scholarly journals Therapeutic Response of Extracorporeal Shock Wave Therapy for Insertional Achilles Tendinopathy Between Sports-Active and Nonsports-Active Patients With 5-Year Follow-up

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989811 ◽  
Author(s):  
Shurong Zhang ◽  
Hong Li ◽  
Wei Yao ◽  
Yinghui Hua ◽  
Yunxia Li
Keyword(s):  
Extracorporeal Shock Wave Therapy ◽  
Achilles Tendinopathy ◽  
Activity Level ◽  
Control Group ◽  
Activity Levels ◽  
Sports Activity ◽  
Extracorporeal Shock Wave ◽  
Active Patients ◽  
Tegner Activity Level

Background: Insertional Achilles tendinopathy (IAT) is a common cause of posterior heel pain. Extracorporeal shock wave therapy (ESWT) has proven to be an effective treatment, but the relationship between therapeutic responses and sports activity levels has not been studied. Purpose: To compare the clinical outcomes of ESWT used to treat IATs between sports-active and nonsports-active patients over 5 years. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was conducted on 33 patients with IAT who received ESWT from October 2012 to September 2013. Patients were classified into 2 groups according to their preinjury Tegner activity level: a sports-active group, defined as patients who self-reported to be regular joggers (SA group; Tegner activity level >3; n = 16), and a nonsports-active group (control group; Tegner activity level ≤3; n = 17). The mean age was 31 ± 7 years for the SA group and 37 ± 10 years for the control group. The Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire scores and visual analog scale (VAS) pain scores were used to evaluate the clinical outcomes before treatment, immediately after treatment, and 5 years after treatment. Ultrasonography was also used to assess the insertional Achilles tendon quality. Results: Before treatment, there were no significant differences between the groups with regard to VAS scores, while the VISA-A score in the SA group was higher than that in the control group. After ESWT, both groups had increased VISA-A scores and decreased VAS scores, indicating improvement. At 5-year follow-up, the SA group had a significantly lower mean VAS score (0.3 ± 0.8 vs 1.6 ± 1.3; P = .001) and a significantly higher mean VISA-A score (90 ± 4 vs 78 ± 7; P < .001) compared with the control group. There was no significant difference between the groups regarding the calcification and neovascularization of the Achilles tendon based on ultrasonography. Conclusion: ESWT can improve the symptoms of Achilles tendinopathy, and patients with IAT who had greater sports activity levels had better therapeutic responses than nonsports-active patients after 5-year follow-up.

scholarly journals Comparing Sports Activity Following Total Ankle Replacement Versus Ankle Arthrodesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003 ◽  
Author(s):  
Seth Richman ◽  
Tyler Rutherford ◽  
Timothy Rearick ◽  
John T. Campbell ◽  
Rebecca Cerrato ◽  
...  
Keyword(s):  
Decision Making ◽  
The United States ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Activity Level ◽  
Activity Levels ◽  
Sports Activity ◽  
Ankle Replacement ◽  
Foot Function

Category: Ankle, Ankle Arthritis, Sports Introduction/Purpose: Total ankle replacement (TAR) and ankle arthrodesis (AA) are two common surgical treatment modalities for end stage tibiotalar arthritis. A key deciding point between the two is anticipated functional outcome postoperatively, especially in regards to sports related activities. However, there is a paucity of data available to help advise patients in their decision making. While TAR provides a theoretical benefit of improved functionality, the outcomes of several European studies have shown mixed results. These studies are limited by small sample size, obsolete TAR implants not used in the United States, and nonspecific outcome measures. The purpose of this study was to compare postoperative sports activity levels following modern TAR and AA in a U.S. population, which may benefit surgical decision making and guide patient expectations. Methods: We conducted a retrospective comparative study that consisted of patients who underwent a TAR (N=62) or AA (N=51) between 2009-2015. The mean age of the arthrodesis group was 57.7 years ± 12.12 (28.84-85.26). There were 27 male participants and 24 female participants. The TAR group had 31 male and 31 female participants with a mean age of 64.9 years ± 8.57 (45-79.6). Exclusion criteria included paralysis, rheumatoid arthritis, revision surgery, incomplete pre- and post-operative scores, and follow up less than 2 years. General health and foot-ankle function were assessed using the SF-12 Health Survey and the revised Foot Function Index (FFI-R) preoperatively and at final follow-up. In addition, activity levels were assessed using a Return to Activities Following Surgery questionnaire that was administered at final follow up. This form included a Visual Analog Scale for Pain, satisfaction questions, and a list of 25 activities. Patients were asked to record their current level of activity, ability to participate pre- and post-surgery, and whether their desired level was met. All three measurements tools were compared between both treatment groups. Results: The SF-12 physical score both groups significantly increased postoperatively from 33.18 ± 10.37 to 43 ± 10.32 for AA’s and from 32.88 ± 9.44 to 45.81 ± 12.94 (p < 0.001) for TAR’s. The FFI scores showed a significant increase in both groups (p < 0.001). In the AA group, 88% of patients returned to work and would repeat the surgery, compared to 92% of patients in the TAR group. In terms of satisfaction and pain, the TAR group was more satisfied (1.78 vs. 1.44) and had less postoperative pain (1.32 vs. 2.56 p < 0.05). The AA group reported a significant increase in six activities including: golf (p < 0.05), weight lifting, and walking (p<0.001), while the TAR group reported significant increase in 15 activities, including hiking, tennis, and yoga (p<0.001). Conclusion: Our study revealed a significant increase in general physical function, foot function, and activity level in both groups. The TAR group was able to perform a wider range of activity and sports compared to the AA group. Overall, TAR patients were significantly more satisfied with their procedure compared to AA patients.

scholarly journals Effect of a Tailored Activity Pacing Intervention on Fatigue and Physical Activity Behaviours in Adults with Multiple Sclerosis

2020 ◽  
Vol 18 (1) ◽  
pp. 17
Author(s):  
Ulric S. Abonie ◽  
Florentina J. Hettinga
Keyword(s):  
Physical Activity ◽  
Multiple Sclerosis ◽  
Mean Difference ◽  
Activity Level ◽  
Self Report ◽  
Control Group ◽  
Activity Levels ◽  
Average Activity ◽  
And Gender

Tailored activity pacing could help manage fatigue and improve physical activity. However, little is known about how to tailor activity pacing for people with multiple sclerosis. This study aims to evaluate the effect of a tailored activity pacing intervention on fatigue and physical activity behaviours in adults with multiple sclerosis. Twenty-one adults with multiple sclerosis, stratified by age and gender, are randomly allocated to either a tailored pacing or control group. Participants wear an accelerometer for seven days that measures physical activity behaviours, and self-report fatigue at the baseline and four-week follow-up. Physical activity behaviours are assessed by examining activity level (seven-day average activity counts per minute) and activity variability (seven-day average highest activity counts each day divided by activity counts on that day). The intervention improves activity levels (Mean difference = 40.91; 95% Confidence Interval [CI] (3.84–77.96); p = 0.03) and lessens activity variability (Mean difference = −0.63; 95% CI (−1.25–0.02); p = 0.04). No significant effect is found for fatigue (Mean difference = −0.36; 95% CI (−1.02–0.30); p = 0.27). This investigation shows that tailoring activity pacing based on physical activity behaviours and fatigue is effective in improving physical activity levels, without exacerbating fatigue symptoms.

scholarly journals The Efficacy of Unfocused Extracorporeal Shock Waves for the Treatment of Achilles Tendinopathy

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0020
Author(s):  
Ashraf M. Fansa ◽  
Martin J. O’Malley ◽  
Eoghan T. Hurley ◽  
John G. Kennedy
Keyword(s):  
Shock Wave ◽  
Shock Waves ◽  
Extracorporeal Shock Wave Therapy ◽  
Achilles Tendinopathy ◽  
Shock Wave Therapy ◽  
Invasive Treatment ◽  
Non Invasive ◽  
Extracorporeal Shock Waves ◽  
Extracorporeal Shock Wave

Category: Sports Introduction/Purpose: Extracorporeal shock wave therapy (ESWT) may be a viable non-invasive treatment modality for patients suffering from Achilles Tendinopathy. There seems to be a relationship between the ESWT protocol and patient outcomes. Data suggest that higher energy levels of shock waves together with adequate treatment delivery to the affected area is necessary to achieve favorable outcomes. The aim of this study is present our experience with the use of electrohydraulically produced unfocused extracorporeal shock waves for the treatment of Achilles Tendinopathy. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who had received ESWT for plantar fasciitis heel pain between January 2013 and September 2018. The primary outcomes included change in pain intensity on the visual analog pain scale and patient satisfaction at final follow-up. Pre and post-procedure Foot and Ankle Outcome Scores were also assessed for change. Results: A total of 158 patients (179 heels) were followed-up for a mean duration of 17 +- 6.8 months post ESWT. The mean pre-ESWT pain VAS improved from 7.2 +- 1.4 to 2.3 +- 2.1 (p< 0.001) at final follow-up. The FAOS Symptoms, Pain, Function of Daily Living, Function of Sports and Recreational activities and Quality of Life domains improved from 57.7 +- 12.7 to 79.7 +- 13.6 (p< 0.001), from 35 +- 15.8 to 72.6 +- 22 (p< 0.001), from 43.8 +- 15.3 to 81.4 +- 11 (p< 0.001), from 41.2 +- 21.3 to 66.4 +- 18.3 (p< 0.001) and from 33.9 +- 17.4 to 78 +- 24.4 (p< 0.001), respectively. Overall, 85.4% were satisfied with the procedure at final follow-up. Conclusion: For patients with Achilles tendinopathy, unfocussed extracorporeal shock wave therapy appears to be a safe and viable non-invasive treatment option with a patient satisfaction rate of 85.4% and a 68% reduction in patient reported pain intensity.

scholarly journals The Effectiveness of Radial Extracorporeal Shock Wave Therapy for Chronic Achilles Tendinopathy: A Case Report with 18 Months Follow-Up

2018 ◽  
Vol 6 (3) ◽  
pp. 523-527
Author(s):  
Erieta Dimitrije Nikolikj-Dimitrova ◽  
Cvetanka Gjerakaroska-Savevska ◽  
Valentina Koevska ◽  
Biljana Mitrevska ◽  
Marija Gocevska ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Extracorporeal Shock Wave Therapy ◽  
Numeric Rating Scale ◽  
Achilles Tendinopathy ◽  
Pathological State ◽  
Extracorporeal Shock Wave ◽  
Insertional Achilles Tendinopathy

BACKGROUND: Achilles tendinopathy (AT) is a pathological state resulting from repetitive loading or stress on the tendon. The article aims to evaluate the effects of the low - energy radial extracorporeal shockwave therapy (RESWT) in the treatment of the adult with chronic insertional Achilles tendinopathy (AT) after the unsuccessful conservative treatment, with 18 months follow - up evaluation.CASE REPORT: We report the case of a 55 years - old male suffering from severe right posterior heel pain for 4 months. For his chronic insertional Achilles tendinopathy on the right heel, he received conservative treatment in the Institute of Physical Medicine and Rehabilitation. For outcome assessment, Numerical Rating Scale (NRS) for pain, the range of motion in the ankle, and Roles-Maudsley Score (RMS) for assessment of function were used. At the baseline the pain was severe, and he received physical therapy treatment. After unsuccessful conservative treatment, he underwent RESWT treatment. Numeric Rating Scale was significantly decreased at immediate, short-term and long-term follow-up. After the last treatment, the patient had no pain, and function assessed by Roles-Maudsley Score was excellent. At the follow-up check-up at 3, 6, 12 and 18 months the patient had no pain and excellent functional results.CONCLUSION: Radial ESWT is a safe and effective treatment even for a longer period for patients with chronic insertional Achilles tendinopathy.

scholarly journals Outcome of Extracorporeal Shock Wave Therapy for Insertional Achilles Tendinopathy with and without Haglund’s Deformity

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Ziying Wu ◽  
Wei Yao ◽  
Shiyi Chen ◽  
Yunxia Li
Keyword(s):  
Shock Wave ◽  
Extracorporeal Shock Wave Therapy ◽  
Likert Scale ◽  
Achilles Tendinopathy ◽  
Shock Wave Therapy ◽  
Extracorporeal Shock Wave ◽  
Haglund’S Deformity ◽  
Insertional Achilles Tendinopathy ◽  
Time Point

Purpose.To compare the results of extracorporeal shock wave therapy (ESWT) for insertional Achilles tendinopathy (IAT) with or without Haglund’s deformity.Methods.Between September 2014 and May 2015, all patients who underwent ESWT were retrospectively enrolled in this study. A total of 67 patients were available for follow-up and assigned into nondeformtiy group (n=37) and deformtiy group (n=30). Clinical outcomes were evaluated by VISA-A Score and 6-point Likert scale.Results.The VISA-A score increased in both groups, from49.57±9.98at baseline to83.86±8.59at14.5±7.2months after treatment in nondeformity group (P<0.001) and from48.70±9.38at baseline to67.78±11.35at15.3±6.7months after treatment in deformity group (P<0.001). However, there was a greater improvement in VISA-A Score for the nondeformity group compared with deformity group (P=0.005). For the 6-point Likert scale, there were decreases from3.92±0.80at baseline to1.57±0.73at the follow-up time point in nondeformity group (P<0.001) and from4.0±0.76at baseline to2.37±1.03at the follow-up time point in deformity group (P<0.001). There was no significant difference in improvement of the 6-point Likert scale between both groups (P=0.062).Conclusions.ESWT resulted in greater clinical outcomes in patients without Haglund’s deformity compared with patients with Haglund’s deformity.

scholarly journals Utility of Ultrasonography in Assessing the Effectiveness of Extracorporeal Shock Wave Therapy in Insertional Achilles Tendinopathy

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Yi Cheng ◽  
Jian Zhang ◽  
Yehua Cai
Keyword(s):  
Shock Wave ◽  
Achilles Tendon ◽  
Extracorporeal Shock Wave Therapy ◽  
Achilles Tendinopathy ◽  
Shock Wave Therapy ◽  
Cross Sectional ◽  
Extracorporeal Shock Wave ◽  
Calcific Plaque ◽  
Insertional Achilles Tendinopathy

Introduction. The aim of this study was to investigate the utility of ultrasonography (US) for predicting and assessing the effectiveness of extracorporeal shock wave therapy (ESWT) in insertional Achilles tendinopathy (IAT).Methods. A total of 42 patients with an established diagnosis of chronic IAT were examined by US before ESWT and at 4 weeks and 12 weeks after ESWT. The thickness and cross-sectional area (CSA) of the Achilles tendon, size of calcific plaques, tendon structure score, and neovascularization score were measured at each time point.Results. After therapy, Victorian Institute of Sport Assessment-Achilles (VISA-A) scores increased significantly, and the size of calcific plaques decreased (P<0.05). Neovascularization scores increased at the 4th week and then decreased at the 12th week (P<0.05). The thickness, CSA, and structure of the Achilles tendon did not change. Variables observed by US at baseline were not associated with changes in VISA-A scores at follow-up. However, the changes in calcific plaque size and neovascularization scores were related to the improvement of VISA-A scores between pre- and posttherapy (P<0.01).Conclusion. Ultrasonography can reveal some changes in the insertion of the Achilles tendon after ESWT, but the outcome of ESWT in IAT cannot be predicted by the variables observed by US.

scholarly journals FRI0094 SIGNIFICANT IMPROVEMENT OF NT-PROBNP LEVELS IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH TOCILIZUMAB AND TOFACITINIB

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 625.2-626
Author(s):  
H. Gerasimova ◽  
T. Popkova ◽  
I. Kirillova ◽  
M. Cherkasova ◽  
A. Martynova ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Cardiovascular Death ◽  
Control Group ◽  
Activity Levels ◽  
Das 28 ◽  
Interleukin 6 Receptor ◽  
Inflammatory Drugs ◽  
Roche Diagnostics

Background:N-terminal pro-brain natriuretic peptide (NT-proBNP) is a recognized predictor of congestive heart failure (CHF) and cardiovascular death. Rheumatoid arthritis (RA) patients (pts) were shown to have higher NT-proBNP concentrations than in general population, but it remains unclear, whether NT-proBNP levels are related to RA duration, activity or treatment.Objectives:To investigate the effect of interleukin 6 receptor inhibitor - tocilizumab (TCZ) and JAK inhibitor - tofacitinib (TOFA) on NT-proBNP levels in RA pts during a 12-month (m) follow-up period.Methods:The study enrolled 60pts (50women/10men) with the lack of efficacy/resistance and/or intolerance of basic anti-inflammatory drugs (DMARDs); median age was 55[42;61] years, median disease duration 55[29;120]m, with moderate to high activity (DAS28-5,1[4,6;6,1], serum positivity for rheumatoid factor (RF)(85%)/ anti-cyclic citrullinated peptide antibodies (ACCP)(80%). The study did not include RA pts with CHF and clinically overt cardiovascular disease (CVD). Twenty nine RA pts received TCZ(8mg/kg) every 4 weeks: 61% received TCZ in combination with methotrexate (MTX), 35% - with low-dose glucocorticoids (GCs). Thirty one RA pts were prescribed oral TOFA at 5 mg BID with dose escalation to 10 mg BID in 8 (26%)pts. TOFA was used in combination with MTX in 90% pts, with GCs – in 29% pts. Pts treated with TCZ and TOFA were comparable in terms of age, sex, body mass index. RA activity rates (DAS28, SDAI, ESR, CRP) were higher in pts on TCZ -therapy compared with pts treated with TOFA. Echocardiography data and NT-proBNP levels using electrochemiluminescence method Elecsys proBNP II (Roche Diagnostics, Switzerland) were obtained at baseline and after 12m.Results:Significant positive changes in major disease activity, clinical and laboratory parameters were found in RA pts after 12 m of TCZ infusion and TOFA intake: remission (DAS28<2,6) was achieved in 54% and 39% pts, low activity levels (DAS28<3,2) – in 46% and 51% pts, respectively.The NT-proBNP levels were significantly higher in RA pts than in the control group (median 69,1 (37,9;105,8) pg/mL vs 55,3 (36,6;67,3) pg/mL,p<0.05).Six pts (10%) (three in each pts group) had NT-proBNP levels over 125pg/ml, but were asymptomatic and had unremarkable echocardiography.There was a good correlation between NT-proBNP level at baseline with age (r=0,55,p<0,001), SDAI (r=0,5, h=0,01), ACCP (r=0,23,p=0,01).Decrease of median NT-proBNP levels was documented after 12m of TCZ therapy (81,5[43,0;102,0]vs41,6[25,4;64,2]pg/ml (p<0,01) and after 12m TOFA therapy (66,1[30,5;105,0]vs16,8 [5,0;81,0]pg/ml,p=0,001).After 12m of TCZ correlations of ΔNT-proBNP were established with ΔESR (R=0,43;p<0,05], ΔСRP (R=0,46;p<0,05], ΔEe left ventricle (LV) (r=0,88,p=0,03).In the group of pts treated with TOFA ΔNT-proBNP level significantly correlated with the percentage change in DAS 28 (r=0,41,p=0,038), there was no direct correlation with changes in the parameters of the LV diastolic function.Conclusion:TCZ and TOFA treatment for 12 m reduced NT-proBNP levels in RA pts without clinically manifest CVD and CHF. Falling NT-proBNP concentrations are associated with positive dynamics of RA activity (DAS 28) and inflammatory markers (CRP, ESR), therefore allowing to suggest that increased NT-proBNP levels should be considered as a component of disease activity. Correlation between ΔNT-proBNP and ΔEeLF may be indicative as possible impact of these biomarkers on the LV diastolic function’s development in RA pts.Disclosure of Interests:None declared

scholarly journals Platelet rich plasma versus extracorporeal shock wave therapy in patients with non-calcific supraspinatous tears

2020 ◽  
Vol 47 (1) ◽  
Author(s):  
Samah M. Alian ◽  
Rabab S. Zaghlol ◽  
Sahar S. Khalil
Keyword(s):  
Shock Wave ◽  
Outcome Measures ◽  
Platelet Rich Plasma ◽  
Extracorporeal Shock Wave Therapy ◽  
Shock Wave Therapy ◽  
Tendon Tear ◽  
Extracorporeal Shock Wave ◽  
Group I ◽  
Group Ii

Abstract Background To compare the clinical efficacy of platelet rich plasma (PRP) subacromial injection and extracorporeal shock wave therapy (ESWT) on refractory non-calcific partial thickness supraspinatous tendon tear. Results Significant improvement in all outcome measures achieved in both groups at 4 weeks follow-up period (the end of treatment course) (P< 0.05). At 12 weeks follow-up period, group I, showed significant improvement in all outcome measures compared to baseline and group II; however, in group II, there was no significant difference compared to baseline; moreover, deterioration in the previous improvement was noticed. Conclusion Both PRP (group I) and ESWT (group II) are effective therapeutic methods in the management of refractory non-calcific partial thickness supraspinatous tendon tear; however, PRP (group I) has better long-term effects on both pain and function.

scholarly journals Line- and Point-Focused Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Placebo-Controlled RCT Study

2021 ◽  
pp. 194173812199179
Author(s):  
Matthias Gatz ◽  
Sebastian Schweda ◽  
Marcel Betsch ◽  
Timm Dirrichs ◽  
Matias de la Fuente ◽  
...  
Keyword(s):  
Shock Wave ◽  
Power Doppler ◽  
Extracorporeal Shock Wave Therapy ◽  
Achilles Tendinopathy ◽  
Shock Wave Therapy ◽  
Ultrasound Tissue Characterization ◽  
Score Improvement ◽  
Extracorporeal Shock Wave ◽  
Tendon Adaptation ◽  
Over Time

Background: Extracorporeal shock wave therapy (ESWT) is a widely considered treatment option for Achilles tendinopathy. Line-focused ESWT is a novel technique treating a larger tendon area than point-focused ESWT. Monitoring capacities of clinical symptoms with ultrasound under ESWT treatment are unknown. Hypothesis: Point- and line-focused ESWT have a superior outcome than placebo ESWT. ESWT leads to morphological tendon changes detectable with ultrasound. Study Design: Single-blinded placebo-controlled randomized contolled trial. Level of Evidence: Level 1. Methods: The study was conducted in 3 cohorts, namely ESWT point (n = 21), ESWT line (n = 24), and ESWT placebo (n = 21). Victorian Institute of Sports Assessment–Achilles (VISA-A) score was measured before the intervention (T0), after 6 weeks (T1), and after 24 weeks (T2). All cohorts performed daily physiotherapy for 24 weeks and received 4 sessions of point-focused, line-focused, or placebo ESWT in the first 6 weeks. Ultrasound was performed with B-mode, power Doppler, shear wave elastography (SWE) at T0 and T2 and with ultrasound tissue characterization (UTC) at T0, T1, and T2. Data were analyzed with a mixed analysis of variance and t test. Results: There was a significant VISA-A improvement over time for all groups ( P < 0.001). ESWT point had the strongest VISA-A score improvement +23 (ESWT line: +18; ESWT placebo: +15), but there was no significant interaction between time and any of the groups: F(4, 116) = 1.393; P = 0.24. UTC, power Doppler, and B-mode could not show significant alterations over time. SWE revealed a significant increase of elastic properties for ESWT point in the insertion ( t = −3.113, P = 0.03) and midportion ( t = −2.627, P = 0.02) over time. Conclusion: There is a significant VISA-A score improvement for all study groups without a statistically significant benefit for ESWT point or ESWT line compared with ESWT placebo. Tendon adaptation could only be detected with SWE for ESWT point. Clinical Relevance: The present study could not detect any statistically relevant effect of ESWT compared to placebo. SWE is able to demonstrate tendon adaptation.

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