Patient ratings in exercise therapy for the management of tendinopathy: a systematic review with meta-analysis

Abstract

Objective: To synthesise exercise therapy intervention data investigating patient rating outcomes for the management of tendinopathy.

Design: A systematic review and meta-analysis of randomized controlled trials investigating exercise therapy interventions and reporting patient rating outcomes.

Setting: Any setting in any country listed as very high on the human development index.

Participants: People with a diagnosis of any tendinopathy of any severity or duration.

Interventions: Exercise therapy for the management of tendinopathy comprising five different therapy classes: 1) resistance; 2) plyometric; 3) vibration; 4) flexibility, and 5) movement pattern retraining modalities, were considered for inclusion.

Main outcome measures: Outcomes measuring patient rating of condition, including patient satisfaction and Global Rating of Change (GROC).

Results: From a total of 124 exercise therapy studies, 34 (Achilles: 41%, rotator cuff: 32%, patellar: 15%, elbow: 9% and gluteal: 3%) provided sufficient information to be meta-analysed. The data were obtained across 48 treatment arms and 1246 participants. The pooled estimate for proportion of satisfaction was 0.63 [95%CrI: 0.53-0.73], and the pooled estimate for percentage of maximum GROC was 53 [95%CrI: 38-69%]. The proportion of patients reporting positive satisfaction and perception of change increased with longer follow-up periods from treatment onset.

Conclusion: Patient satisfaction and GROC appear similar and are ranked moderately high demonstrating that patients generally perceive exercise therapies positively. Further research including greater consistency in measurement tools is required to explore and where possible, identify patient- and exercise-related moderating factors that can be used to improve person-centred care.

Systematic review registration number: PROSPERO ID=CRD42020168187 CONTRIBUTION OF PAPER.

Keywords: Exercise therapy; Global rating of change; Meta-analysis; Patient Satisfaction; Patient rating of condition; Tendinopathy.