem

  12. Department of Physical and Rehabilitation Medicine and Sports Traumatology, University and University Hospital of Liège, Liège, Belgium

    Jean-Francois Kaux

  13. School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland

    Paul Kirwan

  14. Institute of Sport Exercise and Health (ISEH), University College London, London, UK

    Bhavesh Kumar & Lorenzo Masci

  15. Aintree University Hospital, Liverpool Foundation Trust, Liverpool, UK

    Trevor Lewis

  16. School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK

    Adrian Mallows

  17. National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia

    Myles Murphy

  18. School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

    Myles Murphy & Richard Norris

  19. School of Allied Health, Department of Physiotherapy, La Trobe University, Melbourne, VIC, Australia

    Richard Newsham-West

  20. Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK

    Richard Norris

  21. School of Allied Health, University of Leicester, Leicester, UK

    Seth O’Neill

  22. Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium

    Koen Peers

  23. Physiotherapy Department, University of Deusto, San Sebastian, Spain

    Igor Sancho

  24. Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, VIC, Australia

    Patrick Vallance

  25. Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands

    Arco van der Vlist

  26. School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia

    Bill Vicenzino

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  1. Karin Grävare Silbernagel
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  28. Bill Vicenzino
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Corresponding author

Correspondence to Karin Grävare Silbernagel.

Ethics declarations

Funding

This research was supported by the National Institutes of Health under award number R01AR07203401A1.

Competing interests

Karin Grävare Silbernagel, Peter Malliaras, Robert-Jan de Vos, Shawn Hanlon, Mitchel Molenaar, Hakan Alfredson, Inge van den Akker-Scheek, Jarrod Antflick, Mathijs van Ark, Kenneth Färnqvist, Zubair Haleem, Jean-Francois Kaux, Paul Kirwan, Bhavesh Kumar, Trevor Lewis, Adrian Mallows, Lorenzo Masci, Dylan Morrissey, Myles Murphy, Richard Newsham-West, Richard Norris, Seth O’Neill, Koen Peers, Igor Sancho, Kayla Seymore, Patrick Vallance, Arco van der Vlist and Bill Vicenzino declare that they have no conflicts of interest relevant to the content of this review.

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Author contributions

BV devised the systematic review idea. KS, PM, RN-W and RJDV originally designed the systematic review and all authors were subsequently involved in refining its design. AV and RJDV performed the literature search with assistance from the librarian. SH and IS screened trials for inclusion. SH, MM, PV, AM, ZH, MV, KF, SO and KS performed data-extraction. SH and MM analyzed the data. KS, PM and RJDV interpreted the results of the data-analyses. SH, MM, KS, PM and RJDV drafted the manuscript. KS, PM and RJDV are study guarantors. All authors reviewed the final manuscript and agreed to be accountable for all aspects of the work and approved the final manuscript for submission. The corresponding author attests that all listed authors meet authorship criteria.

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The article's guarantors affirm that the article is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned have been explained.

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Grävare Silbernagel, K., Malliaras, P., de Vos, RJ. et al. ICON 2020—International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy. Sports Med 52, 613–641 (2022). https://doi.org/10.1007/s40279-021-01588-6

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