. 2022 Mar;52(3):613-641.

doi: 10.1007/s40279-021-01588-6. Epub 2021 Nov 19.

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

Karin Grävare Silbernagel^#¹, Peter Malliaras^#², Robert-Jan de Vos^#³, Shawn Hanlon^#⁴, Mitchel Molenaar⁵, Håkan Alfredson⁶, Inge van den Akker-Scheek⁷, Jarrod Antflick⁸, Mathijs van Ark⁹, Kenneth Färnqvist¹⁰, Zubair Haleem^{11

12}, Jean-Francois Kaux¹³, Paul Kirwan¹⁴, Bhavesh Kumar¹⁵, Trevor Lewis¹⁶, Adrian Mallows¹⁷, Lorenzo Masci¹⁵, Dylan Morrissey¹¹, Myles Murphy^{18

19}, Richard Newsham-West²⁰, Richard Norris^{19

21}, Seth O'Neill²², Koen Peers²³, Igor Sancho^{11

24}, Kayla Seymore⁴, Patrick Vallance²⁵, Arco van der Vlist²⁶, Bill Vicenzino²⁷

Affiliations

¹ Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA. kgs@udel.edu.
² Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia.
³ Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands.
⁴ Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA.
⁵ Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
⁶ Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
⁷ Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁸ Department of Bioengineering, School of Engineering, Imperial College, London, UK.
⁹ 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.
¹⁰ , Stockholm, Sweden.
¹¹ Sports and Exercise Medicine, Queen Mary University of London, London, UK.
¹² Arsenal Football Club, London, UK.
¹³ Department of Physical and Rehabilitation Medicine and Sports Traumatology, University and University Hospital of Liège, Liège, Belgium.
¹⁴ School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
¹⁵ Institute of Sport Exercise and Health (ISEH), University College London, London, UK.
¹⁶ Aintree University Hospital, Liverpool Foundation Trust, Liverpool, UK.
¹⁷ School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK.
¹⁸ National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia.
¹⁹ School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
²⁰ School of Allied Health, Department of Physiotherapy, La Trobe University, Melbourne, VIC, Australia.
²¹ Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK.
²² School of Allied Health, University of Leicester, Leicester, UK.
²³ Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.
²⁴ Physiotherapy Department, University of Deusto, San Sebastian, Spain.
²⁵ Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, VIC, Australia.
²⁶ Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
²⁷ School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia.

^# Contributed equally.

PMID: 34797533
PMCID: PMC8891092
DOI: 10.1007/s40279-021-01588-6

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

Karin Grävare Silbernagel et al. Sports Med. 2022 Mar.

. 2022 Mar;52(3):613-641.

doi: 10.1007/s40279-021-01588-6. Epub 2021 Nov 19.

Authors

Affiliations

¹ Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA. kgs@udel.edu.
² Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia.
³ Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands.
⁴ Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA.
⁵ Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
⁶ Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
⁷ Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁸ Department of Bioengineering, School of Engineering, Imperial College, London, UK.
⁹ 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.
¹⁰ , Stockholm, Sweden.
¹¹ Sports and Exercise Medicine, Queen Mary University of London, London, UK.
¹² Arsenal Football Club, London, UK.
¹³ Department of Physical and Rehabilitation Medicine and Sports Traumatology, University and University Hospital of Liège, Liège, Belgium.
¹⁴ School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
¹⁵ Institute of Sport Exercise and Health (ISEH), University College London, London, UK.
¹⁶ Aintree University Hospital, Liverpool Foundation Trust, Liverpool, UK.
¹⁷ School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK.
¹⁸ National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia.
¹⁹ School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
²⁰ School of Allied Health, Department of Physiotherapy, La Trobe University, Melbourne, VIC, Australia.
²¹ Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK.
²² School of Allied Health, University of Leicester, Leicester, UK.
²³ Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.
²⁴ Physiotherapy Department, University of Deusto, San Sebastian, Spain.
²⁵ Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, VIC, Australia.
²⁶ Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
²⁷ School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia.

^# Contributed equally.

PMID: 34797533
PMCID: PMC8891092
DOI: 10.1007/s40279-021-01588-6

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.

PubMed Disclaimer

Conflict of interest statement

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 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.

Figures

**Fig. 1**
PRISMA flow diagram of study selection process

**Fig. 2**
Overview of the number of studies and outcome measures per core domain

See this image and copyright information in PMC

References

1. Scott A, Squier K, Alfredson H, Bahr R, Cook JL, Coombes B, et al. ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology. Br J Sports Med [Internet]. 2020;54:260–2. Available from: http://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2019-100885 - DOI - PubMed
1. De Jonge S, Van Den Berg C, De Vos RJ, Van Der Heide HJL, Weir A, Verhaar JAN, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. 2011;45:1026–8. - PubMed
1. Ceravolo ML, Gaida JE, Keegan RJ. Quality-of-Life in Achilles Tendinopathy : An Exploratory Study. Clin J Sport Med. 2018;00:1–8. - PubMed
1. Silbernagel KG, Brorsson A, Lundberg M, Grävare Silbernagel K, Brorsson A, Lundberg M. The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone: A 5-year follow-up. Am J Sports Med. 2011;39:607–13. - PubMed
1. Van Der Plas A, De Jonge S, De Vos RJ, Van Der Heide HJL, Verhaar JAN, Weir A, et al. A 5-year follow-up study of Alfredson’s heel-drop exercise programme in chronic midportion Achilles tendinopathy. Br J Sports Med. 2012;46:214–8. - PMC - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical