Intramuscular stimulation vs sham needling for the treatment of chronic midportion Achilles tendinopathy: A randomized controlled clinical trial.

BACKGROUND: The insertion of filiform needles intramuscularly (a.k.a. intramuscular stimulation/dry needling) has been suggested as a possible treatment for various painful musculoskeletal conditions. Our aim was to answer the question, is intramuscular stimulation more effective than sham intramuscular stimulation/dry needling for the treatment of Achilles tendinopathy? METHODS: 52 participants with persistent midportion Achilles tendinopathy began and 46 completed one of three treatment protocols which were randomly assigned: (G3) a 12-week rehabilitation program of progressive tendon loading plus intramuscular stimulation (n = 25), (G2) the same rehabilitation program but with sham intramuscular stimulation (n = 19), or (G1) a reference group of rehabilitation program alone (as an additional control) (n = 8). The a priori primary outcome measure was change in VISA-A score at 12 weeks-VISA-A was also measured at 6 weeks, and at 6 and 12 months. Secondary outcome measures include the proportion of patients who rated themselves as much or very much improved (%), dorsiflexion range of motion (degrees), and tendon thickness (mm). RESULTS: The study retention was 94% at 12 weeks and 88% at 1 year. VISA-A score improved in all three groups over time (p<0.0001), with no significant difference among the three groups in VISA-A score at the start of the study (mean ± SD: G3 59 ± 13, G2 57 ± 17, G1 56 ± 22), at 12 weeks (G3 76 ± 14, G2 76 ± 15, G1 82 ± 11) or at any other timepoint. The percentage of patients who rated themselves as much or very much improved (i.e. treatment success) was not different after 12 weeks (G3 70%, G2 89%, G1 86% p = 0.94), or at 26 (p = 0.62) or 52 weeks (p = 0.71). No clinically significant effects of intervention group were observed in any of the secondary outcome measures. CONCLUSION: The addition of intramuscular stimulation to standard rehabilitation for Achilles tendinopathy did not result in any improvement over the expected clinical benefit achieved with exercise-based rehabilitation alone.

Changes in Clinical Status after Completion of an Interdisciplinary Pain Management Programme Incorporating Pain Neurophysiology Education.

Purpose: The purpose of this study was to observe the clinical outcomes of people who completed a 6-week outpatient interdisciplinary pain management programme and to determine whether a change in pain knowledge predicts these clinical outcomes (pain interference, pain severity, depression, and opioid intake). Method: A single-group, pretest-posttest analysis was conducted on data from 102 participants; five t-tests and three hierarchical multiple regressions were carried out. Results: Participants experienced significant improvements in pain knowledge, pain interference, pain severity, depression, and opioid intake between intake assessment and discharge, but change in pain knowledge did not significantly predict any clinical outcomes. Conclusions: This study provides valuable evidence to inform interdisciplinary pain management. Knowledge of pain neurophysiology, despite its potential contribution to positive clinical outcomes, did not predict clinical success. Psychosocial factors are proposed as a candidate for effectiveness of the pain neurophysiology education classes.

Objectif : la présente étude visait à observer les résultats cliniques de personnes qui avaient suivi un programme ambulatoire interdisciplinaire de gestion de la douleur de six semaines et à déterminer si des modifications aux connaissances sur la douleur permettaient de prédire ces résultats (interférence à la douleur, gravité de la douleur, dépression et prise d'opioïdes). Méthodologie : les chercheurs ont procédé à une analyse prétest-postest auprès d'un seul groupe de données provenant de 102 participants. Ils ont effectué cinq tests de Student et trois régressions hiérarchiques multiples. Résultats : les participants ont beaucoup amélioré leurs connaissances sur la douleur, l'interférence à la douleur, la gravité de la douleur, la dépression et la prise d'opioïdes entre le moment de leur évaluation lors de leur hospitalisation et leur congé, mais ces connaissances n'ont pas été des prédicteurs significatifs de leurs résultats cliniques. Conclusions : la présente étude fournit des données précieuses pour corroborer la gestion interdisciplinaire de la douleur. Les connaissances sur la neurophysiologie de la douleur, malgré son apport potentiel à des résultats cliniques positifs, n'étaient pas des prédicteurs d'une réussite clinique. Les facteurs psychosociaux pourraient être proposés comme des éléments pour assurer l'efficacité des cours sur la neurophysiologie de la douleur.

A cross-sectional evaluation examining the use of the Achilles tendinopathy toolkit by physiotherapists in British Columbia, Canada.

PURPOSE: To evaluate the awareness and use of the Achilles tendinopathy toolkit (ATT), a knowledge translation (KT) strategy supporting evidence-informed management of midportion Achilles Tendinopathy (AT), by British Columbian physiotherapists (PTs). Secondarily, to assess PTs strategies for AT management by examining the association between exploring the ATT and following best practice in clinical care as recommended by the ATT. METHODS: Members of the Physiotherapy Association of British Columbia (BC) completed an online cross-sectional survey collecting information on demographics; awareness and exposure; perceptions, usability and applicability to clinical practice; knowledge; and attitudes. A clinical vignette assessed if respondents adhered to recommendations made by the ATT. Multi-variable logistic regression examined the association between exploring the ATT and following its recommendations. RESULTS: Of 238 participants, 81% (n = 154) were aware of the ATT and of those 53% (n = 81) explored its contents. Time was the most frequent barrier. Bi-variable analyses showed those who explored the ATT had over double the odds of following the best practice (odds ratio = OR = 2.8; 95% confidence interval = 95% CI = 1.3-6.0). This did not remain significant in the final adjusted model (OR = 2.2; 95% CI = 0.9-5.4). CONCLUSIONS: Evaluation of KT strategies is critical. This study revealed high awareness and moderate use of the ATT. Future work should consider the impact of toolkits on patient outcomes. Implications for Rehabilitation A toolkit is a novel knowledge translation (KT) strategy designed to provide accessibleevidence-informed resources to facilitate best practice by clinicians. The evaluation of the Achilles tendinopathy toolkit (ATT) revealed favourable findingsregarding the impact of this KT strategy on the knowledge and attitudes of British Columbia(BC) PTs and the possibility of a positive impact on best practice in clinical care. This research suggests toolkits are a feasible and meaningful KT strategy to provide clinicianswith valuable synthesized resources that have the potential to benefit patient outcomes.