A PEEK BEHIND THE STUDY … WITH MYLES MURPHY

Murphy MC, Debenham J, Bulsara C, et al. Assessment and monitoring of Achilles tendinopathy in clinical practice: a qualitative descriptive exploration of the barriers clinicians face. 

 

Tell us more about yourself and the author team

Dr Myles Murphy is a Physiotherapist and performed this research as a component of his PhD at The University of Notre Dame Australia.

 

@myles_physio

 

Dr James Debenham is a Physiotherapist and Academic at The University of Notre Dame Australia.

A/Prof Caroline Bulsara is a qualitative biostatistician within the University of Notre Dame Australia’s Institute for Health Research.

A/Prof Paola Chivers is a biostatistician and the Deputy Director of the University of Notre Dame Australia’s Institute for Health Research.

Dr Ebonie Rio is a Physiotherapist and Senior Research Fellow at La Trobe University.

Dr Sean Docking is a research fellow at the Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology at Cabrini Health.

Dr Mervyn Travers is a Physiotherapist and Senior Research Fellow at The University of Notre Dame Australia.

A/Prof William Gibson is a Physiotherapist and Head of the School of Health Sciences and Physiotherapy at The University of Notre Dame Australia.

 

What is the story behind your study?

Various assessment tools exist for mid-portion Achilles tendinopathy and have been used for diagnosis, as study inclusion criteria, and as outcome measures to monitor progress. Examples include a patient’s self-reported pain with functional tasks, validated patient-reported outcome measures or an objective assessment of functional capacity. However, not all tools have been validated, thus it is valuable to find out what is being used (and how) in clinical practise regarding the assessment and monitoring of Achilles tendinopathy.

There is little consistency between published studies in the assessments used to quantify demographic information, diagnose the condition or assess improvements in different systems (e.g., tendon structure or muscle force production) relevant to rehabilitation. For instance, across exercise rehabilitation trials to treat midportion Achilles tendinopathy, we identified numerous assessment tools utilised to assess different aspects of pain and function yet few reported data related to their reliability and validity. The lack of data on the identified assessments’ reliability is an issue as it undermines any analysis to determine if the change has truly occurred and likely makes the diagnosis and monitoring of mid-portion Achilles tendinopathy even more challenging for clinicians, because if research studies are not using consistent assessments how can we expect that from clinicians.

 

In your own words, what did you find?

No consensus exists that helps clinicians decide which clinical assessment tools assist in the diagnosis or monitoring over time of patients with Achilles tendinopathy. Assessments related to Function, Pain On Loading, Pain Over A Specified Timeframe And Palpation are commonly used to assist in diagnosis. Assessments related to Disability, Pain On Loading, Pain Over A Specified Timeframe and Physical Function Capacity are used to monitor progress over time. Furthermore, Pain On Loading and Pain Over A Specified Timeframe was considered the most important outcome measure domains for assisting diagnosis whereas Pain On Loading, Patient Rating Of The Condition and Physical Function Capacity were the most important outcome measure domains for monitoring progress. Finally, four main themes were perceived as barriers to implementing ideal practice of assessment and monitoring in people with Achilles tendinopathy: Financial Constraints, Time Constraints, Access To Equipment and Patient Symptom Severity.

 

What was the main challenge you faced in your study?

We interviewed a heterogeneous population of clinicians across disciplines and across career stages to capture a breadth of perspective, which results in some limitations. Firstly, our final sample only included one Sport and Exercise Medicine Physician and one Sport and Exercise Medicine Registrar. Therefore, Sports and Exercise Medicine may be under-represented within our sample. Secondly, we did not include other health care providers who manage mid-portion Achilles tendinopathy (e.g. podiatrists, exercise physiologists or general practitioners). Although thematic saturation was reached within the interviews conducted, the results are not intended to be representative of the broader population and cannot be assumed to represent other provider groups. Nonetheless, the findings were insightful, and generalisability could be rectified by future larger studies (e.g. survey).

 

If there is one take-home message from your study, what would that be?

When making recommendations for clinicians on what assessments should be used in clinical practice, we should consider the barriers to optimal clinical assessment that we identified within this study. Considering these barriers may assist compliance with recommendations in providing optimal clinical care for patients with Achilles tendinopathy.

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