Systematic Review and Meta-analyses of Randomized Controlled Trials Comparing Exercise Loading Protocols With Passive Treatment Modalities or Other Loading Protocols for the Management of Midportion Achilles Tendinopathy
Notice bibliographique
Résumé
Background: There is no clear consensus as to which intervention to prioritize for midportion Achilles tendinopathy (AT), although recent clinical practice guidelines have recommended eccentric exercises. Purpose/Hypothesis: The purpose of this study was to (1) compare exercise loading protocols with passive treatment modalities for the management of midportion AT and (2) compare different exercise loading protocols. We hypothesized that loading exercises would be associated with a greater decrease in pain and symptoms compared with passive treatment modalities but that no loading protocols would be associated with improved results. Study Design: Systematic review; Level of evidence, 1. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the MEDLINE, EMBASE, CINHAL, and Web of Science databases for randomized controlled trials (RCTs) and compared eccentric loading protocols with passive treatment modalities or different eccentric loading protocols as an intervention for midportion AT. A total of 5126 articles were identified after the initial search. After selection, the risk of bias (RoB) and the Grading of Recommendations, Assessment, Development and Evaluation approach were applied to pooled studies for quantitative analysis. The outcomes of interest were pain and function, which were measured using the visual analog scale and the Victorian Institute of Sport Assessment–Achilles scale. Mean differences (MDs) and 95% CIs were calculated using random effects (significant heterogeneity) or fixed effects (nonsignificant heterogeneity) inverse variance models. Results: In this study, 12 RCTs (N = 543 participants) were included, of which 2 had a high RoB and 10 showed some concerns of bias. Passive interventions resulted in greater pain reduction in the short term compared with eccentric loading protocols (n = 4 studies; n = 212 participants; pooled MD, 10.22 [95% CI, 2.18 to 18.25]; P = .01). For function, there was a nonsignificant trend in favor of eccentric loading in the short- (n = 3 studies; n = 144 participants; pooled MD, –7.91 [95% CI, –16 to 0.19]; P = .06) and midterm follow-up (n = 5 studies; n = 258 participants; pooled MD, –6.78 [95% CI, –14.23 to 0.68]; P = .07). Meta-analyses of RCTs comparing different types of exercise loading protocols showed no significant differences in the short, mid-, and long term with regard to pain and function. Conclusion: Our meta-analyses did not highlight the superiority of one treatment over another for midportion AT.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,054 | 0,006 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».