Exercise therapy in the treatment of tendinopathies of the lower limbs: a protocol of a systematic review

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

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.

Effectiveness of warm-up interventions on work-related musculoskeletal disorders, physical and psychosocial functions among workers: a systematic review

OBJECTIVES

The aim of this systematic review was to identify from published literature the available evidence regarding the effects of warm-up intervention implemented in the workplace on work -related musculoskeletal disorders (WMSDs) and physical and psychosocial functions.

DESIGN

Systematic review.

DATA SOURCES

The following four electronic databases were searched (from inception onwards to October 2022): Cochrane Central Register of Controlled Trials (CENTRAL), PubMed (Medline), Web of Science and Physiotherapy Evidence Database (PEDro).

ELIGIBILITY CRITERIA

Randomised and non-randomised controlled studies were included in this review. Interventions should include a warm-up physical intervention in real-workplaces.

DATA EXTRACTION AND SYNTHESIS

The primary outcomes were pain, discomfort, fatigue and physical functions. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used the Grading of Recommendations, Assessment, Development and Evaluation evidence synthesis. To assess the risk of bias, the Cochrane ROB2 was used for randomised controlled trial (RCT) and the Risk Of Bias In Non-randomised Studies-of Interventions was used for the non-RCT studies.

RESULTS

Three studies met the inclusion criterion, one cluster RCT and two non-RCTs. There was an important heterogeneity in the included studies principally concerning population and warm-up intervention exercises. There were important risks of bias in the four selected studies, due to blinding and confounding factors. Overall certainty of evidence was very low.

CONCLUSION

Due to the poor methodological quality of studies and conflicting results, there was no evidence supporting the use of warm-up to prevent WMSDs in the workplace. The present findings highlighted the need of good quality studies targeting the effects of warm-up intervention to prevent WMSDs.

PROSPERO REGISTRATION NUMBER

CRD42019137211.

Resistance Training Interventions for Lower Limb Tendinopathies: A Scoping Review of Resistance Training Reporting Content, Quality, and Scientific Implementation

The objectives of this scoping review were as follows: (1) to describe what exercises and intervention variables are used in resistance training interventions for lower limb tendinopathy,  (2) to assess the completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework, and (3) to assess the implementation of scientific resistance training principles. We searched MEDLINE, CINAHL, AMED, Embase, SPORTDiscus, and Cochrane Library databases. Randomized controlled trials, cohort studies, case series, case reports, and observational studies that reported using resistance exercises for lower limb tendinopathies were considered for inclusion, with 194 studies meeting the inclusion criteria. Completeness of the reporting of exercise descriptors and programme variables was assessed by the CERT and the Toigo and Boutellier framework. Reporting of exercise descriptor items from the Toigo and Boutellier framework ranged from 0 to 13, with an average score of 9/13, with only 9 studies achieving a full 13/13. Reporting of items from the CERT ranged from 0 to 18, with an average score of 13/19. No study achieved a full 19/19; however, 8 achieved 18/19. Scoring for resistance training principles ranged from 1 to 10, with only 14 studies achieving 10/10. Eccentric heel-drops were the most common exercise (75 studies), followed by isotonic heel raises (38), and single-leg eccentric decline squats (27). The reporting of exercise descriptors and intervention content was high across studies, with most allowing exercise replication, particularly for Achilles and patellar tendinopathy. However, reporting for some tendinopathies and content items such as adherence was poor, limiting optimal translation to clinical practice.

Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice

Tendinopathy is labeled by many authors as a troublesome, common pathology, present in up to 30% medical care consultations involving musculoskeletal conditions. Despite the lasting interest for addressing tendon pathology, current researchers agree that even the exact definition of the term tendinopathy is unclear. Tendinopathy is currently diagnosed as a clinical hypothesis based on the patient symptoms and physical context. One of the main goals of current clinical management is to personalize treatment approaches to adapt them to the many different needs of the population. Tendons are complex structures that unite muscles and bones with two main objectives: to transmit forces and storage and release energy. Regarding the tensile properties of the tendons, several authors argued that tendons have higher tensile strength compared with muscles, however, are considered less flexible. Tendinopathy is an accepted term which is used to indicated a variety of tissue conditions that appear in injured tendons and describes a non-rupture damage in the tendon or paratendon, which is intensified with mechanical loading Even when the pathoetiology of tendinopathy is unclear, there is a wide array of treatments available to treat and manage tendinopathy. Although tendinitis usually debuts with an inflammatory response, the majority of chronic tendinopathies do not present inflammation and so the choosing of treatment should vary depending on severity, compliance, pain and duration of symptoms. The purpose of this article is to review and provide an overview about the currently research of the tendon diagnosis, management and etiology.

The analgesic effect of joint mobilization and manipulation in tendinopathy: a narrative review

Objective: To summarize the available literature with regards to the potential analgesic effect and mechanism of joint mobilization and manipulation in tendinopathy. Results: The effect of these techniques in rotator cuff tendinopathy and lateral elbow tendinopathy, applied alone, compared to a placebo intervention or along with other interventions has been reported in some randomized controlled trials which have been scrutinized in systematic reviews. Due to the small randomized controlled trials and other methodological limitations of the evidence base, including short-term follow-ups, small sample size and lack of homogenous samples further studies are needed. Literature in other tendinopathies such as medial elbow tendinopathy, de Quervain's disease and Achilles tendinopathy is limited since the analgesic effect of these techniques has been identified in few case series and reports. Therefore, the low methodological quality renders caution in the generalization of findings in clinical practice. Studies on the analgesic mechanism of these techniques highlight the activation of the descending inhibitory pain mechanism and sympathoexcitation although this area needs further investigation. Conclusion: Study suggests that joint mobilization and manipulation may be a potential contributor in the management of tendinopathy as a pre-conditioning process prior to formal exercise loading rehabilitation or other proven effective treatment approaches.

Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues, and Inadequate Outcomes

Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.

SCIENTIFIC PHYSICAL EXERCISE TO PREVENT MUSCLE INJURY IN COMPETITIVE SPORTS

ABSTRACT Introduction: Various factors cause many sports traumas in groups engaged in mass sports activities, amateur sports training, and professional sports training in China that must be called to our attention. Objective: Scientific Sports Therapy is a scientific and reasonable systemic sports training program formulated for competitive athletes based on their physical and disease characteristics. Methods: This article conducted scientific sports therapy interventions on tennis elbow patients and analyzed multiple physiological indicators such as muscle endurance before and after the intervention. Results: There are significant differences in the athletes’ muscle strength and muscle endurance data after physical exercise therapy. Conclusion: We analyzed the causes of muscle damage and adopted scientific and practical sports therapy. In this way, coaches and athletes can find effective ways to prevent and manage muscle injuries, thereby improving competitive sports training. Level of evidence II; Therapeutic studies - investigation of treatment results.

Exercise therapy for the treatment of tendinopathies: a scoping review protocol

OBJECTIVE

The aim of the review is to provide a map of exercise interventions and outcomes that have been reported for the treatment of any tendinopathy.

INTRODUCTION

Tendinopathy is a common condition that affects athletic and non-athletic populations. Exercise is the mainstay of conservative management of tendinopathy, and a range of different exercise types are recommended. There is a significant body of literature on exercise for tendinopathy, but to date no scoping review has provided a clear map of interventions used and outcomes reported in the literature.

INCLUSION CRITERIA

We will include people of any age or gender with a diagnosis of tendinopathy of any severity or duration at any anatomical location. We will exclude full-thickness/massive tears and plantar fasciitis. The exercise therapy may take place at any location, including hospital, community, or people's homes, and may be supervised or unsupervised. We will include systematic reviews, quantitative, qualitative, and mixed-methods studies conducted in any developed nation.

METHODS

We will search MEDLINE, CINAHL, AMED, Embase, SPORTDiscus, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, Epistemonikos, four trial registries, and six gray literature databases. We will use Scopus to search for cited/citing articles from included studies and will perform hand searching where relevant. We will include literature from 1998 to 2020 in any language for which we can access translation. Studies will be screened by two independent reviewers at title/abstract and full-text screening stages; a third reviewer will resolve conflicts. Data will be extracted into a bespoke charting form and will be presented as figures/tables with accompanying narrative.

Autoregulated and individualised resistance training versus predetermined and standardised resistance training in tendinopathy: A systematic review protocol

REVIEW OBJECTIVE

To synthesise the best available evidence on the effectiveness of interventions that have used autoregulated and individualised resistance training versus predetermined and standardised resistance training in treating any tendinopathy.

INTRODUCTION

Recent evidence suggests that individualised exercise may be more effective than standardised exercise for musculoskeletal disorders such as tendinopathy. However, no systematic reviews have been conducted on the topic and optimal treatment protocols and clinical recommendations are lacking.

INCLUSION CRITERIA

Randomised controlled trials assessing the effectiveness of autoregulated and individualised resistance training versus predetermined and standardised resistance training for tendinopathy in adults will be included.

METHODS

The authors will search for a wide range of sources to find both published and unpublished studies via EBSCOhost, including, but not limited to, MEDLINE, SPORTDiscus, CINAHL, Cochrane Central Register of Controlled Trials and Allied and Complementary Medicine Database. Studies published in a language other than English will only be considered if a translation is available. The Joanna Briggs Institute systematic review methodology will be followed when conducting the review. Data synthesis will be conducted using meta-analysis or narrative synthesis, where appropriate.

How much do we know about the effectiveness of warm-up intervention on work related musculoskeletal disorders, physical and psychosocial functions: protocol for a systematic review

INTRODUCTION

Work-related musculoskeletal disorders (WMSDs) are a growing worldwide burden and effective interventions to prevent them are needed. Physical activity at the workplace is now recognised as a relevant component of WMSDs prevention. Along these lines, warm-up interventions are now offered in a large number of companies to manage WMSDs. Although benefits of warm-up have been previously documented in sports context, to the best of our knowledge, the effectiveness of such intervention in workplaces still remains to be established. Within this context, the aim of the present review is to identify from published literature the available evidence regarding the effects of warm-up on WMSDs and physical and psychosocial functions.

METHODS

The following electronic databases will be searched (from inception onwards to June 2020): Cochrane Central Register of Controlled Trials, PubMed (Medline), Web of Science and Physiotherapy Evidence Database. Randomised and non-randomised controlled studies will be included in this review. Participants should be adult employees without specific comorbidities. Interventions should include a warm-up physical intervention in real-workplaces. The primary outcomes will be pain, discomfort or fatigue. The secondary outcomes will be job control or motivation at work. This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and two team members will independently screen all citations, full-text articles and abstract data. A systematic narrative synthesis will be provided with information presented in the text and tables to summarise the characteristics and findings of the included studies.

ETHICS AND DISSEMINATION

The approval of an ethical committee is not required. All the included studies will comply with the current ethical standards. The results of this review will summarise the effects of warm-up intervention on WMSDs, physical or psychosocial functions. This information could help professionals in decision making related to the use of these interventions to prevent WMSDs. Findings will be disseminated to academic audiences through peer-reviewed publications, as well as to policy-makers.

PROSPERO REGISTRATION NUMBER

CRD42019137211.