Exercise therapy for tendinopathy: a mixed-methods evidence synthesis exploring feasibility, acceptability and effectiveness.
| Autor: | Cooper K; School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK., Alexander L; School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK., Brandie D; Sportscotland Institute of Sport, Airthrey Road, Stirling, UK., Brown VT; Wolfson Institute of Population Health, Queen Mary University of London, UK., Greig L; School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK., Harrison I; School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK., MacLean C; Library Services, Robert Gordon University, Garthdee Road, Aberdeen, UK., Mitchell L; NHS Grampian, Physiotherapy Department, Ellon Health Centre, Schoolhill, Ellon, Aberdeenshire, UK., Morrissey D; William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, UK., Moss RA; School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK., Parkinson E; School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK., Pavlova AV; School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK., Shim J; School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK., Swinton PA; School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK. |
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| Jazyk: | angličtina |
| Zdroj: | Health technology assessment (Winchester, England) [Health Technol Assess] 2023 Oct; Vol. 27 (24), pp. 1-389. |
| DOI: | 10.3310/TFWS2748 |
| Abstrakt: | Background: Tendinopathy is a common, painful and functionally limiting condition, primarily managed conservatively using exercise therapy. Review Questions: (i) What exercise interventions have been reported in the literature for which tendinopathies? (ii) What outcomes have been reported in studies investigating exercise interventions for tendinopathy? (iii) Which exercise interventions are most effective across all tendinopathies? (iv) Does type/location of tendinopathy or other specific covariates affect which are the most effective exercise therapies? (v) How feasible and acceptable are exercise interventions for tendinopathies? Methods: A scoping review mapped exercise interventions for tendinopathies and outcomes reported to date (questions i and ii). Thereafter, two contingent systematic review workstreams were conducted. The first investigated a large number of studies and was split into three efficacy reviews that quantified and compared efficacy across different interventions (question iii), and investigated the influence of a range of potential moderators (question iv). The second was a convergent segregated mixed-method review (question v). Searches for studies published from 1998 were conducted in library databases ( n = 9), trial registries ( n = 6), grey literature databases ( n = 5) and Google Scholar. Scoping review searches were completed on 28 April 2020 with efficacy and mixed-method search updates conducted on 19 January 2021 and 29 March 2021. Results: Scoping review - 555 included studies identified a range of exercise interventions and outcomes across a range of tendinopathies, most commonly Achilles, patellar, lateral elbow and rotator cuff-related shoulder pain. Strengthening exercise was most common, with flexibility exercise used primarily in the upper limb. Disability was the most common outcome measured in Achilles, patellar and rotator cuff-related shoulder pain; physical function capacity was most common in lateral elbow tendinopathy. Efficacy reviews - 204 studies provided evidence that exercise therapy is safe and beneficial, and that patients are generally satisfied with treatment outcome and perceive the improvement to be substantial. In the context of generally low and very low-quality evidence, results identified that: (1) the shoulder may benefit more from flexibility (effect size Limitations: Despite a large body of literature on exercise for tendinopathy, there are methodological and reporting limitations that influenced the recommendations that could be made. Conclusion: The findings provide some support for the use of exercise combined with another conservative modality; flexibility and proprioception exercise for the shoulder; and a combination of eccentric and concentric strengthening exercise across tendinopathies. However, the findings must be interpreted within the context of the quality of the available evidence. Future Work: There is an urgent need for high-quality efficacy, effectiveness, cost-effectiveness and qualitative research that is adequately reported, using common terminology, definitions and outcomes. Study Registration: This project is registered as DOI: 10.11124/JBIES-20-00175 (scoping review); PROSPERO CRD 42020168187 (efficacy reviews); https://osf.io/preprints/sportrxiv/y7sk6/ (efficacy review 1); https://osf.io/preprints/sportrxiv/eyxgk/ (efficacy review 2); https://osf.io/preprints/sportrxiv/mx5pv/ (efficacy review 3); PROSPERO CRD42020164641 (mixed-method review). Funding: This project was funded by the National Institute for Health and Care Research (NIHR) HTA programme and will be published in full in HTA Journal; Vol. 27, No. 24. See the NIHR Journals Library website for further project information. |
| Databáze: | MEDLINE |
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